Rhodotorula mucilaginosa Fungemia, a Rare Opportunistic Infection without Central Venous Catheter Implantation, Successfully Treated by Liposomal Amphotericin B

Abstract

Background. Fungemia due to Rhodotorula mucilaginosa is rare and highly resistance to antifungal therapy. Since most cases of R. mucilaginosa fungemia are attributed to medical devices, limited information is currently available on infection without central venous catheter (CVC) implantation. We herein report a case of R. mucilaginosa fungemia without implantation of CVC, successfully treated by liposomal amphotericin B (L-AMB). Case Presentation. An 81-year-old man with a history of chronic obstructive lung disease and rheumatoid arthritis was admitted with dyspnea and fever. The present case had no previous history of CVC implantation. Candidemia was suspected based on yeast and salmon-pink colonies in blood cultures, and thus, micafungin (MCFG) was administered. The isolated yeast was identified as R. mucilaginosa, which exhibited resistance to MCFG. Therefore, antifungal therapy was changed to L-AMB. The sterile blood culture and defervescence were observed from the initiation of L-AMB. Conclusion. Although the obvious entry point was unclear, long-term immunosuppressive therapy for RA may have damaged the gastrointestinal tract, which leading to the bacterial translocation of R. mucilaginosa. An early class switch to L-AMB was effective. Physicians need to consider the administration of L-AMB in cases suspected of R. mucilaginosa fungemia following the detection of salmon-pink colonies in blood cultures.

<em>Rhodotorula mucilaginosa </em>Fungaemia in an Infected Biloma Patient Following a Traumatic Liver Injury

“…However, the other antifungals, azoles (fluconazole, itraconazole, posaconazole, voriconazole), and echinocandins (anidulafungin, caspofungin) showed high MICs, indicating poor response to treatment (Table 1). Another case of Rhotodorula mucilaginosa fungaemia reported in literature showed that the MIC was comparable with our finding with amphotericin B and fluconazole was 0.25 μg/mL and 128 μg/mL respectively [5]. Clinically, this was evident when the patient's condition did not improve despite adequate dosing and duration of fluconazole during the initial treatment.…”

“…Rhodotorula mucilaginosa is an emerging pathogen with a high resistance profile and the mortality rate has been reported around 10% with the complications of sepsis, shock and organ dysfunction [2][3][4]. It forms salmon-pink colonies when cultured on standard artificial media -a vital and early clue to its presence in a fungal culture [5]. In order to prevent the risk of treatment failure, it is crucial for a timely clinical assessment in detecting Rhodotorula mucilaginosa infection so that appropriate antifungal therapy can be initiated early [4].…”

Clinical Challenges of Emerging and Re-Emerging Yeast Infections in the Context of the COVID-19 Pandemic

“…The overall mortality rate was approxi-mately 12% before the pandemic [80]. The diagnosis of this mycosis can be difficult because it is a capsulated yeast and can be confused with several fungal agents; until recently, it was considered nonpathogenic, making it necessary to alert health professionals for a correct diagnosis of rhodotorulosis [86].…”