Endocarditis caused by Rhodotorula successfully treated with 5-fluorocytosine.

Abstract

A 7-year-old boy suffering from aortic regurgitation and mitral stenosis and regurgitation was admitted with endocarditis caused by Rhodotorula pilimanae and was treated successfully with orally administered antifungal agent, namely 5-fluorocytosine (5-FC). A dose of IOO mg per kg body weight, divided into four equal parts, was prescribed. After a prolongedfebrile period his temperature dropped to normal on thefourth day of 5-FC therapy. Review of the published reports disclosed few cases of endocarditis due to Rhodotorula spp. and this case seems to be the first treated with 5-FC. Follow-up in one year, after discharge from the hospital, revealed no evidence of relapse. Cardiac impulse was maximal at the apex, and visible outward pulsations at that area were noted.At the apex, M1 was diminished and a third sound was heard. A grade 3/6 pansystolic murmur radiating to the left axilla and a grade i/6 short diastolic murmur were heard as well. At Erb's area, a grade 2/6 ejection type systolic murmur and a grade I/6 early diastolic murmur were heard. The liver was palpable 3 cm below the right costal margin but the spleen was not palpable. No joint involvement was observed on admission, but on the following day he complained of pain in the knees and ankles, and the left ankle was mildly swollen and hot. These complaints continued for three days. Funduscopic examination was normal. Laboratory examination revealed a haemoglobin of 9 g/ioo ml, with slight hypochromia, and white blood cell count (WBC) of 19,400/mm3 of which 3 per cent were band forms and 78 per cent were segmented neutrophils. Urine analysis normal. Throat swab negative. Erythrocyte sedimentation rate (ESR) I25 mm in the first hour (Westergren). Blood urea nitrogen 23 mg/IOO ml. Total protein was 7-I g/IOO ml, of which albumin was 3.9 g/ioo ml and globulin was 3-2 g/ioo ml. Blood serological tests were negative. C-reactive protein + + +. Antistreptolysin-0 titre was 256 Todd units and 5I2 three days later. Multiple blood and urine cultures were negative.An electrocardiogram showed normal sinus rhythm, normal PR interval, QRS axis + 300, and signs of hypertrophy of left atrium and ventricle. Chest x-ray disclosed an enlarged heart silhouette, with straightening of the left border, raised left main bronchus, and signs of venocapillary hypertension. The barium-filled oesophagus was indented by the left atrium and there was enlargement of the left ventricle.

Infective Endocarditis and Other Intravascular Infections

“…Coccidioides immitis, Corprinus species, Cryptococcus neojormans, and Curvularia neojormans(SS); Paecilomyces varioti(SS,283); Penicillium species, Phialophora, and Phycomyces(SS); Rhodotorula(SS,284); Saccharomyces cerevisiae(SS); Torulopsis glabrata<ss,28S); Trichosporon cutaneum (286); Petriellidium boydii (Allescheria boydii) (274,287,288); and Hormodendrum dermatitidis. (66) …”

Activities of Available and Investigational Antifungal Agents against Rhodotorula Species

“…This agent has been used in treatment of serious Rhodotorula infections (4,17), and it should be considered a first-line agent in combination with amphotericin B for invasive Rhodotorula infections.…”

Aortic Homograft Endocarditis Caused by Rhodotorula mucilaginosa

“…have been isolated from the skin, nails, conjunctiva as well as from the respiratory and gastrointestinal tract [1]. Septicemia [3][4][5], endocarditis [6,7], meningitis, ventriculitis, peritonitis, keratitis, endophthalmitis, dacryocystitis and pneumonia have been reported [1,8]. Serious infections in humans are rare but have been reported.…”

“…Serious infections in humans are rare but have been reported. So far, only two unambigously documented cases of endocarditis have been described in the English literature [6,7]. Potential hosts are patients with solid tumors, lymphoproliferative diseases, AIDS, diabetes mellitus and chronic renal failure [2].…”

“…Potential hosts are patients with solid tumors, lymphoproliferative diseases, AIDS, diabetes mellitus and chronic renal failure [2]. The report of Naveh et al [7] concerns a 7-year-old boy with a clinical course of fever and congestive heart failure. Few reports exist describing infections in the immunocompetent host.…”