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Sakai Y, Taniguchi T, Herai Y, Yahaba M, Watanabe A, Kamei K, Igari H. Fungemia With Wickerhamomyces anomalus: A Case Report and Literature Review. Cureus 2024; 16:e53550. [PMID: 38445156 PMCID: PMC10912825 DOI: 10.7759/cureus.53550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
We report the case of an 84-year-old man with a history of IgG4-related sclerosing cholangitis who was diagnosed with advanced esophageal cancer and underwent radiation and chemotherapy. An implantable central venous access port was placed for chemotherapy and total parenteral nutrition. The patient presented with a fever and received antimicrobial therapy for acute cholangitis but remained febrile, and subsequently, yeast was detected in the aerobic bottle of blood culture obtained from the central venous line. The yeast was identified as Wickerhamomyces anomalus. Liposomal amphotericin B was administered, and the central line access port was removed. After confirmation of negative blood cultures and 14 days post treatment, he underwent reinsertion of the central line access port. Due to persistent pain at the insertion site, fluconazole was added for an additional 14 days, and the patient was discharged and transferred to another hospital. Wickerhamomyces anomalus is a rare fungal infection with other synonyms including Pichia anomala, Hansenula anomala, and Candida pelliculosa. A literature review of 53 case reports of Wickerhamomyces anomalus, Pichia anomala, Hansenula anomala, and Candida pelliculosa was conducted, with a total of 211 cases reviewed. Fungemia was reported in 94% of cases, with central venous catheterization, parental feeding, low birth weight, and immunocompromised status identified as major risk factors. The majority of cases were pediatric, particularly neonatal, and there were reports of nosocomial infections causing outbreaks, with some cases involving the eye such as endophthalmitis or keratitis.
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Affiliation(s)
- Yui Sakai
- Infectious Diseases, Chiba University School of Medicine, Chiba, JPN
| | | | - Yoriko Herai
- Infectious Diseases, Chiba University Hospital, Chiba, JPN
- Respiratory Medicine, Misato Central General Hospital, Misato, JPN
| | - Misuzu Yahaba
- Infectious Diseases, Chiba University Hospital, Chiba, JPN
| | - Akira Watanabe
- Clinical Research, Chiba University Medical Mycology Research Centre, Chiba, JPN
| | - Katsuhiko Kamei
- Clinical Research, Chiba University Medical Mycology Research Centre, Chiba, JPN
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Aboutalebian S, Mirhendi H, Eshaghi H, Nikmanesh B, Charsizadeh A. The first case of Wickerhamomyces anomalus fungemia in Iran in an immuneodeficient child, a review on the literature. J Mycol Med 2023; 33:101351. [PMID: 36413850 DOI: 10.1016/j.mycmed.2022.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/24/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
The incidence of invasive candidiasis in pediatric patients is increasing and is associated with significant morbidity and mortality. C. pelliculosa has been rarely reported as a human pathogen, however, it has been associated with serious nosocomial infections and clonal outbreaks with poor clinical outcomes in immunocompromised children were reported. Here, we describe the first case of candidemia due to Candida pelliculosa in a 5-year-old immunocompromised male suffered from Griscelli syndrome with hemophagocytic syndrome hospitalized in the pediatric intensive care unit (PICU), Tehran, Iran. In addition, the history of reported cases or case-series due to C. pelliculosa is reviewed.
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Affiliation(s)
- Shima Aboutalebian
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Mirhendi
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Eshaghi
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran Iran
| | - Bahram Nikmanesh
- Department of Medical Laboratory Science, School of Allied Medical Science, Tehran University of Medical Science, Tehrn, Iran; Zoonoses Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Charsizadeh
- Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran Iran.
