Epidemiology and outcome of Rhodotorula infection in haematological patients

Abstract

Rhodotorula spp. are emergent opportunistic pathogens, particularly in haematological patients. However, no systematic review of this infection has been undertaken in this high-risk patient group. The aim of this study was to review all reported cases of Rhodotorula infection to determine the epidemiology and outcome of this infection in this high-risk population. The 29 reported cases were fungaemias. The most common underlying haematological disorder was the presence of acute leukaemia (65.5%). Rhodotorula mucilaginosa was the species found more frequently (79.3%). Most cases (58.6%) had several risk factors (≥ 3) simultaneously. The most common predisposing factors were the presence of central venous catheter (CVC, 100%) and neutropenia (62.1%). A substantial number of patients (81.5%) received antifungal treatment with amphotericin B. The overall mortality was higher (13.8%) than that described in non-haematological patients (5.8% in solid-organ neoplasms and 9% in AIDS or other chronic diseases). Patients with acute leukaemia had a higher mortality rate (15.7%) than patients with non-Hodgkin's lymphoma (0%). Our data suggest that patients with acute leukaemia might be managed as high-risk patients and intensive measures might be taken. In addition, it appears that the subgroup of patients without acute leukaemia have a good outcome and might be managed as low-risk patients with a less intensive approach.

Clinical and microbiological characteristics of Rhodotorula mucilaginosa infections in a tertiary-Care facility

“…As Rhodotorula infection has low virulence in immunocompetent patients and have good prognosis and therefore require less intensive approach. [15] In this study, the duration of treatment ranged from 3 to 6 weeks for successful treatment with amphotericin B. Similarly, one study also documented similar duration of treatment (2-5 weeks).…”

“…[1,5,10] Similarly, other prior study also observed several risk factors (>/=3) simultaneously in one patient. [15] The incidence of CVC as risk factor is low in this study because no patient was admitted in intensive care unit. The incidence of risk factor of prolonged use of antibiotics and hospital stay is high as the isolation of Rhodotorula spp.…”

“…This is similar to prior studies that documents R. mucilaginosa as a predominant species of Rhodotorula. [4,12,15,19] Other two common species are R. glutinis and R. minuta.…”

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

“…Rhodotorula spp. Amphotericin B † ± 5-flucytosine B-III In vitro susceptibility only to these two agents; in vitro resistance to all azoles and echinocandins 176,177 Trichosporon spp. Voriconazole C-III Preferred therapy but scarce data; in vitro resistance to fluconazole, 5-flucytosine and amphotericin B † reported 178,179 †Refers to amphotericin B deoxycholate and its lipid formulations.…”

An unusual case of Rhodotorula mucilaginosa fungaemia in a cancer patient

“…Most cases of Rhodotorula fungaemia are associated with the presence of central catheters in patients with haematological malignancies (2,8).…”