Severe pneumonia with pleural effusion caused by co-infection of Paecilomyces variotii and Penicillium oxalicum in a diabetic patient

• Published in: BMC infectious diseases 2024-06, Vol.24 (1), p.605-6, Article 605
• Main Authors: Wang, Xiuri, Chen, Xingchun, Liang, Yunxiao, Hu, Liuyang
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Amphotericin B; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antifungal Agents - therapeutic use; Antiparasitic agents; Appetite loss; Bacterial pneumonia; Blood; Blood culture; Blood pressure; Care and treatment; Case Report; Co-infection; Coinfection - drug therapy; Coinfection - microbiology; Computed tomography; Contaminants; Development and progression; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetics; Diagnosis; Drug resistance in microorganisms; E coli; Endocarditis; Escherichia coli; Female; Fever; Fungal infections; Fungi; Fungicides; Gram-positive bacteria; Health aspects; Humans; Imipenem; Immunocompromised Host; Immunocompromised hosts; Lungs; Medical equipment; Medical examination; Middle Aged; Multidrug resistance; Mycoses - drug therapy; Mycoses - microbiology; Nausea; Nosocomial infections; Opportunist infection; Paecilomyces; Paecilomyces - isolation & purification; Paecilomyces variotii; Pathogens; Patients; Penicillium; Penicillium - isolation & purification; Penicillium oxalicum; Pleural effusion; Pleural Effusion - drug therapy; Pleural Effusion - microbiology; Pleural effusions; Pneumonia; Pneumonia - drug therapy; Pneumonia - microbiology; Posaconazole; Prevention; Prostheses; Respiration; Sulbactam; Transplants & implants; Type 2 diabetes; Vancomycin; Vomiting
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09496-6

BACKGROUND PAECILOMYCES: and Penicillium are considered as rare opportunistic pathogens in immunocompromised hosts, and pneumonia caused by Paecilomyces and Penicillium is rare. In this study, we present first case of severe pneumonia with pleural effusion caused by co-infection of Paecilomyces variotii (P. variotii) and Penicillium oxalicum (P. oxalicum) in a 66-year-old female with poorly controlled type 2 diabetes. CASE PRESENTATION: A 56-year-old woman patient presented to hospital for nausea, poor appetite, and vomiting for one day. On the second day of admission, blood culture and renal puncture fluid culture grew multidrug-resistant Escherichia coli (imipenem/cilastatin sensitive), and she received combination therapy with imipenem/cilastatin (1 g, every 8 h) and vancomycin (0.5 g, every 12 h). On the fourth day, she developed symptoms of respiratory failure. Pulmonary computed tomography (CT) showed an increase in pneumonia compared to before, with minor pleural effusion on both sides. Two fungi were isolated repeatedly from BALF culture, which were confirmed as P. variotii and P. oxalicum by Internal transcribed spacer (ITS) sequencing. Her pleural effusion was completely absorbed, pneumonia symptoms have significantly improved and discharged with receiving liposomal amphotericin B treatment for four weeks. CONCLUSIONS: It is worth noting that clinicians and laboratory personnel should not simply consider Paecilomyces and Penicillium species as contaminants, especially in immunocompromised patients. Early fungal identification and antifungal drug sensitivity are crucial for clinical drug selection and patient prognosis.