Fatal Case of Fungemia by Wickerhamomyces anomalus in a Pediatric Patient Diagnosed in a Teaching Hospital from Brazil

Abstract

In recent decades, emerging fungal infections have changed the clinical mycology scenario as a consequence of the advances in medical diagnostics and therapeutic procedures, long hospitalization times, and the growing number of individuals with debilitating chronic diseases and impaired immune systems. This report presents a 19 months old Brazilian female patient who developed a severe fungal sepsis by an uncommon yeast. She was admitted at the intensive care unit with severe pneumonia, bronchopulmonary dysplasia, and weight-for-age z score of less than −2. She remained more than 30 days in the intensive care unit where she had a femoral venous catheter placement, enteral nutrition, broad-spectrum antibiotic therapy, and prophylaxis with fluconazole. Moreover, pericardiocentesis was performed due to cardiac tamponade. She had a previous history of prematurity, cardiac surgery due to patent ductus arteriosus, and a long period of hospital stay. Despite the antifungal prophylaxis, two yeast isolates were recovered from blood and then identified by classical mycological methods and internal transcribed spacer (ITS) sequencing as Wickerhamomyces anomalus. Both isolates exhibited susceptibility to amphotericin B, ketoconazole, itraconazole, voriconazole, and fluconazole. Her clinical state worsened, presenting anasarca, epistaxis, and hemorrhagic suffusions in the mouth, sclera, oliguria, and bradycardia. Two days after the first positive culture, she presented a gradual reduction of the white blood cells count, with severe leukopenia and neutropenia. She died five days after.

Azole Susceptibility Profiles of More than 9,000 Clinical Yeast Isolates Belonging to 40 Common and Rare Species

“…ohmeri and Cy. jadinii were less susceptible to fluconazole with "intermediate" MICs (12,(31)(32)(33)(34)(35)(36)(37)(38).…”

Investigation of Alternative Therapeutic and Biocidal Options to Combat Antifungal-Resistant Zoonotic Fungal Pathogens Isolated from Companion Animals

“…Additionally, fungi possess a number of facilitating attributes such as dimorphism, adhesins and invasins, proteases and biofilm-forming capabilities [ 22 ], which can further enhance pathogenesis and lead to infectious species crossing over from the dermis to the systemic circulation causing invasive mycoses. Opportunistic yeasts such as M. pachydermatis , W. anomalus and B. pseudobassiana are becoming of increasing importance in both animal and human diseases, where these pathogens are now being reported in cases of fungemia, where neonates and ICU patients are at most risk [ 5 , 23 , 24 , 25 , 26 , 27 ]. Such findings emphasise the importance of considering these pathogens within the diagnostics realm, where current CBPs are lacking.…”

“…Wickerhamomyces anomalus (formerly Pichia anomala ) is a zoonotic and nosocomial yeast, associated with the production of lethal mycotoxins having a mortality rate of 38% in adults and 42% in paediatric patients globally [ 5 ]. Several case reports describe disseminated candidiasis in dogs, with Candida parapsilosis associated with fungal pneumonia, urinary tract, and dermal infections [ 6 ] and is one of the most common fungus associated with respiratory disease in humans [ 7 ].…”

Formulation and Safety Tests of a Wickerhamomyces anomalus–Based Product: Potential Use of Killer Toxins of a Mosquito Symbiotic Yeast to Limit Malaria Transmission

“…Concerning the W. anomalus safety aspect, the evaluation potential toxicity plays a critical role, although the yeast is considered to be non-virulent and is reported rarely as an opportunistic pathogen in immunocompromised patients [28]. On the other hand, a large screening of donors, including different classes of patients and healthy people exposed to mosquito bites, detected a single W. anomalus fungemia positive case in an immunocompromised patient [29].…”