Fluconazole-resistant Kodamaea ohmeri fungemia associated with cellulitis: Case report and review of the literature

Abstract

Kodamaea (Pichia) ohmeri was formerly considered a contaminant, but is now known to be a significant human pathogen that has been shown to cause fungemia, endocarditis, funguria, and peritonitis in immunocompromised patients. We report a case of fungemia caused by K. ohmeri in a 71-year-old man with cellulitis. The patient was sent to the emergency room due to leg edema, fever, and change of consciousness. During hospitalization, a series of examinations including blood cultures were performed. On hospital day 8, blood culture yielded a yeast colony. Fluconazole was given empirically, but had no effect. The pathogen was identified as K. ohmeri by Vitek YBC card, API 20C, sequencing of the 18S rRNA gene, and the D1/D2 domains of the 26S rRNA gene and the internally transcribed spacer (ITS) regions. Antifungal susceptibility testing was performed with the ATB-Fungus system, and a high minimum inhibitory concentration (level up to 64 mg/l) for fluconazole was found. Fluconazole was replaced with amphotericin B deoxylate, and the fever and cellulitis inflammation gradually subsided. The patient was discharged in a stable condition. This is the first case of K. ohmeri fungemia in Taiwan.

Kodameae ohmeri – An Emerging Yeast: Two Cases and Literature Review

“…It was also reported to cause outbreak in paediatric intensive care unit [11]. Although majority of cases reported are fungemia (as in the indexed patients), infections of other sites have also been documented [2, [12][13][14][15][16][17][18]. We reported a case of funguria due to K. ohmeri in a diabetic patient earlier [13].…”

“…Automated identification systems like API 20C, Vitek 2 ID YST and Microscan along with molecular methods are the mainstay of laboratory identification of this rare fungus [1,24]. Molecular identification is done by PCR amplification followed by sequencing of 18S rRNA, the D1/D2 domains of 26SrRNA, the internal transcriber spacer 1/2 (ITS) of the ribosomal DNA,28SrRNA and/or 5.8SrRNA [5,7,9,12,18,24]. Lee et al, used pulsed field gel electrophoresis for karyotyping.…”

“…However, in vitro resistance to Fluconazole has been reported [18]. According to the review by Shang et al, majority of patients receiving fluconazole have succumbed [1].…”

Infección por Kodamaea ohmeri en un recién nacido con una masa mediastinal

“…7,8 Hasta 2009, solo 2 casos habían sido reportados en el período neonatal y ambos en neonatos pretérmino extremo. 9 Pero hay un grupo de neonatos que, sin ser prematuros, tienen riesgo asociado de infección micótica: los pacientes con cirugía abdominal, que condicionan ayuno prolongado y soporte nutricional parenteral.…”

Photodynamic inactivation of biofilms formed by Candida spp., Trichosporon mucoides, and Kodamaea ohmeri by cationic nanoemulsion of zinc 2,9,16,23-tetrakis(phenylthio)-29H, 31H-phthalocyanine (ZnPc)

“…It causes invasive opportunistic infections in immunocompromised hosts and is often associated with the presence of implanted devices. It also has developed resistance to azoles and a reduced susceptibility to caspofungin [16][17][18][19]. K. ohmeri has already been isolated from HIV-positive patients with pseudomembranous oral candidiasis and from diabetic and hemodialyzed users of dental prostheses [20,21].…”