Lodderomyces elongisporus endocarditis in an intravenous drug user: a new entity in fungal endocarditis

Abstract

Lodderomyces elongisporus has been recently identified in the literature as an infrequent human bloodstream isolate, commonly mistaken for a non-albicans Candida. A case of Lodderomyces endocarditis in an intravenous drug user is described. To our knowledge, this report highlights the first documented case of Lodderomyces as a cause of endocarditis and summarizes the susceptibility patterns in the reported literature. All isolates reported so far have fluconazole MICs of ¡0.25 mg ml "1 . Case reportA 30-year-old male carpenter presented febrile to a hospital emergency department with associated recurrent swelling of his left forefoot. He had experienced a week of night sweats and rigors and no history of foot trauma. He had sought medical treatment in primary care for his foot symptoms in the preceding weeks prior to the commencement of the night sweats. The presumptive diagnosis had been a soft tissue injury and was treated symptomatically with no improvement.His past medical history included depression and claustrophobia. He was known to have a pre-existing cardiac murmur that had never been investigated. He was an intravenous heroin user, cigarette smoker and social drinker. He injected primarily via his left cubital fossa and occasionally the venous networks on the dorsal surfaces of his hands. He last admitted to intravenous drug use 8 weeks prior to presentation. His medications included oral quetiapine and he had no allergies.Vital signs on admission were as follows: temperature 38.4 u C, pulse rate regular at 102 beats min 21 , blood pressure of 102/ 74 and respiratory rate of 18 respirations min 21 . Examination revealed an ejection systolic murmur and oedema localized to the left ankle region associated with full range of movement. There were no peripheral stigmata of endocarditis, neurological abnormalities or cardiac failure.Three sets of blood cultures in addition to standard bloods were taken from two different sites (BacT/ALERT; bioMérieux). The aerobic bottles of all sets flagged positive after approximately 40 h (range 37.6-43.8 h). Yeast was seen on microscopy. Preliminary identification was that of a non-albicans Candida after growth on Sabouraud Dextrose Agar, a negative germ tube test and subsequent isolation of blue/green colonies on CHROMagar Candida media (BD Diagnostics). The isolate was referred to a reference laboratory for definitive identification. A further two sets of blood cultures taken 2 days later also flagged positive prior to the commencement of antifungal agents. He was empirically commenced on caspofungin whilst awaiting further investigations and results. Blood cultures taken 48 h after therapy was commenced had no growth.A transoesophageal echo was performed and demonstrated a bicuspid aortic valve with mild stenosis and aortic regurgitation. Bulky lesions up to 1 cm were attached to both leaflet margins. An MRI of his brain revealed right frontal and left parietal hyperintense lesions on the T2 weighted images consistent with presumed embolic lesions. A bone scan was con...

Isolation ofLodderomyces elongisporusfrom the Catheter Tip of a Fungemia Patient in the Middle East

“…Interestingly, all 10 L. elongisporus isolates were recovered from blood samples, thus underscoring the role of this species in the etiology of candidemia. More recently another case of bloodstream infection from a patient in Malaysia and a case of endocarditis from Australia have been reported due to L. elongisporus [8, 9]. Here, we describe the isolation of L. elongisporus from the Middle East.…”

“…Although the etiologic significance of isolation of L. elongisporus from the catheter tip culture of our patient was not accompanied by concomitant recovery from blood, its role as bloodstream pathogen capable of causing deep-seated infection has already been recognized [7–9]. The inability to culture the organism from blood is in conformity with previous observations showing that the blood culture positivity for Candida species even in autopsy-proven cases of invasive candidiasis remains low (~50%) [20].…”

DNA barcoding revealed Nematodospora valgi gen. nov., sp. nov. and Candida cetoniae sp. nov. in the Lodderomyces clade

“…Lodderomyces elongisporus was originally considered to be a nonpathogenic yeast, but the species has recently been isolated from multiple bloodstream infections (Lockhart et al 2009;Daveson et al 2012). The clade includes an additional 30 anamorphic Candida species, among them the major human pathogens Candida albicans, Candida dubliniensis, Candida parapsilosis, Candida metapsilosis, Candida orthopsilosis, and Candida tropicalis (Lachance et al 2011a).…”

Catheter-Related Bloodstream Infection Due to <i>Lodderomyces elongisporus</i>

“…L. elongisporus is an unusual causative organism of bloodstream infections in humans and has been isolated from Asia and Mexico (4,5). L. elongisporus was also reported as the causative organism of endocarditis (6). CRBSI caused by this organism has not been described to date.…”