Invasive infections with Purpureocillium lilacinum: Clinical characteristics and outcome of 101 cases from FungiScope®and the literature

Rosanne Sprute, Jon Salmanton-García, Ertan Sal, Xhorxha Malaj, Zdeněk Ráčil, Carlos Ruiz De Alegría Puig, Iker Falces-Romero, Aleksandra Barać, Guillaume Desoubeaux, Anupma Jyoti Kindo, Arthur J. Morris, René Pelletier, Joerg Steinmann, George R. Thompson, Oliver A. Cornely, Danila Seidel, Jannik Stemler

Research output: Contribution to journalArticlepeer-review


Objectives: To provide a basis for clinical management decisions in Purpureocillium lilacinum infection. Methods: Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed. Results: We identified 101 cases with invasive P. lilacinum infection. Main predisposing factors were haematological and oncological diseases in 31 cases (30.7%), steroid treatment in 27 cases (26.7%), solid organ transplant in 26 cases (25.7%), and diabetes mellitus in 19 cases (18.8%). The most prevalent infection sites were skin (n=37/101, 36.6%) and lungs (n=26/101, 25.7%). Dissemination occurred in 22 cases (21.8%). Pain and fever were the most frequent symptoms (n=40/101, 39.6% and n=34/101, 33.7%, respectively). Diagnosis was established by culture in 98 cases (97.0%). P. lilacinum caused breakthrough infection in 10 patients (9.9%). Clinical isolates were frequently resistant to amphotericin B, whereas posaconazole and voriconazole showed good in vitro activity. Susceptibility to echinocandins varied considerably. Systemic antifungal treatment was administered in 90 patients (89.1%). Frequently employed antifungals were voriconazole in 51 (56.7%) and itraconazole in 26 patients (28.9%). Amphotericin B treatment was significantly associated with high mortality rates (n=13/33, 39.4%, P = <0.001). Overall mortality was 21.8% (n=22/101) and death was attributed to P. lilacinum infection in 45.5% (n=10/22). Conclusions: P. lilacinum mainly presents as soft-Tissue, pulmonary or disseminated infection in immunocompromised patients. Owing to intrinsic resistance, accurate species identification and susceptibility testing are vital. Outcome is better in patients treated with triazoles compared with amphotericin B formulations.

Original languageEnglish (US)
Pages (from-to)1593-1603
Number of pages11
JournalJournal of Antimicrobial Chemotherapy
Issue number6
StatePublished - Jun 1 2021
Externally publishedYes

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)


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