Rhodotorula glutinis -Related Meningitis

Abstract

Rhodotorulae are members of the family Cryptococcaceae, subfamily Rhodotorulodeae; although several species have been described, Rhodotorula glutinis and Rhodotorula rubra are the most common. Rhodotorula spp. are common saprophytes, widespread in nature. They have accidentally been isolated in human biological materials without pathological significance: they have been found in sputum and urine, especially in patients with severe debilitating diseases, in blood from patients with permanent intravenous devices, and in saliva obtained from denture wearers.Only rarely has an etiological role been attributed to these yeasts, and in all cases infection was clearly opportunistic (1-6). The following case is a R. glutinis-related meningitis in an immunocompetent patient that was successfully treated with amphotericin B.The patient was a 69-year-old white male (retired farmer) who was in his usual state of good health until 5 days before admission, when he developed persistent fever and headache. At physical examination, clear meningeal signs were observed, while the first hematochemical tests were not significant. Three separate blood cultures from a peripheral vein and a lumbar puncture (LP) were performed. Blood specimens were inoculated into Bactec Plus Aerobic/F and Bactec Anaerobic/F vials, which were placed in the BACTEC 9249 instrument and held for 8 days. The LP yielded clear cerebrospinal fluid (CSF), with a protein content of 0.82 g/liter, normal glucose concentration (and normal glycemia), and 30 lymphocytes/l. A Gram stain of the CSF was negative, as was a search for capsular antigens for Neisseria spp., pneumococcus, Haemophilus spp., and Cryptococcus neoformans; cultures of CSF for bacteria, mycobacteria, and fungi were also obtained. Empirical therapy with ceftriaxone, ampicillin, and acyclovir was started. Serologic tests for herpes, parotitis, enterovirus, human immunodeficiency virus, and treponemes were negative. Moreover, the Mantoux test, the chest x-ray, and a cerebral computerized tomography scan had no significant findings. After 3 days, both blood and CSF culture results were still negative, with the exception of the growth of one colony of R. glutinis in CSF. R. glutinis grew on Sabouraud dextrose agar containing chloramphenicol and gentamicin and was identified by the API 32-C System Biomerieux (API 32-C Bio-Merieux). The reported organism was considered a contaminate and therefore neglected. Because of the persisting symptoms, on day 5 of the hospital stay, a second LP was performed. The CSF analysis revealed a clear fluid, proteins at 0.9 g/liter, normal glucose (and normal glycemia), and 40 lymphocytes/l. Once again, after 3 days of incubation at 37°C, the Sabouraud dextrose agar showed the growth of three colonies of R. glutinis. On day 8 of the hospital stay, the previous therapy was stopped and the patient was treated intravenously with amphotericin B at dose of 1 mg/kg/day. In 3 days, the patient's temperature was back to normal, with a progressive improvement of clinical condition. W...

Experimental evaluation of antifungal and antiseptic agents against Rhodotorula spp.

“…was first described as common non‐pathogenic yeast. However, they have been implicated in several severe infections such as fungemia, 2,6,7 meningitis, 5,9 peritonitis 3 or transplant infection, 4 especially in immunocompromised patients (AIDS, 2,3,5 lymphoma, 1 solid tumor, 1 and organ transplantation 4 ). Major risk factors are prolonged use of indwelling intravenous catheter 2,7 or continuous ambulatory peritoneal dialysis (CAPD) 3…”

“…Removal of the infected catheter and medical treatment have been proposed, either alone or together 1,2 . Several antifungal agents have been used: amphotericin B 2,3,7,9 has often been prescribed, however, other antifungal agents have been proposed such as 5‐FC, 5 amphotericin B lipid complex, 4,6 ketoconazole, 6 fluconazole 1 or itraconazole 5 . Various durations of treatment have also been proposed, from 2 weeks 4 to several months 5 …”

Rare and Emerging Opportunistic Fungal Pathogens: Concern for Resistance beyondCandida albicansandAspergillus fumigatus

“…These yeastlike fungi are found as commensals in skin, nails, and mucous membranes as well as in cheese and milk products and environmental sources, including air, soil, shower curtains, bathtub grouts, and toothbrushes. Rhodotorula species are emerging as important human pathogens in immunocompromised patients and those with indwelling devices (8,23,40,46). Rhodotorula has been implicated as a cause of central venous catheter infection and fungemia (40,113), ocular infections (34), peritonitis (23), and meningitis (46).…”

Rhodotorula glutinis meningitis: a case report and review of literature

“…R. glutinis seems to be rare species associated with meningitis with only few cases reported in literature. 9,25 It appears that Rhodotorula meningitis should be considered a hospital infection, although there is one case of community acquired infection was reported. 19 In our case, it is very difficult to hypothesise the pathogenesis of meningitis.…”