Fungemia Caused by Yarrowia lipolytica

Abstract

Yarrowia lipolytica is weakly pathogenic yeast, which is rarely isolated from the blood. We report unusual cases of Y. lipolytica fungemia occurred between October 2012 and June 2014 in the intensive care unit (ICU) of the UH Habib Bourguiba Sfax. During this period, 55 cases of Y. lipolytica septicemia were diagnosed. There were 44 men and 11 women (sex ratio = 4).The median age was 43 years. The broad-spectrum antibiotics (100 %), the catheterization (96 %), and the prolonged hospitalization in ICU (91 %) were the main risk factors. Patients were hospitalized in ICU, mostly, for polytraumatism (45.4 %), pneumopathy (9 %), and post-operative complications (7 %). Fever unresponsive to broad-spectrum antibacterial therapy was the predominant sign of infection (83.6 %). Y. lipolytica was isolated in one or several blood cultures (14.5 %) and in the catheter tip culture of nine patients (16.3 %).Treatment was based on intravenous amphotericin B (58.2 %), fluconazole (45.4 %) and/or removal catheter (69 %). Apyrexia or blood cultures sterilization was obtained for 34 patients (61.8 %). Y. lipolytica candidemia is an opportunistic and emerging human yeast pathogen. It can reach to the bloodstream of immunocompromised or critically ill patients during hospitalization through intravascular catheterization. Further clinical data need to be evaluated for formulating management strategies of seriously ill patients infected with uncommon fungal agents.

Clinical Characteristics, Laboratory Identification, and In Vitro Antifungal Susceptibility of Yarrowia (Candida) lipolytica Isolates Causing Fungemia: a Multicenter, Prospective Surveillance Study

“…This was based on previous observations that most Y. lipolytica isolates were susceptible to fluconazole in vitro (6,8,10). However, three of our patients (cases 8, 9, and 13) who received fluconazole died despite treatment and catheter removal.…”

“…It may occasionally be found as a colonizer in the feces, oropharyngeal swabs, sputa, and skin swabs of asymptomatic persons (5). Its intense secretory activity is widely employed in the food, detergent, and pharmaceutical industries to produce aroma compounds, organic acids, polyalcohols, emulsifiers, and surfactants (4,6,7). Although Y. lipolytica was previously considered to be of low virulence, it has been increasingly recognized to cause sporadic cases and nosocomial clusters of human infections, especially catheter-related suppurative thrombophlebitis and fungemia associated with biofilm formation in immunocompromised or critically ill patients who experience prolonged hospitalization and who required longdwelling intravascular catheterization and broad-spectrum antibacterial agents (5,(8)(9)(10).…”

“…A major limitation of the literature on Y. lipolytica infection is that most studies were case reports or small case series focusing only on clinical characteristics (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Recently, Trabelsi and colleagues reported the epidemiological risk factors and clinical outcomes of 55 cases of Y. lipolytica fungemia in Tunisia and provided some data on the in vitro susceptibility test results of the isolates to a few antifungal drugs (6). However, details about the correlative microbiological characteristics, including phenotypic and genotypic identification and in vitro susceptibility test results for newer antifungal drugs such as the echinocandins and posaconazole, were lacking in this larger case series.…”

Cutaneous Yarrowia lipolytica infection in an immunocompetent woman

“…A strictly aerobic organism, it is found in refrigerated meat products, agricultural processing plants, petroleum products, and soil 2 . This organism is known for its slime production in culture material, which might be responsible for its ability to adhere to intravenous catheters 5 .…”

“…Infections from this microbe have also been reported as postoperative/postsurgical ocular infections, sinusitis, and wounds, but most have presented as sepsis 4, 10. Over an 18-month period, 55 of 77 patients in a Tunisian hospital with a positive blood culture for yeast were infected with Y lipolytica 2 . Most were related to infected vascular catheters, although the organism was found on the hands of a hospital worker and in infusion pumps.…”