Rhodotorula fungemia: two cases and a brief review

Emerging Fungal Pathogen Rhodotorula Species Isolated From a Patient With a Lung Malignancy

Rhodotorula is a genus of ubiquitous pigmented yeast found in the environment and as a commensal of human and animal microbiota. Previously considered nonpathogenic, Rhodotorula has emerged as an important cause of nosocomial and opportunistic infections in susceptible patients. While Rhodotorula spp. are common commensals in healthy individuals, the yeast may overgrow in patients with compromised immune systems causing disease. Herein, we provide a detailed presentation of a rare case involving a 79-year-old Caucasian female with a lung malignancy who developed massive cavitations in her lungs. The patient's lung tissue was cultured and grew an unidentified species of the genus Rhodotorula. The patient's health declined rapidly, and she expired due to hypoxemia. Clinicians must recognize patient groups potentially at risk for infection with Rhodotorula spp. Early identification and initiation of appropriate interventions are crucial in reducing mortality associated with this opportunistic fungal infection.

Delayed Medical Care Following an Alligator Bite: A Case Report and Literature Review

Alligator bites in humans present a significant concern for public safety in the southern United States, especially in states like Florida with substantial alligator populations. Although these reptiles play a vital role in the local ecology, encounters with humans can lead to severe injuries and even fatalities. A case report is presented of a 58-year-old male who suffered an alligator bite while attempting to take a selfie with the reptile during a hunting trip in rural Florida. The patient's injuries included multiple lacerations on the dorsum of his right hand. Despite the incident, the patient hesitated in seeking medical attention due to a lack of insurance, emphasizing the need for public awareness of alligator bite management. The discussion highlights the potential complications of alligator bites, including hemorrhage and infection, as well as the importance of appropriate medical treatment, including wound irrigation, debridement, and antibiotic therapy. Moreover, preventive strategies are discussed, such as maintaining a safe distance from alligators and refraining from feeding them, to ensure coexistence between humans and these reptiles in their natural habitats. As knowledge of alligator bites remains limited, this case report contributes valuable information to promote public safety and guide future research in this area.

Draft Genome Sequence of Rhodotorula mucilaginosa from an Adult Patient in Qatar

Rhodotorula mucilaginosa is an opportunistic fungal pathogen of public health importance. We present the draft genome sequence of an isolate (Rhodo3571) cultured from an immunocompetent patient. The isolate is similar to other R. mucilaginosa genomes in the NCBI database. Presented here are the genome assembly and its comparison to other reference genomes.

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.

Evaluation of Rhodotorula spp. contamination in hospital environments

Microbiological monitoring of air and surfaces is a valuable tool for assessing the level of environmental contamination by bacteria and fungi in hospitals, especially in high-risk wards. The presence of these microorganisms requires strict control in view of their role as opportunistic pathogens. As regard yeasts, Candida albicans is one of the main opportunistic pathogens. However, in recent years, many other "non-Albicans" species have been identified that are implicated in the onset of both localised infections in immunocompetent patients and systemic infections in immunocompromised patients. The aim of the work was to evaluate the frequency of isolation of Rhodotorula spp. in environmental samples of hospital origin in order to highlight how its presence may represent an increased risk for hospitalised patients. The samples were taken in at-risk wards, divided into six types of environments, in three hospitals in southern Sardinia between 2016 and 2019. The presence of moulds and yeasts was higher in the air (55.7%) than on surfaces (44.3%) in the hospital environments (p < 0.001). Similarly, the isolation frequency of Rhodotorula spp. was found to be greater (p < 0.001) in the air (14.2%) than on surfaces (9.2%). This study made it possible to evaluate the presence of pathogenic fungi in hospital environments, paying particular attention to Rhodotorula spp. since it is an emerging opportunistic yeast. It also highlights the importance of control measures especially in those where immunocompromised patients are present.

Along came a spider: an unusual organism identified in a peritoneal dialysis patient, a case report and literature review

Background

Peritoneal dialysis-associated peritonitis can uncommonly be caused by fungal infections. When they do present, they are associated with significant mortality and morbidity. We describe a case where a sample of peritoneal dialysate fluid grew Rhodotorula muciliginosa, a yeast organism present in the normal environment which has previously been reported as rarely causing peritonitis. We believe this is the first case where the Rhodotorula spp. and its origin has been identified.

