The fungus Paecilomyces lilacinus is an emerging pathogen that causes severe human
infections, including devastating
oculomycosis. Usually, it shows low susceptibility to conventional antifungal drugs in vitro, and variable susceptibility to novel
triazoles. A review of the published literature identified 119 reported cases of human
infection by P. lilacinus between 1964 and 2004. Most were cases of
oculomycosis (51.3%), followed by cutaneous and sub-cutaneous
infections (35.3%), and a smaller group of miscellaneous
infections (13.4%). Lens implantation is the most frequent predisposing factor for
oculomycosis. Cutaneous and sub-cutaneous
infections occur mainly in solid organ and bone marrow transplant recipients, although surgery and primary or acquired immunodeficiency are also relevant predisposing factors.
Infections in apparently immunocompetent patients have also been reported. Surgical
debridement combined with antifungal
drug therapy, or the correction of predisposing factors, such as
neutropenia, are usually required to obtain improvement. Treatment with traditional antifungal drugs often fails.
Voriconazole has demonstrated good activity in both cutaneous and
ocular infections in the few cases in which this
drug has been used. The new
triazoles ravuconazole and
posaconazole show good in-vitro activity against P. lilacinus and could be promising therapeutic alternatives.