Pseudozyma and other non‐Candida opportunistic yeast bloodstream infections in a large stem cell transplant center

Abstract

Non-Candida opportunistic yeasts are emerging causes of bloodstream infection (BSI) in immunocompromised hosts. However, their clinical presentation, management, and outcomes in stem cell transplant (SCT) recipients are not well described. We report the first case to our knowledge of Pseudozyma BSI in a SCT recipient. He had evidence of cutaneous involvement, which has not been previously described in the literature. He became infected while neutropenic and receiving empiric micafungin, which is notable because Pseudozyma is reported to be resistant to echinocandins. He was successfully treated with the sequential use of liposomal amphotericin B and voriconazole. A review of the literature revealed nine reported instances of Pseudozyma fungemia. We performed a retrospective review of 3557 SCT recipients at our institution from January 2000 to June 2015 and identified four additional cases of non-Candida yeast BSIs. These include two with Cryptococcus, one with Trichosporon, and one with Saccharomyces. Pseudozyma and other non-Candida yeasts are emerging pathogens that can cause severe and disseminated infections in SCT recipients and other immunocompromised hosts. Clinicians should have a high degree of suspicion for echinocandin-resistant yeasts, if patients develop breakthrough yeast BSIs while receiving echinocandin therapy.

Fungaemia due to rare yeasts in a tertiary care university centre within 18 years

“…Rare yeasts other than Candida have been reported as emerging causes of fungaemia 1‐2,5‐15 . Sporadic outbreaks in haematology units were also reported 7,23 .…”

“…Candida species are the most common yeast pathogens responsible for fungaemia in humans 3,4 . However, rare yeasts other than Candida such as Cryptococcus , Malassezia , Rhodotorula , Saccharomyces , Saprochaete and Trichosporon have been increasingly reported as agents of fungaemia and caused sporadic outbreaks in the last two decades 1‐2,5‐15 . Early initiation of effective antifungal therapy is crucial in dealing with fungaemia and any delay or inappropriate antifungal use is associated with increased mortality 7,9 .…”

Dermatological manifestations of fungal infection in patients with febrile neutropaenia: A review of the literature

“…We discovered 54 publications with a total of 215 reported cases of cutaneous manifestations of fungal injury in patients with FNP (Table ). Descriptions of all lesions were either cited as described by the presenters of the case, or if such descriptions were lacking, described by the authors herein.…”

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

“…Cryptococcal infection could arise in patients not receiving azole prophylaxis, or in patients with sub-therapeutic azole levels, as might be seen with itraconazole, voriconazole or posaconazole. Other rare yeasts reported to cause disseminated infection following HSCT include Trichosporon, Saccharomyces, Rhodotorula, Geotrichum and Pseudozyma [43]. These infections may manifest as breakthrough fungemia in patients with indwelling central venous catheters who are receiving antifungal prophylaxis.…”