A Case of Mandibular Osteomyelitis Caused by Geotrichum candidum

Öz

Geotrichum is a genus of yeast-like fungi of the family Endomycetaceae. It can be isolated from the bronchi, lungs, mouth and the intestinal tract, especially causing invasive disease in immunocompromised patients. Herein, an 61 year old case of mandibular osteomyelitis admitted with swelling on the left cheek and discharge into the mouth and unresponsive to oral antibiotics with Geotrichum candidum growth in tissue culture was reported. He was treated tigecycline and piperacillin/tazobactam empirically without any improvement. G.candidum susceptibility testing revealed low minimum inhibitory concentration values against azole group antifungals. Voriconazole treatment was changed to oral posaconazole due to detection of elevated levels of cholestasis enzyme levels. Clinical and radiological improvement were achieved after four weeks of treatment. The patient died due to necrotizing fasciitis caused by Enterococcus avium in the fourth month of follow-up with antifungal treatment. In osteomyelitis which does not improve with antibiotics, fungi should be considered as an etiological agent.

Anahtar Kelimeler

• Geotrichum candidum
• osteomyelitis
• posaconazole
• voriconazole

Geotrichum candidum’un Sebep Olduğu Bir Mandibular Osteomiyelit Olgusu†

Öz

Geotrichum maya benzeri bir mantar olup Endomycetaceae ailesinde yer almaktadır. Bronş, akciğer, ağız ve bağırsaklardan izole edilebilir, özellikle immün sistemi baskılanmış hastalarda invaziv hastalık yapabilir. Bu yazıda, 61 yaşında yanakta şişlik ve ağız içine akıntı şikayetleriyle başvuran, oral antibiyotikler ile yanıt sağlanamayan, doku örneğinde Geotrichum candidum üreyen bir mandibular osteomiyelit olgusu bildirilmiştir. Olgu ampirik tigesiklin ve piperasilin/tazobaktam almış ancak yarar görmemiştir. Doku kültüründe üreyen G.candidum’un duyarlılık testinde azol grubu antifungallere düşük minimum inhibitör konsantrasyon değerleri saptanmıştır. Vorikonazol başlanan hastada kolestaz enzim seviyelerinin artması nedeniyle, tedavi per oral posakonazol olarak değiştirilmiştir. Tedavinin dördüncü hafta kontrolünde klinik ve radyolojik iyileşme sağlanmıştır. Antifungal tedavi ile izleminin dördüncü ayında Enterococcus avium’a bağlı olarak gelişen nekrotizan fasiit nedeniyle kaybedilmiştir. Antibiyotiklerle düzelmeyen osteomiyelitlerde, mantarlar etken olarak düşünülmelidir.

Anahtar Kelimeler

• Geotrichum candidum
• osteomiyelit
• posakonazol
• vorikonazol

Kaynakça

1. Andre N, Coze C, Gentet JC, Perez R, Bernard JL. Geotrichum candidum septicemia in a child with hepatoblastoma. Pediatr Infect Dis J. 2004;23(1): 86-7. https://doi.org/10.1097/01.inf.0000107293.89025.a8
2. Arnold AG, Gribbin B, De Leval M, Macartney F, Slack M. Trichosporon capitatum causing recurrent fungal endocarditis. Thorax. 1981;36(6):478-80. https://doi.org/10.1136/thx.36.6.478
3. Berbari EF, Steckelberg JM, Osmon DR. “Mandell, Douglas, and Bennett’s Principles &Practice of Infectious Diseases”, 8. baskı, s.1318-20 (2015).
4. Bonifaz A, Vázquez-González D, Macías B ve ark. Oral geotrichosis: report of 12 cases. J Oral Sci. 2010;52(3):477-83. https://doi.org/10.2334/josnusd.52.477
5. Clinical and Laboratory Standarts Institute: Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved Standard, CLSI document M27-A3. 2008, 3rd ed. Clinical and Laboratory StandardsInstitute, Wayne, PA.
6. Heinic GS, Greenspan D, MacPhail LA, Greenspan JS. Oral Geotrichum candidum infection associated with HIV infection. A case report.Oral Surg Oral Med Oral Pathol. 1992;73(6):726-8. https://doi.org/10.1016/0030-4220(92)90019-M
7. Howell SA, Hazen KC. Candida, Cryptococcus and other yeasts of medical importance. ‘’Versalovic J, Caroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW(eds): Manual of Clinical Microbiology, 10. baskı’’ kitabında s.2-29, ASM press, Washington (2011).
8. Koorbusch GF, Fotos P, Goll KT. Retrospective assessment of osteomyelitis. Oral Surgery, Oral Med Oral Pathol. 1992;74(2):149-154. https://doi.org/10.1016/0030-4220(92)90373-X

