Fungemia due to Rhodotorula mucilaginosa after allogeneic hematopoietic stem cell transplantation

ArticleinTransplant Infectious Disease 14(1):91-4 · April 2011with15 Reads
DOI: 10.1111/j.1399-3062.2011.00647.x · Source: PubMed
Abstract
Rhodotorula species have been increasingly recognized as emerging pathogens, particularly in immunocompromised patients. We herein report on a patient with myelodysplastic syndrome who developed fungemia due to Rhodotorula mucilaginosa after allogeneic hematopoietic stem cell transplantation (HSCT) from an unrelated donor. He developed severe acute graft-versus-host disease requiring high-dose steroids, and had serially been administered fluconazole and micafungin for the prophylaxis of fungal infection. Although several cases of Rhodotorula infection after HSCT have been reported, all of them were recipients of autologous HSCT, not allogeneic HSCT. A review of all the reported cases of Rhodotorula infection after HSCT revealed that all patients had received fluconazole or echinocandins before the onset of infection. The findings suggest that Rhodotorula species could be causative yeasts, particularly in patients receiving fluconazole or echinocandins, both of which are inactive against the species.
    • "Susceptibility testing has yielded amphotericin B MICs of <1 mg/L and flucytosine MICs of <0.5 mg/L, but fluconazole MICs of >32 mg/L and voriconazole, itraconazole and posaconazole median MICs of 2 mg/L, which is above the breakpoints for not only Candida albicans but also Aspergillus fumigatus [153][154][155][156][157]. Hence, Rhodotorula species are regarded as intrinsically resistant to azoles and echinocandins, but susceptible to amphotericin B and flucytosine [153,158,159]. This is further supported by the finding that many cases have been breakthrough infections during fluconazole or echinocandin treatment [131,147,148]. Consequently, the preferred treatment of choice is with any kind of amphotericin B preparation. "
    Full-text · Article · Oct 2013
    • "Solid organ transplant [66] 1 R. glutinis Liver cirrhosis [67] 1 R. glutinis Acute lymphoid leukemia [68] 1 R. mucilaginosa MS/BMT [69] "
    [Show abstract] [Hide abstract] ABSTRACT: This is an updated paper focusing on the general epidemiological aspects of Rhodotorula in humans, animals, and the environment. Previously considered nonpathogenic, Rhodotorula species have emerged as opportunistic pathogens that have the ability to colonise and infect susceptible patients. Rhodotorula species are ubiquitous saprophytic yeasts that can be recovered from many environmental sources. Several authors describe the isolation of this fungus from different ecosystems, including sites with unfavourable conditions. Compared to R. mucilaginosa, R. glutinis and R. minuta are less frequently isolated from natural environments. Among the few references to the pathogenicity of Rhodotorula spp. in animals, there are several reports of an outbreak of skin infections in chickens and sea animals and lung infections and otitis in sheep and cattle. Most of the cases of infection due to Rhodotorula in humans were fungemia associated with central venous catheter (CVC) use. The most common underlying diseases included solid and haematologic malignancies in patients who were receiving corticosteroids and cytotoxic drugs, the presence of CVC, and the use of broad-spectrum antibiotics. Unlike fungemia, some of the other localised infections caused by Rhodotorula, including meningeal, skin, ocular, peritoneal, and prosthetic joint infections, are not necessarily linked to the use of CVCs or immunosuppression.
    Full-text · Article · Oct 2012
    • "MIC to amphotericin B was relatively high (1.5 mg/L), whereas the strain was resistant to fluconazole , posaconazole and voriconazole according to the revised break points for Candida spp [37]. Echinocandins appeared completely inactive, as previously described [11, 12, 29, 38]. Our patient was also receiving fluconazole as prophylaxis. "
    [Show abstract] [Hide abstract] ABSTRACT: Rhodotorula species are commensal yeasts that have emerged as a cause of life-threatening fungemia in severely immunocompromised patients. A case of Rhodotorula mucilaginosa fungemia in a 48-year-old woman that had undergone consecutive abdominal surgeries due to ovarian cancer and bowel necrosis while she was receiving fluconazole prophylaxis is presented. Several risk factors were identified such as presence of central venous catheters, solid organ neoplasm, abdominal surgery and administration of antibiotics. Identification was performed using commercial systems. The yeast was resistant to fluconazole, posaconazole and voriconazole and to echinocandins, whereas MIC to amphotericin B was 1.5 mg/L. Furthermore, published cases of Rhodotorula spp fungemia during the last decade are reviewed. In conclusion, Rhodotorula spp must be considered a potential pathogen in patients with immunosupression and central venous catheters. Correct identification is mandatory for appropriate management, as Rhodotorula spp are resistant to antifungal agents, such as fluconazole and echinocandins.
    Full-text · Article · May 2012
Show more