Case presentation

A 20 year old male grew Rhodotorula muciliginosa from his peritoneal dialysis fluid on three separate occasions when a fluid sample was sent following a disconnection and subsequent set change. He was not systemically unwell and his peritoneal dialysate was clear. As Rhodotorula spp. is exceedingly difficult to treat our patient had his Tenchkoff catheter removed. Subsequent samples of soil and sand from his bearded dragon and Chilean tarantula cases, kept in his bedroom where dialysis occurred, were tested. The tarantula sand was identified as the source of the Rhodotorula spp. Of note, Candida was isolated from sand from the bearded dragon case. Once his Tenchkoff was removed he was treated with an intravenous course of antifungal therapy. He has since had a new Tenchkoff catheter inserted and recommenced PD following education around pets and hygiene.

Conclusions

In this era where people are keeping increasingly rare and unusual wildlife in their homes, this case highlights the need for clinician and nursing staff awareness of a patient’s home environment and hobbies when they are undergoing peritoneal dialysis. Sand from our patient’s tarantula case grew the colonising organism but interestingly soil from his bearded dragon case also isolated candida. This can also cause difficult to treat peritonitis.

Rare Invasive Yeast Infections in Greek Neonates and Children, a Retrospective 12-Year Study

Although Candida species remain the leading cause of invasive fungal infections (IFI), the list of other isolated fungal pathogens is increasing. The aim of the study was to report cases of IFI caused by rare yeasts in the largest tertiary Greek pediatric hospital. A retrospective study was performed from 6/2008–6/2020 regarding IFI caused by rare species. Identification of isolates was attained by conventional, molecular, and MALDI TOF MS methods, and susceptibility testing was performed according to the Clinical and Laboratory Standards (CLSI) methodology. During a 12-year period, 14 different rare fungal species in 33 neonates and children with IFI hospitalized in intensive care and oncology units were isolated from blood, central catheters, peritoneal, pleural, or pericardial fluid specimens. It is the first time for IFI caused by Wickerhamomyces anomalus (Candida pelliculosa), Pichia fermentans (Candida lambica), Yarrowia (Candida) lipolytica, Pichia (Hansenula) kluyveri, Rhodotorula mucilaginosa, Wickerhamiella (Candida) pararugosa and Cyberlindnera (Candida) fabianii in Greek neonates and children to be reported. For most of these rare fungal species isolated in the present study, no official antifungal breakpoints have been defined, and there are no guidelines for their treatment. Clinical laboratories should be aware of uncommon and emerging yeast pathogens and be able to detect them with molecular and proteomic methods.

Multicenter Evaluation of a PCR-Based Digital Microfluidics and Electrochemical Detection System for the Rapid Identification of 15 Fungal Pathogens Directly from Positive Blood Cultures

Routine identification of fungal pathogens from positive blood cultures by culture-based methods can be time-consuming, delaying treatment with appropriate antifungal agents. The GenMark Dx ePlex investigational use only blood culture identification fungal pathogen panel (BCID-FP) rapidly detects 15 fungal targets simultaneously in blood culture samples positive for fungi by Gram staining. We aimed to determine the performance of the BCID-FP in a multicenter clinical study. Blood culture samples collected at 10 United States sites and tested with BCID-FP at 4 sites were compared to the standard-of-care microbiological and biochemical techniques, fluorescence in situ hybridization using peptide nucleic acid probes (PNA-FISH) and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS).

Routine identification of fungal pathogens from positive blood cultures by culture-based methods can be time-consuming, delaying treatment with appropriate antifungal agents. The GenMark Dx ePlex investigational use only blood culture identification fungal pathogen panel (BCID-FP) rapidly detects 15 fungal targets simultaneously in blood culture samples positive for fungi by Gram staining. We aimed to determine the performance of the BCID-FP in a multicenter clinical study. Blood culture samples collected at 10 United States sites and tested with BCID-FP at 4 sites were compared to the standard-of-care microbiological and biochemical techniques, fluorescence in situ hybridization using peptide nucleic acid probes (PNA-FISH) and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). Discrepant results were analyzed by bi-directional PCR/sequencing of residual blood culture samples. A total of 866 clinical samples, 120 retrospectively and 21 prospectively collected, along with 725 contrived samples were evaluated. Sensitivity and specificity of detection of Candida species (C. albicans, C. auris, C. dubliniensis, C. famata, C. glabrata, C. guilliermondii, C. kefyr, C. krusei, C. lusitaniae, C. parapsilosis, and C. tropicalis) ranged from 97.1 to 100% and 99.8 to 100%, respectively. For the other organism targets, sensitivity and specificity were as follows: 100% each for Cryptococcus neoformans and C. gattii, 98.6% and 100% for Fusarium spp., and 96.2% and 99.9% for Rhodotorula spp., respectively. In 4 of the 141 clinical samples, the BCID-FP panel correctly identified an additional Candida species, undetected by standard-of-care methods. The BCID-FP panel offers a faster turnaround time for identification of fungal pathogens in positive blood cultures that may allow for earlier antifungal interventions and includes C. auris, a highly multidrug-resistant fungus.

