First Case of Fungemia Due to Pseudozyma aphidis in a Pediatric Patient with Osteosarcoma in Latin America

Abstract

We report the first case of blood infection due to Pseudozyma aphidis in Latin America. We contribute evidence showing this organism to be a potential human pathogen, and we provide new data about its identification, drug susceptibility, and treatment outcome. CASE REPORTA 6-year-old female from Córdoba, Argentina, was diagnosed with osteosarcoma of the left tibia and lung metastasis and started chemotherapy administered through a long-term indwelling central line (a central venous catheter [CVC]) on 2 September 2013 at the Hospital de niños de la Santísima Trinidad. On 2 October, she presented with febrile neutropenia and was empirically treated with ceftazidime, vancomycin, and amikacin; blood and urine samples were submitted for laboratory testing, and both cultures were negative. On 4 October, she received clindamycin due to facial edema. From 6 October to 13 November, she was transfused with platelets and red blood cells several times due to thrombocytopenia and anemia. On 5 November, she developed severe mucositis and erythroderma and was treated with ceftazidime, nystatin, amikacin, vancomycin, and fluconazole. On 13 November, she received a 1-week treatment with meropenem and liposomal amphotericin B. On 18 November, she developed conjunctival hyperemia and was treated with tobramycin. On 28 November, she underwent supracondylar amputation of the left lower limb. On 20 December, the patient presented with febrile neutropenia (white blood cells [WBCs], 1,030/mm 3 ) and was admitted to the intensive care unit (ICU) in the same hospital. Table 1 summarizes the clinical data and evolution of the case since admission. A blood sample (BS1) obtained by venipuncture and a hub blood sample (drawn through the catheter hub) (HBS1) were taken and sent to the microbiology laboratory. Yeast cells (Pseudozyma aphidis; isolate Y1) were detected in the hub blood sample after 2.6 days of incubation in a Bact/ALERT PF (bioMérieux Inc., Durham, NC). However, the patient did not show clinical signs of illness on day 3 after admission; therefore, the isolate was considered not significant and she was discharged. Four days later, the patient presented with vomiting, dehydration, and febrile neutropenia (WBCs, 200/mm 3 ) and was admitted once again at the ICU in the same institution. At that point, an empirical antibiotic treatment with ceftazidime and amikacin was initiated and a new blood sample and hub blood sample (BS2 and HBS2) were taken and processed. After 18 h of incubation, both cultures were positive for Pseudomonas aeruginosa. Four days after readmission, the patient presented with fever and severe neutropenia (WBCs, 80/ mm 3 ) and showed high (233 mg/liter) C-reactive protein levels. A blood sample and a hub blood sample (BS3 and HBS3) were taken and processed. After 12 h of incubation, the blood sample culture was positive for Escherichia coli, and 2 h later, the hub blood sample culture was positive for yeast (Y2). This isolate (Y2) had the same phenotypic features as the first yeast isolate (Y1). Six days after...

Identification of Mycoses in Developing Countries

“…Although fungal infections are generally neglected by healthcare communities, there is mounting evidence associating fungi with many pathological complications such as bowel-related diseases [1], neurodegenerative diseases [2], and invasive bloodstream infections [3]. Fungal infections cause 1.5 million deaths annually [4] and the number of patients prone to development of these infections is on the rise [5][6][7]. The lack of clinically effective antifungal agents together with the emergence of multi-drug-resistant organisms and new fungal species are major public health threats [8,9].…”

Pseudozyma aphidis fungaemia with invasive fungal pneumonia in a patient with acute myeloid leukaemia: case report and literature review

“…We retrospectively reviewed the global literature to identify the possible risk factors, clinical presentation, and optimal treatment strategies for Pseudozyma infection; in addition to the present case, 14 case reports were found (Table ) . Since 2014 when previous literature review was reported by Prakash et al .…”

“…We retrospectively reviewed the global literature to identify the possible risk factors, clinical presentation, and optimal treatment strategies for Pseudozyma infection; in addition to the present case, 14 case reports were found (Table 1). 3,[7][8][9][10][11][12][13][14][15] Since 2014 when previous literature review was reported by Prakash et al [8], there were seven additional cases including our case. Therefore, we present a updated literature review with some modifications and adding recent cases.…”

“…Antifungal susceptibility testing was performed in 11 cases of human infections caused by Pseudozyma spp., P. aphidis was susceptible to itraconazole, voriconazole, and amphotericin B; had varying susceptibility to fluconazole; and was resistant to echinocandines and flucytosine. 7,8,11,14,15 Non-aphidis Pseudozyma spp. seemed to have susceptibility to amphotericin B only.…”

Molecular identification of Pseudozyma aphidis (Henninger & Windisch) Boekhout: first record from a Brazilian mangrove swamp

“…This species is commonly found as a saprotroph on leaves and flowers (Han et al 2015, Limtong & Kaewwichian 2015, Tantrungkij et al 2015, although it is not pathogenic to plants. However, there are reports of this species as pathogenic in humans (Prakash et al 2014, Herb et al 2015, Joo et al 2015, Orecchini et al 2015, usually occurring in patients with some type of immunosuppression that predisposes opportunistic infections.…”