[Table/Fig-3]:
Epidemiological, clinical and microbiological data of the 6 patients reviewed.
| S. No. | Parameter | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 |
|---|---|---|---|---|---|---|---|
| 1 | Age/Sex | 48/F | 65/F | 19/F | 60/M | 58/F | 35/M |
| 2 | Underlying disease | Biphenotypic acute leukaemia | Chronic lymphocytic leukaemia | Acute myeloid leukaemia | DM type II, HTN | DM type II, found to be HbS Ag and HCV positive after admission | Post renal transplant |
| 3 | Chemotherapy | Induction | Induction | Not started because of ongoing febrile neutropenia | NA | NA | Immunosuppression with tacrolimus, prednisolone and mycophenolate mofetil |
| 4 | Duration of Neutropenia (<500/cu.mm) before isolation of S. capitata | 9 days | 6 days | 7 days | NA | NA | No neutropenia |
| 5 | Day post initiation of chemotherapy when S. capitata was isolated | 13 days | 5 days | NA | NA | NA | NA |
| 6 | Clinical manifestations | Fever, abdominal pain, diarrhoea, hepatopathy, ARDS, septic shock | Fever, shortness of breath, bilateral crepitations | Fever, cough with haemoptysis, shortness of breath, nasal block, crepitations bilaterally in the infra mammary areas | Fever, cough with mucoid expectoration, haemoptysis, shortness of breath, right sided Chest pain. Chest X-ray and CT-masssive pleural effusion with thick internal septations and underlying collapsed lung. | Fever associated with chills and rigor, dysuria. Urine culture showed significant growth of ESBL producing E.Coli | Fever, productive cough since 20 days. HRCT chest showed consolidation and nodular lesions in the lateral basal segment of the right lower lobe of lung |
| 7 | Sample from which S .capitata was isolated | Blood | Blood | Blood and sputum | Blood | Blood | Bronchoalveolar lavage |
| 8 | No. of positive blood cultures | 5 | 1 | 5 | 1 | 1 | None |
| 9 | Concomitant organisms isolated | Enterococcus gallinarum | Coagulase negative staphylococci skin contaminant | None | None | None | None |
| 10 | Antifungal therapy | AMB emulsion(320 mg/day/IV)-5 mg/kg body weight | No specific antifungal therapy started as the growth was seen in only one of four blood cultures bottles sent on day 6 of admission, while the rest 3 bottles grew coagulase negative staphylococci. Patient recovered with only broad spectrum antibacterial therapy. | Inj AMB 50 mg IV OD -started on day 10 after admission, after identification of yeast as S. capitata | No specific antifungal therapy started. Patient responded to antitubercular therapy and repeated drainage of pleural fluid. Decortication advised but deferred to a later date. Patient was stable at discharge. | No specific antifungal therapy initiated as only one of four bottles sent on the day of admission grew yeast. Patient became asymptomatic on therapy with Meropenem for UTI. | i) dAMB 1mg/kg body weight-2 weeks ii) Oral Voriconazole - 400 mg BD-1 day followed by 200 mg BD-6 weeks |
| 11 | Outcome | Death on day 22 post diagnosis | Recovery-followed up till 4 months. | Death on day 12 | Recovery | Recovery | Recovery |
| 12 | Remarks | Clinically significant | ? Transient Fungemia | Clinically significant | ? Transient Fungemia | ? Transient Fungemia | Clinically significant |
*Diabetes Mellitus Type II and Hypertension (DM type II and HTN), Hepatitis B Surface Antigen and Hepatitis C Virus (HBsAg and HCV), Hepatitis C Virus (HCV), Acute Respiratory Distress Syndrome (ARDS), Amphotericin B (AMB), Extended Spectrum Beta Lactamase (ESBL), High-Resolution Computerized Tomography (HRCT), Urinary Tract Infection (UTI)