Biochemical response of Rhodotorula mucilaginosa and Cladosporium herbarum isolated from aquatic environment on iron(III) ions

The objective of the paper was to determine the influence of iron(III) ions on the growth and metabolism of fungi commonly occurring in waters: the yeast Rhodotorula mucilaginosa and filamentous fungus Cladosporium herbarum. Cells of R. mucilaginosa were shown to absorb the most iron(III) ions at a concentration of 1 mg/L iron(III) ions. Yeast cells showed a considerable increase in the content of proteins and monosaccharides, as well as biomass growth. At higher concentrations of iron(III) ions, the yeast limited the intake of iron(III) ions, and a decrease in the basic metabolites in cells was observed, as well as an increase in the secretion of such metabolites into the medium. Moreover, the activity of antioxidant enzymes increased in the fungal cells, suggesting that iron(III) ions have a toxic effect. Simultaneously, even at high concentrations of iron(III) ions in the medium, no decrease in the yeast biomass was recorded. It seems therefore that the potentially pathogenic R. mucilaginosa will likely be present in waters moderately contaminated with iron(III) ions. It can be useful as a water quality bioindicator. A considerably higher capacity for the biosorption of iron(III) ions was recorded for the filamentous fungus C. herbarum. Defensive mechanisms were observed for C. herbarum, which were manifested in a substantial increase in the content of proteins and monosaccharides, as well as an increase in the activity of antioxidant enzymes, particularly under the influence of high concentrations of iron(III) ions. Moreover, it was evidenced that in the filamentous fungus, iron(III) ions limited the extracellular secretion of metabolites. These results suggest that the fungus can actively accumulate iron(III) ions and therefore eliminate them from the aquatic environment. It can be useful in water treatment processes, which has a significant impact on water ecology.

Diversity, Virulence Factors, and Antifungal Susceptibility Patterns of Pathogenic and Opportunistic Yeast Species in Rock Pigeon (Columba livia) Fecal Droppings in Western Saudi Arabia

Bird fecal matter is considered a potential source of pathogenic microbes such as yeast species that contaminate the environment. Therefore, it needs to be scrutinized to assess potential environmental health risks. The aim of this study was to investigate the diversity of the yeasts in pigeon fecal droppings, their antifungal susceptibility patterns, and virulence factors. We used culturing techniques to detect the yeasts in pigeon fecal droppings. The isolates were then characterized based on colony morphologies, microscopic examinations, and biochemical reactions. The molecular identification of all yeast isolates was performed by sequencing of the amplified ITS gene. Genes encoding virulence factors CAP1, CAP59, and PLB were also detected. Antifungal susceptibility patterns were examined by the disk diffusion method. A total of 46 yeast-like isolates were recovered, and they belonged to nine different genera, namely, Cryptococcus, Saccharomyces, Rhodotorula, Candida, Meyerozyma, Cyberlindnera, Rhodosporidium, Millerozyma, and Lodderomyces. The prevalence of two genera Cryptococcus and Rhodotorula was high. None of the yeast isolates exhibited any resistance to the antifungal drugs tested; however, all pathogenic Cryptococcus species were positive for virulence determinants like urease activity, growth at 37°C, melanin production, the PLB and CAP genes. This is the first report on the molecular diversity of yeast species, particularly, Cryptococcus species and their virulence attributes in pigeon fecal droppings in Saudi Arabia.

