Fungemia due to Rhodotorula mucilaginosa in an immunocompetent, critically ill patient

Central line-associated Rhodotorula mucilaginosa fungemia in an immunocompetent host: Case report and review of the literature

Rhodotorula mucilaginosa is an emerging fungal infection with the ability of biofilms formation. The identification of R mucilaginosa fungemia should trigger reflexes of prompt central venous line removal and using Amphotericin therapy.

Low sensitivity of conventional fungal agars in fungemia by Rhodotorula mucilaginosa: description of two cases

Background

Although most bloodstream yeast infections are caused by Candida spp., infections by rare or less common species have increased in recent years. Diagnosis of infections caused by these species is difficult due to the lack of specific symptoms and adequate diagnostic tools.

Cases presentation

We describe two cases of fungemia by Rhodotorula mucilaginosa within a few months of each other, in a secondary Spanish hospital. In both cases, diagnosis was challenging. Blood subcultures in conventional fungal media were persistently negatives and the use of non-conventional fungal media was essential for isolating the yeasts and achieving a correct diagnosis. 1–3 beta-d-glucan detection and a panfungal PCR assay were helpful techniques to confirm the diagnosis

Conclusion

It is highly important to establish an early diagnosis for fungemia. The process is challenging because often non-specific symptoms are presents. When yeasts grow in blood cultures other genera than Candida spp. could be the cause of infection. Patient risk factors should be assessed to incorporate alternative culture media and the available rapid diagnostic test, in order to provide an early recognition of the pathogen.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12941-021-00427-w.

Generation of BSA-capsaicin Nanoparticles and Their Hormesis Effect on the Rhodotorula mucilaginosa Yeast

Capsaicin is a chemical compound found in pungent chili peppers (Capsicum spp.). In biotechnology, capsaicin has been proposed as a pathogen control; however, its low solubility in water and high instability limits its uses. The aim of this work was to study the effect of high concentrations of capsaicin on the synthesis of nanoparticles and to evaluate their inhibitory effect on the growth of Rhodotorula mucilaginosa yeast. Bovine serum albumin (BSA)-capsaicin nanoparticles were formulated at 0, 16.2, 32.5, 48.7 and 65.0 µg of capsaicin per mg of BSA. Nanoparticle properties were evaluated and they were added to cultures of R. mucilaginosa to quantify their effect on cell viability. We found that increased capsaicin levels caused several changes to the physicochemical parameters, probably due to changes in the hydrophobicity sites of the albumin during the nanostructuration. The administration of nanoparticles to cultures of R. mucilaginosa produced a maximal viability with nanoparticles at 16.2 µg/mg; on the contrary, nanoparticles at 65.0 µg/mg caused maximal cell death. R. mucilaginosa cells displayed a hormesis effect in response to the nanoparticle dose concentration. The nanoparticles showed different responses during the uptake process, probably as a consequence of the nanostructural properties of capsaicin in the BSA molecules.

Yeasts and filamentous fungi in psittacidae and birds of prey droppings in midwest region of Brazil: a potential hazard to human health

Birds of prey and from Psittacidae family are host to fungal microbiota and play an important role in the epidemiology of zoonoses. Few studies in the literature have characterized mycelial and yeast fungi in the droppings of these birds and correlated the isolates with the zoonotic potential of the microorganisms. Droppings from 149 birds were evaluated and divided into two groups: captive: Rhea americana araneipes, Primolius maracana, Ara ararauna, Ara chloropterus, Anodorhynchus hyacinthinus, Amazona aestiva, Ara macao macao, Ramphastos toco, Sarcoramphus papa, Busarellus nigricollis, Bubo virginianus nacurutu, Buteogallus coronatus, Buteogallus urubitinga urubitinga, Spizaetus melanoleucus, Spizaetus ornatus ornatus, Buteo albonotatus, Geranoaetus albicaudatus albicaudatus, Rupornis magnirostris magnirostris and Harpia harpyja, and quarantined birds: Amazona aestiva and Eupsitulla aurea. The fungal isolates were identified according to macroscopic (gross colony appearance), micromorphological and biochemical characteristics. Among birds displayed in enclosures, Aspergillus niger (41.1%) and Candida kefyr (63.8%) were the fungi most frequently isolated in Harpia harpyja and Ramphastos toco, respectively. For quarantined birds, the following percentages were observed in Eupsittula aurea , (76.6%) C. krusei, (84.4%) C. kefyr and (15.2%) C. famata, while in Amazona aestiva, (76.2%) C. krusei was observed. These findings indicate potentially pathogenic species in the bird droppings assessed, which constitute a risk of exposure for keepers and individuals who visit the zoo. Birds of the Cerrado and Pantanal of Mato Grosso (Central Western region of Brazil) could act in the epidemiological chain of important zoonoses.

