Fungemia Caused by Certain Nonpathogenic Strains of the Family Cryptococcaceae

Louria, Donald B.; Greenberg, Sidney; Molander, David W.

doi:10.1056/nejm196012222632504

Cited by 79 publications

(32 citation statements)

References 10 publications

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“…The first report of human infection was in 1960 [10] and the last two decades have seen a dramatic increase in Rhodotorula infection demonstrating the association between infection, immunodeficiency and the presence of CVCs [6].…”

Section: Discussionmentioning

confidence: 99%

Rhodotorula Fungaemia in a Preterm Infant with umbilical Venous Catheter and Parenteral Nutrition Intraperitoneal Extravasation

Habibollah¹

2017

Austin Pediatr

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Rhodotorula species are emerging opportunistic fungi causing fungaemia in patients with underlying diseases of immunosuppression and the presence of central venous catheters (CVCs). The association between Rhodotorula fungaemia and indwelling CVCs in adults, paediatrics and neonates is well recognised. Rhodotorula infection in the preterm neonate has been reported with variable management. We report the clinical presentation, course, management and outcome of Rhodotorula infection in an immunocompromised preterm neonate in a tertiary neonatal unit with a CVC and parenteral nutrition extravasation into the abdomen. Keywords Case PresentationA 31+4 weeks gestation female weighing 1660 grams was delivered vaginally. Apgar scores were 8 and 8 at 1 and 5 minutes. Continuous positive airway pressure (CPAP) support was required at birth. Umbilical venous catheter (UVC) was inserted under aseptic technique and position confirmed with abdominal X-ray. The line tip was at level of thoracic vertebrae 8 overlying the liver. Intravenous Benzyl penicillin and Gentamicin was started for suspected infection after obtaining blood cultures from the UVC. Total parenteral nutrition (TPN) (standard 10% solution) via UVC with SMOFlipid® emulsion was administered.Fever developed at 6 hours of life with an axillary temperature of 38.4 o C. Blood cultures were repeated and fever persisted till 25 hours of age. Infant was not septic on examination. Fever subsided and antibiotics were discontinued by 48 hours of age as initial blood cultures were negative. Expressed Breast Milk (EBM) feeds were started and TPN through the UVC continued.At 69 hours of life, she developed abdominal distension and clinically deteriorated requiring intubation. Gastric aspirates were milky and meconium had been passed. Blood cultures were repeated, feeds withheld and intravenous Amoxicillin, Gentamicin, Flucloxacillin and Metronidazole started based on local guidelines for suspected necrotising enterocolitis and sepsis. Abdominal X-ray showed UVC tip at level of thoracic vertebrae 10 overlying the liver with dilated bowel loops. fluconazole was started at 6mg/kg twice weekly following unit policy for PICC lines.Repeat abdominal X-rays showed evidence of abdominal ascites and no free air in the abdomen. Antibiotics were adjusted to Ceftazidime, Vancomycin and Metronidazole on the discretion of attending consultant. Laboratory investigations showed a minimal drop in platelet count to 125,000 and an increase in total white cell counts with normal neutrophil and lymphocyte counts.Abdominal distension improved within 24 hours and ascites was managed conservatively in view of improving clinical condition. She was extubated on day 4 of life, EBM feeds restarted and antibiotics discontinued after 48 hours as blood cultures showed no growth. Abdominal ultrasound on day 4 showed intra-abdominal fluid in the left flank and echogenic debris suggestive of TPN leak via UVC. A 20mm hyper-echoic lesion was noted in the left lobe of the liver suggesting acute intra-pa...

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Section: Discussionmentioning

confidence: 99%

Rhodotorula Fungaemia in a Preterm Infant with umbilical Venous Catheter and Parenteral Nutrition Intraperitoneal Extravasation

Habibollah¹

2017

Austin Pediatr

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“…fungemia, central venous catheter, therapy with broad-spectrum sys temic antimicrobials, and neurosurgery might be causal factors for the development of the fungemia. The major risk factor of the 12 Rho dotorula fungemias currently reported world wide [7][8][9][10][11] and from a single cancer center [6] is insertion of a central venous catheter. In 13 of 35 cases of catheter-associated fungemia, the fungus was found on the catheter tip.…”

Section: Discussionmentioning

confidence: 99%

<i>Rhodotorula</i> spp. Fungemia in an Immunocompromised Boy after Neurosurgery Successfully Treated with Miconazole and 5-Flucytosine: Case Report and Review of the Literature

et al. 1994

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“…Louria et al in a patient with endocarditis [5]. Since then, a number of Rhodotorula infections have been reported.…”

Section: The First Case Of Rhodotorula Fungemia Was Reported In 1960 Bymentioning

confidence: 96%

Sepsis Due to Rhodotorula mucilaginosa in a Patient with Advanced Non-Small Cell Lung Cancer

et al. 2016

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CASE REPORTA 77-yr-old woman presented to the hospital with cough and dyspnea. Two years ago, she was diagnosed with non-small cell lung cancer and had been treated with wedge resection and several rounds of combined chemotherapy and radiation therapy.In the present visit, her initial diagnosis was bronchopneumonia with pleural effusion. Empirical antibiotic therapy by intravenous piperacillin/sulbactam was started. She was stable and afe- Rhodotorula species are round to oval-shaped, multilateral budding, encapsulated yeasts that produce urease and do not ferment carbohydrates. Rhodotorula species form characteristic salmon-pink colored colonies owing to carotenoid pigment production. These yeasts form a part of the normal flora of moist skin and are found in the environment. Rhodotorula was traditionally considered a contaminant but is now progressively recognized as a human pathogen, especially in immunocompromised patients with central venous catheters. However, isolation of Rhodotorula species from blood has been very rarely reported in Korea. We report a case of sepsis due to Rhodotorula mucilaginosa infection in a patient who had received chemotherapy and supportive care for non-small cell lung cancer.

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Fungemia Caused by Certain Nonpathogenic Strains of the Family Cryptococcaceae

Cited by 79 publications

References 10 publications

Rhodotorula Fungaemia in a Preterm Infant with umbilical Venous Catheter and Parenteral Nutrition Intraperitoneal Extravasation

Rhodotorula Fungaemia in a Preterm Infant with umbilical Venous Catheter and Parenteral Nutrition Intraperitoneal Extravasation

<i>Rhodotorula</i> spp. Fungemia in an Immunocompromised Boy after Neurosurgery Successfully Treated with Miconazole and 5-Flucytosine: Case Report and Review of the Literature

Sepsis Due to Rhodotorula mucilaginosa in a Patient with Advanced Non-Small Cell Lung Cancer

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