Femoral Prosthesis Infection byRhodotorula mucilaginosa

Abstract

This case report is a case history of a femoral prosthesis infection caused by Rhodotorula mucilaginosa in a human immunodeficiency virus patient. Though the pathogenicity of this organism for bone tissue has been previously reported, this is the first reported case of an orthopedic prosthesis infection by this species of the genus Rhodotorula. CASE REPORTA 41-year-old female human immunodeficiency virus patient sustained a fracture of the left femoral epiphysis in a road traffic accident in 1996. Surgical internal fixation was done but was followed by an outbreak of chronic coxitis (confirmed by magnetic resonance) until a femoral prosthesis was finally inserted in 2006. During 2007, an acute infection of the implanted prosthesis was diagnosed, with the patient suffering from a fever (38.5°C), strong local pain, and tumefaction. Furthermore, a fistula developed from the internal site of the prosthetic infection as far as the skin of the femoral region, with continuous pus discharge from its external opening. No overt signs of septicemia were observed, and mild leukocytosis was documented, whereas CD4 and CD8 levels were found to be normal. After receiving a 10-day course of intramuscular piperacillin, empirically, followed by no clinical improvement, the patient was admitted to the hospital. Magnetic resonance and bone scintigraphy documented the prosthesis infection. Also, drainage from the fistula was cultured. Particularly, it was plated onto sheep blood agar, mannitol salt agar, MacConkey agar, and Sabouraud dextrose agar (plates were provided by bioMérieux, Marcy l'Etoile, France). Blood culture plates were incubated at 36°C in air, anaerobically, and under 5% CO 2 -enriched atmosphere. Mannitol and MacConkey media were processed at 36°C under aerobic conditions. Finally, two Sabouraud plates were incubated at 36°C and 25°C, respectively, both in ambient air. After 24 h of incubation, neither bacterial nor fungal growth was observed, whereas Sabouraud cultures processed at 25°C yielded about 150 colonies of Rhodotorula mucilaginosa, as a single organism, after 48 h of incubation. Cultures from all of the other mentioned media remained negative, so that no aerobic, anaerobic, or microaerophilic organisms other than Rhodotorula were observed. Identification of the isolate was suggested by the phenotype of colonies, which were typically pink-red and smooth, and by microscopic features (round-shaped yeast cells without hyphae) and confirmed by the Vitek2 system (YST card; bioMérieux) and by the mini API system (ID32C gallery; bioMérieux). Gram staining of the secretion was carried out and documented the presence of numerous images of phagocytosis by polymorphonuclear leukocytes against yeast-like cells (the yeast-like cells were mostly observed inside the cytoplasm of granulocytes), indicating acute infection caused by yeast-like organisms. Low MICs were observed for amphotericin B and flucytosine against the isolate studied (MICs, 0.25 g/ml and Յ0.03 g/ml, respectively), whereas higher values were documented ...

Molecular Identification, Antifungal Susceptibility Profile, and Biofilm Formation of Clinical and Environmental Rhodotorula Species Isolates

“…Rhodotorula species infections are frequently associated with the presence of CVCs and other implantable medical devices (9)(10)(11)30). These devices provide the necessary surfaces for biofilm formation and are currently responsible for a significant percentage of human infections.…”

“…The most frequent infection caused by Rhodotorula species is fungemia, followed by eye infections, peritonitis, and meningitis (4,7,(9)(10)(11).…”

What do we know about Candida guilliermondii? A voyage throughout past and current literature about this emerging yeast

“…In particular, although Candida albicans only rarely shows resistance to antifungals, multidrug resistance among non-albicans isolates has emerged over the past decades. [1][2][3][4][5][6][7][8] Among these fungi, Candida guilliermondii is presently considered an uncommon yeast, the incidence of which appears as low even among compromised hosts; although the organism shows a reduced innate virulence compared with C. albicans, its role as an agent of serious pathologies (mostly fungaemias and deep-seated infections in cancer patients) has been emphasised throughout the literature. 1,2,[7][8][9][10][11] Furthermore, this species has appeared as especially notable for its greater propensity to express multidrug resistance than other organisms of the genus Candida.…”

Isolation of Rhodotorula mucilaginosa from skin lesions in a Southern sea lion (Otaria flavescens): a case report

“…Although the pathogenicity of these basidiomycetous yeasts has been questioned, in recent years, an increase in the number of infections caused by Rhodotorula spp. in humans has been reported (Galan-Sanchez et al, 1999;Zaas et al, 2003;Cerikcioglu et al, 2005;Gomez-Lopez et al, 2005;Savini et al, 2008;Tuon and Costa, 2008), with R. mucilaginosa being the species most frequently isolated (Tuon and Costa, 2008).…”

“…It should be borne in mind that different environmental factors could cause stress to the animal and contribute, directly or indirectly, to In spite of the increasing importance of infections due to Rhodotorula spp., there are few publications reporting the in vitro susceptibility of Rhodotorula strains to antifungal agents with a standardized method (Gomez-Lopez et al, 2005;Tuon and Costa, 2008). These yeasts seem to be resistant to some therapeutic agents, especially to azoles and echinocandins (Galan-Sanchez et al, 1999;Preney et al, 2003;Zaas et al, 2003;Serena et al, 2004;Gomez-Lopez et al, 2005;Savini et al, 2008). Sertaconazole is a topical antifungal of the azole family (Carrillo-Munoz et al, 1999;Pfaller and Sutton, 2006).…”