Bird fecal matter is considered a potential source of pathogenic microbes such as yeast species that contaminate the environment. Therefore, it needs to be scrutinized to assess potential environmental health risks. The aim of this study was to investigate the diversity of the yeasts in pigeon fecal droppings, their antifungal susceptibility patterns, and virulence factors. We used culturing techniques to detect the yeasts in pigeon fecal droppings. The isolates were then characterized based on colony morphologies, microscopic examinations, and biochemical reactions. The molecular identification of all yeast isolates was performed by sequencing of the amplified ITS gene. Genes encoding virulence factors CAP1, CAP59, and PLB were also detected. Antifungal susceptibility patterns were examined by the disk diffusion method. A total of 46 yeast-like isolates were recovered, and they belonged to nine different genera, namely, Cryptococcus, Saccharomyces, Rhodotorula, Candida, Meyerozyma, Cyberlindnera, Rhodosporidium, Millerozyma, and Lodderomyces. The prevalence of two genera Cryptococcus and Rhodotorula was high. None of the yeast isolates exhibited any resistance to the antifungal drugs tested; however, all pathogenic Cryptococcus species were positive for virulence determinants like urease activity, growth at 37°C, melanin production, the PLB and CAP genes. This is the first report on the molecular diversity of yeast species, particularly, Cryptococcus species and their virulence attributes in pigeon fecal droppings in Saudi Arabia.

Different toenail onychomycosis due to Rhodotorula mucilaginosa and Candida parapsilosis in an immunocompetent young adult

Candida parapsilosis (C. parapsilosis) and Rhodotorula mucilaginosa (R. mucilaginosa) have emerged as a potential pathogen in immunosuppressed hosts; they rarely induce onychomycosis in immunocompetent hosts without assistance from other pathogens. Here we present onychomycosis induced by two strains on different toenails in an immunocompetent young adult. The patient presented with onychomycosis on left and right first toenails due to R. mucilaginosa and C. parapsilosis, respectively. Based on the diagnosis, he had been orally treated with itraconazole 200 twice daily for one week every four weeks that repeated 7 times; however, the toenails did not respond satisfactorily to the treatment. After two months of drug cessation, we confirmed that the two toenails were infected with different fungi. R. mucilaginosa was isolated from the left first toenail, and C. parapsilosis was isolated from the right first toenail. Identifications were confirmed by morphological and cultural characteristics as well as by DNA molecular analysis. After determining in vitro drug susceptibility, the patient was successfully treated with a topical application of ketoconazole cream on the left toenail and oral itraconazole. It is the rare known case of different nails being infected by R. mucilaginosa and C. parapsilosis respectively.

Rhodotorula fungemia of an intensive care unit patient and review of published cases

Rhodotorula species are commensal yeasts that have emerged as a cause of life-threatening fungemia in severely immunocompromised patients. A case of Rhodotorula mucilaginosa fungemia in a 48-year-old woman that had undergone consecutive abdominal surgeries due to ovarian cancer and bowel necrosis while she was receiving fluconazole prophylaxis is presented. Several risk factors were identified such as presence of central venous catheters, solid organ neoplasm, abdominal surgery and administration of antibiotics. Identification was performed using commercial systems. The yeast was resistant to fluconazole, posaconazole and voriconazole and to echinocandins, whereas MIC to amphotericin B was 1.5 mg/L. Furthermore, published cases of Rhodotorula spp fungemia during the last decade are reviewed. In conclusion, Rhodotorula spp must be considered a potential pathogen in patients with immunosupression and central venous catheters. Correct identification is mandatory for appropriate management, as Rhodotorula spp are resistant to antifungal agents, such as fluconazole and echinocandins.

Biofilm formation by the yeast Rhodotorula mucilaginosa: process, repeatability and cell attachment in a continuous biofilm reactor

Yeast biofilms contribute to quality impairment of industrial processes and also play an important role in clinical infections. Little is known about biofilm formation and their treatment. The aim of this study was to establish a multi-layer yeast biofilm model using a modified 3.7 l bench-top bioreactor operated in continuous mode (D = 0.12 h(-1)). The repeatability of biofilm formation was tested by comparing five bioprocesses with Rhodotorula mucilaginosa, a strain isolated from washing machines. The amount of biofilm formed after 6 days post inoculation was 83 μg cm(-2) protein, 197 μg cm(-2) polysaccharide and 6.9 × 10(6) CFU cm(-2) on smooth polypropylene surfaces. Roughening the surface doubled the amount of biofilm but also increased its spatial variability. Plasma modification of polypropylene significantly reduced the hydrophobicity but did not enhance cell attachment. The biofilm formed on polypropylene coupons could be used for sanitation studies.