Saprochaete clavata (Geotrichum clavatum) septicemia in a patient with multiple myeloma; An emerging case from Southeastern Turkey

Document Type : Case report


1 Department of Medical Microbiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey

2 Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey



Background and Purpose: Invasive fungal infections (IFI) are life-threatening and can be seen in immuno-compromised patients with malignancy, those who undergo chemotherapy, or transplant recipients. The Candida and Aspergillus species are the most common IFI agents; however, infections can also be caused by rare fungal species. This case report is about a bloodstream infection due to Saprochaete clavata (formerly known as Geotrichum clavatum) in a woman with multiple myeloma.
Case report: A 59-years-old woman suffered from fever, widespread rashes, and diarrhea after an autologous bone marrow transplantation. Peripheral blood cultures were taken from the patient and sent to the microbiology laboratory. Cultures grew white to cream-colored cottony colonies. Moreover, septate and branched hyphae and arthroconidia were seen under a microscope by lactophenol blue staining. The fungi colonies were identified by Maldi Biotyper 3. 1. (manufactured by Bruker Daltonics, USA) as S. clavata (G. clavatum) with a reliable score. Antifungal susceptibility test was carried out by the concentration gradient strip Etest method. Minimal inhibitory concentrations of Amphotericin B, fluconazole, voriconazole, posaconazole, and anidulafungin were determined as 4, 3, 0.125, 0.125, and > 32 mg/dL, respectively. Despite amphotericin B treatment, the patient died three days after the identification of the fungi.
Conclusion: The IFIs are serious conditions that have high mortality rates. In the current case report, we aimed to draw attention to S. clavata which is a rare fungal agent.


1. Larone DH. Medically Important Fungi. 5th edition. New York: ASM Press; 2011.
2. Purohit P, Al-Obaid I, Al-Oneizi E, Al-Hindi O, Joseph L, Ahmad S, et al. Breakthrough disseminated Saprochaete capitata infection in a child with acute myeloid leukaemia receiving caspofungin therapy. JMM Case Reports. 2014; 1.
3. Pemmaraju N, Shetty A V., Prieto VG, Jain N, Kontoyiannis DP, Borthakur G. Disseminated Saprochaete capitata (formerly known as Geotrichum capitatum and Blastoschizomyces capitatus) in a patient with acute myeloid leukemia. Eur J Haematol. 2014; 93: 543–4.
4. Liu X, Zhou W, Jiang Y, Kuang L. Invasive Fungal Infection Caused by Geotrichum clavatum in a Child with Acute Leukemia: First Documented Case from Mainland China. Jpn J Infect Dis. 2019; 72: 130–2.
5. Del Principe MI, Sarmati L, Cefalo M, Fontana C, De Santis G, Buccisano F, et al. A cluster of Geotrichum clavatum( Saprochaete clavata) infection in haematological patients: a
first Italian report and review of literature. Mycoses. 2016; 59: 594–601.
6. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2011; 52: e56–93. doi: 10. 1093/ cid/cir073.
7. Chitasombat MN, Kofteridis DP, Jiang Y, Tarrand J, Lewis RE, Kontoyiannis DP. Rare opportunistic( non-Candida, non-Cryptococcus) yeast bloodstream infections in patients with cancer. J Infect. 2012; 64: 68–75.
8. Camus V, Thibault M-L, David M, Gargala G, Compagnon P, Lamoureux F, et al. Invasive Geotrichum clavatum Fungal Infection in an Acute Myeloid Leukaemia Patient: A Case Report and Review. Mycopathologia. 2014; 177: 319–24. doi: 10. 1007/s11046-014-9746-4.
9. Durán Graeff L, Seidel D, Vehreschild MJGT, Hamprecht A, Kindo A, Racil Z, et al. Invasive infections due to Saprochaete and Geotrichum species: Report of 23 cases from the FungiScope Registry. Mycoses. 2017; 60: 273–9.
10. Buchta V, Bolehovská R, Hovorková E, Cornely OA, Seidel D, Žák P. Saprochaete clavata Invasive Infections – A New Threat to Hematological-Oncological Patients. Front Microbiol. 2019; 10: 2196.
11. Picard M, Cassaing S, Letocart P, Verdeil X, Protin C, Chauvin P, et al. Concomitant cases of disseminated Geotrichum clavatum infections in patients with acute myeloid leukemia. Leuk Lymphoma. 2014; 55: 1186–8. doi: 10. 3109/10428194. 2013. 820290.
12. Lacroix C, Brethon B, Boissel N. Geotrichum clavatum an emerging pathogen responsible for invasive infection in two neutropenic leukemia patients. In: 3rd Trends in Medical Mycology. Turin, Italy; 2007. p. 180.
13. FungiScope Query Tool. http: //www. fungiquest. net/ search?_sq=Saprochaete+clavata&_alive=0. Accessed 16 Oct 2020.
14. Favre S, Rougeron A, Levoir L, Pérard B, Milpied N, Accoceberry I, et al. Saprochaete clavata invasive infection in a patient with severe aplastic anemia: Efficacy of voriconazole and liposomal amphotericin B with adjuvant granulocyte transfusions before neutrophil recovery following allogeneic bone marrow transplantation. Med Mycol Case Rep. 2016; 11: 21–3.
15. Stanzani M, Cricca M, Sassi C, Sutto E, De Cicco G, Bonifazi F, et al. Saprochaete clavata infections in patients undergoing treatment for haematological malignancies: A report of a monocentric outbreak and review of the literature. Mycoses. 2019; 62: 1100–7.
16. Kolecka A, Khayhan K, Groenewald M, Theelen B, Arabatzis M, Velegraki A, et al. Identification of medically relevant species of arthroconidial yeasts by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2013; 51: 2491–500.
17. Hamprecht A, Christ S, Oestreicher T, Plum G, Kempf VAJ, Göttig S. Performance of two MALDI-TOF MS systems for the identification of yeasts isolated from bloodstream infections and cerebrospinal fluids using a time-saving direct transfer protocol. Med Microbiol Immunol. 2014; 203: 93–9.
18. European Committee on Antimicrobial Susceptibility Testing. Antifungal Agents-Breakpoint tables for interpretation of MICs, Version 9. 0. 2018. http: //www. eucast. org/fileadmin/ src/media/PDFs/EUCAST_files/AFST/Clinical_breakpoints/Antifungal_breakpoints_v_9. 0_180212. pdf.
19. Lo Cascio G, Vincenzi M, Soldani F, De Carolis E, Maccacaro L, Sorrentino A, et al. Outbreak of Saprochaete clavata Sepsis in Hematology Patients: Combined Use of MALDI-TOF and Sequencing Strategy to Identify and Correlate the Episodes. Front Microbiol. 2020; 11: 84.
20. Leoni M, Riccardi N, Rotulo GA, Godano E, Faraci M, Bandettini R, et al. Magnusiomyces clavatus infection in a child after allogeneic hematotopoetic stem cell transplantation: Diagnostic and therapeutic implications. Med Mycol Case Rep. 2019; 23: 65–7. doi: 10. 1016/j. mmcr. 2018. 12. 005.