Catheter-related bloodstream infection due to Rhodotorula mucilaginosa with normal serum (1→3)-β-D-glucan level

Rhodotorula species are environmental basidiomycete yeasts that have emerged as a cause of fungemia in immunocompromised hosts. The insertion of a central venous catheter was identified as a major risk factor for Rhodotorula fungemia. Few cases reports have reported (1→3)-β-D-glucan testing at the onset of Rhodotorula mucilaginosa fungemia. We report a case of catheter-related bloodstream infection due to R. mucilaginosa. Serum β-D-glucan level was normal at the onset of the bloodstream infection. It took 5 days to culture the isolate. The patient's fever persisted after empiric treatment with micafungin, and a switch to oral voriconazole immediately resolved the fungemia.

[A skin ulcer infection due to Rhodotorula mucilaginosa in an immunocompromised child]

Human cutaneous infections due to Rhodotorula species as an emerged pathogens yeasts are rarely reported, particularly in skin folds, with the ability to infect immunocompromised as well as immunocompetent patient. In present case, we describe a fungal cutaneous infection due to Rhodotorula mucilaginosa in immunocompromised child, the patient has been diagnosed with retinoblastoma; the diagnosis was established by the cytological and clinical examination. However, the cytological examination found fungal forms. The diagnosis relies on the microbiological analysis of clinical samples but the interpretation of a positive culture should be part of and over all analysis that integrate clinical symptoms and risk factors. Most of cases of infection due to Rhodotorula were associated with central venous catheter in patients who were receiving immunosuppressors and cyotoxic drugs. The antifungal susceptibility testing was done; a fluconazol and ketoconazol showed susceptibles. The patient was treated by combinate antifungal therapy and empirical antimicrobial regimen for prophylaxis.

Rare fungal infectious agents: a lurking enemy

In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies.

Contaminação de torniquetes para punção intravenosa periférica

Resumo Objetivo Identificar a presença de contaminação em torniquetes para punção intravenosa periférica e caracterizar o perfil dosStaphylococcus spp. e leveduras isolados. Métodos Estudo transversal que inseriu análise de 18 torniquetes para punção intravenosa periférica em uso no hospital. Os torniquetes foram imersos em caldo BHI por 24h e cultivados em meios seletivos para isolamento e identificação de Staphylococcus spp. e leveduras. O método disco-difusão foi empregado para analisar o perfil de suscetibilidade dosStaphylococcus spp. aos antimicrobianos. Resultados Treze (72,2%) torniquetes apresentaram crescimento de algum micro-organismo sendo 11 (52,4%) Staphylococcus coagulase-negativo, dois (9,5%) Staphylococcusaureus, quatro (19%)Rodothorulamucilaginosa, três (14,3%)Candidaalbicans. 61,5% dosStaphylococcus spp. apresentaram resistência a oxacilina. Os profissionais da equipe não relataram protocolos para limpeza, desinfecção ou substituição controlada destes materiais na instituição. Conclusão Foi identificada a contaminação de torniquetes por micro-organismos patogênicos com perfil de resistência aos antibióticos muito utilizados em instituições hospitalares.

Draft Genome Sequence of Rhodotorula mucilaginosa, an Emergent Opportunistic Pathogen

Rhodotorula mucilaginosa, a yeast with valuable biotechnological features, has also been recorded as an emergent opportunistic pathogen that might cause disease in both immunocompetent and immunocompromised individuals. Here, we report the draft genome sequence of R. mucilaginosa strain C2.5t1, which was isolated from cacao seeds in Cameroon.

Catheter-Associated Rhodotorula mucilaginosa Fungemia in an Immunocompetent Host

Rhodotorula species live in the environment, but can also colonize human epithelium, as well as respiratory, and gastrointestinal tracts. Reports of infection, especially in the past 2 decades, have noted increasing numbers of Rhodotorula infections, particularly in immunocompromised hosts, leading it to be considered emerging opportunistic pathogen. The major risk factors for infection were prolonged use of central venous catheters in patients with hematological and solid malignancies who are taking corticosteroids or cytotoxic drugs. Herein, we report a case of catheter-associated fungemia due to R. mucilaginosa in an immunocompetent host. The patient was admitted to the intensive care unit with mechanical ventilation for treatment of community-acquired pneumonia. After 10 days, the patient developed new-onset fever confirmed to be a result of catheter-associated blood-stream infection by R. mucilaginosa. It was successfully treated by catheter removal and intravenous amphotericin B.