Amphotericin B Lipid Complex Therapy in an AIDS Patient with Rhodotorula rubra Fungemia

Abstract

2. Domingo P, Ris J, Lopez-Contreras J, Sancho F, Nolla J. Appendicitis disease; normal radiographs of the lungs; and cultures of the blood, due to Mycobacterium avium complex in a patient with AIDS [letter].urine, and gastric aspirate that were negative for mycobacteria. Amphotericin B Lipid Complex Therapy in an AIDS Patient with Rhodotorula rubra FungemiaRhodotorula species, yeasts that belong to the family Cryptococcaceae, characteristically produce a coral-red pigment, hence the term, ''red yeast'' (figure 1). Rhodotorula species are found in soil, water, plant materials, and other environmental sources. They have been isolated from the skin, nails, conjunctiva, and the respiratory, gastrointestinal, and urinary tracts, and they are generally considered commensals or contaminants [1, 2]. However, in immunocompromised individuals, infections due to typically nonpathogenic commensal organisms such as Rhodotorula species may occur and can be lifethreatening. Patients with solid tumors, lymphoproliferative diseases, AIDS, chronic renal failure, and diabetes mellitus are at greatest risk. Reports of infections due to Rhodotorula species include septicemia, endocarditis, meningitis, ventriculitis, and peritonitis [3, 4]. Other Figure 1. Culture of blood, obtained from a 50-year-old patient with than immunologic compromise, the common risk factor associated AIDS, on Sabouraud-dextrose agar that yielded Rhodotorula rubra. with these infections in most patients is the use of indwelling vascular catheters [3, 5,6].The treatment of catheter-related infections due to Rhodotorula gal therapy either alone or together are unclear. We report a case species is controversial. The roles of catheter removal and antifunof Rhodotorula fungemia in a patient with AIDS who required removal of his Hickman catheter and treatment with amphotericin B lipid complex to sterilize his blood.Financial support: The Liposome Company, Princeton, New Jersey.A 50-year-old homosexual man was diagnosed with AIDS in 1992. drome, esophageal candidiasis, and chronic renal insufficiency sec-

Transient Fungemia Due to Rhodotorula rubra in a Cancer Patient: Case Report and Review of the Literature

“…It is of interest that 23 of them were reported from a single cancer center [2].All reported cases of Rhodotorula spp. fungemia, occurring between 1960 and 2000 [2,3,[5][6][7][8][9][10][11][12][13][14][15][16][17], are listed in table 1. The reported risk factors are administration of broad-spectrum antibiotics and steroids and, most commonly, the insertion of central venous catheters (Table 1) [2,3,[5][6][7][8][9][10][11][12][13][14][15][16][17].…”

“…However, it is difficult to rely on results of in vitro tests for clinical guidelines since the tests have not been standardized yet. For the time being amphotericin B continues to be considered "standard" treatment of invasive fungal infections in immunocompromised hosts [2][3][4][5].…”

“…Risk factors include granulocytopenia, damage to the normal anatomic barriers (skin and mucosas), cellular immune dysfunction and the presence of indwelling vascular catheters [2][3][4]. At risk are immunocompromised patients with neoplastic diseases, AIDS, chronic renal failure and diabetes mellitus [5].…”

“…A number of R. rubra infections, ranging from uncomplicated transient fungemia to potentially life-threatening invasive infections, such as endocarditis, meningitis, ventriculitis and peritonitis have been recently published [2,3,[5][6][7][8][9][10][11][12][13][14][15][16][17].…”

"Rhodotorula spp.isoladas de hemocultura no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo: características clínicas e microbiológicas"

“…Em todos os casos, exceto um, os pacientes apresentavam doenças de base, incluindo câncer, endocardite, doença pulmonar e aids, assim como presença de cateter vascular. A espécie mais prevalente foi R. mucilaginosa e a fonte provável da fungemia foi relacionada ao cateter (Louria et al,1960;Kiehn et al,1992;Goldani et al,1995 (Fanci et al, 1997;Lui et al, 1998). Não há até o momento uma recomendação definitiva para tratamento destas infecções, mas a utilização de anfotericina B associada à remoção de cateter venoso é recomendada por alguns autores para prevenir ocorrência de infecção mais grave (Samonis et al, 2001;Petrocheilou-Paschou et al, 2001;Lo Re et al, 2003).…”