9. Lador N, Polacheck I, Gural A, Sanatski E, Garfunkel A. A trifungal infection of the mandible: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(4):451-6. https://doi.org/10.1016/j.tripleo.2005.07.022
10. Larone DH. Medically Important Fungi: A Guide to Identification, 5. baskı, ASM press, Washington (2011) https://doi.org/10.1128/9781555816605
11. Nenoff P, Oswald U, Haustein UF. In vitro susceptibility of yeasts for fluconazole and itraconazole. Evaluation of a microdilution test. Mycoses. 1999;42(11-12):629-39. https://doi.org/10.1046/j.1439-0507.1999.00510.x
12. Ng KP, Soo-Hoo TS, Koh MT, Kwan PW. Disseminated Geotrichum infection. Med J Malaysia. 1994;49(4):424-6.
13. Oscar VT, Teresita CR, Alfredo BA et al. Polymicrobial endocarditis by Geotrichum penicillicatum, Cryptococcus albidus and Staphylococcus epidermidis in a girl. Acta Pediátr Méx. 2001;22(1):406-10.
14. Polacheck I, Salkin IF, Kitzes-Cohen R, Raz R. Endocarditis caused by Blastoschizomyces capitatus and taxonomic review of the genus. J Clin Microbiol. 1992;30(9):2318-22.
15. Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Otolaryngol. 2007;127(2):194-205. https://doi.org/10.1080/00016480600818054
16. Sandhu S, Kaur T. Aspergillosis: a rare case of secondary delayed mandibular involvement. Quintessence Int. 2003;34(2):139-42.
17. Schmitt SK. Osteomyelitis. Infect Dis Clin North Am. 2017;31(2):325-38. https://doi.org/10.1016/j.idc.2017.01.010
18. Sfakianakis A, Krasagakis K, Stefanidou M, et al. Invasive cutaneous infection with Geotrichum candidum: sequential treatment with amphotericin B and voriconazole. Med Mycol. 2007;45(1):81-4. https://doi.org/10.1080/13693780600939948
19. Sharkawy AA. Cervicofacial actinomycosis and mandibular osteomyelitis. Infect Dis Clin North Am. 2007;21(2):543-56. https://doi.org/10.1016/j.idc.2007.03.007 Tong AC, Ng IO, Yeung KM. Osteomyelitis with proliferative periostitis: an unusual case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e14-9. https://doi.org/10.1016/j.tripleo.2006.03.025
20. Vasei M, Imanieh MH.: Duodenal colonization by Geotrichum candidum in a child with transient low serum levels of IgA and IgM. APMIS. 1999;107(7): 681-4. https://doi.org/10.1111/j.1699-0463.1999.tb01459.x
21. Wildfeuer A, Seidl HP, Paule I, Haberreiter A. In vitro evaluation of voriconazole against clinical isolates of yeasts, moulds and dermatophytes in comparison with itraconazole, ketoconazole, amphotericin B and griseofulvin. Mycoses. 1998;41(7-8):309-19. https://doi.org/10.1111/j.1439-0507.1998.tb00344.x