Rhodotorula Rubra Fungemia in an Immunocompromised Patient

Abstract

Medical advances during the past decade have improved preventive, diagnostic and therapeutic capabilities for a variety of diseases. However, certain therapies that involve the use of invasive surgical procedures and immunosuppression predispose the host to an expanding group of opportunistic pathogens. Most fungal infections are caused by commonly recognized opportunistic fungi such as Candida species, Aspergillus species, Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis, and Cryptococcus neoformans. Of late, fungi such as Candida glabrata, Trichosporon beigelii, Malassezia species, Hansenula species, Rhodotorula species and Geotrichum candidum, are emerging as significant causes of infection in immunocompromised patients. In this report, we describe a case of Rhodotorula rubra sepsis in an immunocompromised patient, and discuss the clinical aspect and management of the condition, with a review of the relevant literature. Case ReportA 65-year-old female was admitted at King Fahd General Hospital in Jeddah, Saudi Arabia, in February 1999, with intestinal obstruction, septicemia and fecal fistula. She was treated with cephradine 500 mg iv/6 hr, metronidazole 500 mg iv/8 hr, and cefoxitin 1 mg iv/8 hr for seven days. An emergency laparotomy was done one week later. Her bowel was fragile, with multiple adhesions and multiple perforations during dissection. Hemicolectomy and jejunoileal anastomosis were performed, and about 100 cm of small bowel and jejunum were removed. The patient was put on metronidazole 500 mg iv/8hr, amikacin 500 mg iv/12hr, and cefuroxime 750 mg iv/8hr.Postoperatively, the patient developed a recurrence of fecal fistula through the operation site, and was put on total parenteral nutrition. The histopathology report confirmed metastatic mucoid epidermoid carcinoma. One week later, she had pyrexia of 39°C, and one set of blood was withdrawn from the peripheral line and sent for culture, using Bactec 9240 (Beckton Dickinson Company, USA). The blood culture was positive two days later, and the gram-stained smear showed blastoconidia with a budding (no lyphae) faint capsule (Figure 1). Culture of the blood on Sabouraud agar grew pink, mucoid colonies (Figure 2) that were identified with the use of Candifast (International Microbio., France) and Vitek (Bio Merieux, France) as Rhodotorula rubra. The antifungal susceptibility test using Candifast showed the organism to be sensitive to fluconazole and miconazole, but resistant to amphotericin B, flucytosine, econazole and ketoconazole. The patient was treated with miconazole 200 mg iv/8hr for 10 days. Her total and differential white blood cells before the fungemia were within normal limits.

A successful management of dengue fever in pregnancy: Report of two cases

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Microbial Isolates in Diabetic Foot Lesions of Hospitalized Patients at the University Hospital of the West Indies

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Oral and cloacal aerobic bacterial and fungal flora of free-living four-lined snakes (Elaphe quatuorlineata) from Croatia

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