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Zhang L, Xiao M, Arastehfar A, Ilkit M, Zou J, Deng Y, Xu Y, Liao W, Zhao J, Fang W, Pan W. Investigation of the Emerging Nosocomial Wickerhamomyces anomalus Infections at a Chinese Tertiary Teaching Hospital and a Systemic Review: Clinical Manifestations, Risk Factors, Treatment, Outcomes, and Anti-fungal Susceptibility. Front Microbiol 2021; 12:744502. [PMID: 34690991 PMCID: PMC8527005 DOI: 10.3389/fmicb.2021.744502] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022] Open
Abstract
Wickerhamomyces anomalus is an emerging pathogen, which has been associated with clonal outbreaks and poor clinical outcomes. Despite being an important emerging yeasts species, our understanding concerning the microbiological and clinical characteristics of infections due to this species is limited. Herein, we are reporting a retrospective analysis of fungemia patients with W. anomalus from a 2,100-bed hospital in Shanghai during 2014–2016. Moreover, we conducted an extensive literature review to gain a deeper clinical and microbiological insights. Detailed clinical data were recorded. Antifungal susceptibility testing (AFST) followed CLSI M27-A3, and isolates were identified using MALDI-TOF MS. In total, 13 patients were identified with a mortality rate of 38.5% (5/13). Central venous catheter (CVC), broad-spectrum antibiotic therapy, total parenteral nutrition (TPN), surgery, and mechanical ventilation were the most frequently observed risk factors. Eight patients (61.5%) experienced mixed bacterial/Candida bloodstream infections, and four patients developed mixed candidemia (MC). W. anomalus isolates showed high minimum inhibitory concentrations (MICs) against all azoles tested and flucytosine, while AMB showed the highest in vitro activity. Azoles were used for 84.6% (11/13) of the cases, while 36.4% (4/11) of them died. When combining with the AFST data and the literature review, our study highlights the poor efficacy of azoles and optimal efficacy of AMB and LAMB against infections caused by W. anomalus. In conclusion, our study highlights the emerging threat of W. anomalus affecting both neonates and adults. Furthermore, our results advocate the use of AMB formulations rather than azoles among patients infected with W. anomalus. Future studies are warranted to reach a definitive consensus regarding the utility of echinocandins among such patients.
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Affiliation(s)
- Li Zhang
- Department of Dermatology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meng Xiao
- Peking Union Medical College Hospital, Beijing, China
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
| | - Macit Ilkit
- Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Jun Zou
- The Fourth People's Hospital of Nanning, Nanning, China
| | - Yuchen Deng
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yingchun Xu
- Peking Union Medical College Hospital, Beijing, China
| | - Wanqing Liao
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jingjun Zhao
- Department of Dermatology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenjie Fang
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Weihua Pan
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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da Matta VLR, de Souza Carvalho Melhem M, Colombo AL, Moretti ML, Rodero L, Duboc de Almeida GM, dos Anjos Martins M, Costa SF, Souza Dias MBG, Nucci M, Levin AS. Antifungal drug susceptibility profile of Pichia anomala isolates from patients presenting with nosocomial fungemia. Antimicrob Agents Chemother 2007; 51:1573-6. [PMID: 17261632 PMCID: PMC1855522 DOI: 10.1128/aac.01038-06] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 10/17/2006] [Accepted: 01/13/2007] [Indexed: 11/20/2022] Open
Abstract
In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.
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Linden PK. Amphotericin B lipid complex for the treatment of invasive fungal infections. Expert Opin Pharmacother 2004; 4:2099-110. [PMID: 14596663 DOI: 10.1517/14656566.4.11.2099] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Amphotericin B lipid complex (ABLC; Abelcet, Enzon Pharmaceuticals) has become the dominant marketed lipid amphotericin B compound to emerge since the approval of these agents from the mid-1990s onwards. This agent is a 1:1 combination of amphotericin B and a lipid moiety consisting of dimyristoyl phosphatidylcholine and dimyrisoyl phosphatidylcholine, which exists in a ribbon-like molecular structure. ABLC undergoes rapid reticuloendothelial uptake from the circulation and achieves significantly higher tissue concentrations in the liver, spleen and lung compared to comparably dosed conventional amphotericin B. ABLC is approved by the FDA for all mycoses in amphotericin B-intolerant or -refractory infection. Randomised, controlled trials of amphotericin B have shown comparable efficacy in candidiasis and an improved outcome in invasive aspergillosis versus historical controls. ABLC has demonstrated a reduced incidence of nephrotoxicity and infusion reactions versus amphotericin B. Comparative studies against other lipid formulations are quite limited and have shown variable differences in infusion toxicity, nephrotoxicity, hepatotoxicity and clinical efficacy. Postapproval experience has shown substantial efficacy for less common mycotic pathogens including zygomycosis. The precise position of ABLC versus both other lipid formulations and expanding formulary of new antifungal agents is in flux. Future studies which examine its clinical efficacy, role in combination therapy, toxicity and cost-effectiveness in these complex patients are needed.
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Affiliation(s)
- Peter K Linden
- Abdominal Organ Transplant ICU, University of Pittsburgh Medical Center, Dept Critical Care Medicine, 602-A Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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