New Spectrum of Fungal Infections in Patients with Cancer

Anaissie, Elias; Bodey, Gerald P.; Kantarjian, Hagop; Ro, Jae Y.; Vartivarian, Shahe; Hopfer, Roy L.; Hoy, Jennifer; Rolston, Kenneth V. I.

doi:10.1093/clinids/11.3.369

Cited by 246 publications

(122 citation statements)

References 42 publications

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“…Other fungal variety of species were accounted for the isolates, but of no signific-ant numbers, reports by others have isolated many fungal pathogens other than Candida spp. we obtained in our results (Anaissie et al, 1989).…”

Section: Saccaharomy-cessupporting

confidence: 60%

Fungal Diversity in Gut Microbiota in Patients with Cancer

Khidir

Hamad²,

Ahmad³

2017

ZJPAS

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Section: Saccaharomy-cessupporting

confidence: 60%

Fungal Diversity in Gut Microbiota in Patients with Cancer

Khidir

Hamad²,

Ahmad³

2017

ZJPAS

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“…They all survived the fungemic episode and experienced no recurrence of the infection after treatment with antifungal therapy and by either removal or non-removal of the catheters, or by catheter removal without antifungal therapy. Infections with unusual fungal pathogens including Rhodotorula rubra have been reported by Anaissie et al 8 They studied 44 cancer patients who had serious infections with these fungal pathogens. Twenty-four patients had disseminated infection, 12 had involvement of a single organ, and eight had only fungemia.…”

Section: Discussionmentioning

confidence: 99%

Rhodotorula Rubra Fungemia in an Immunocompromised Patient

Eltahawy

Khalaf

1999

Ann Saudi Med

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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.

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“…Immune deficiencies resulting from AIDS, aggressive cancer treatment, the growing use of organ transplants, and other nosocomial situations have greatly increased the incidence of serious fungal infections (2,3,4,6) and have created a critical need for new, safe fungicidal agents that can be used to treat disseminated infections. Systemic mycoses are not easily diagnosed, and the patient usually has been infected for quite some time before symptoms appear.…”

mentioning

confidence: 99%

Efficacy of FK463, a New Lipopeptide Antifungal Agent, in Mouse Models of Disseminated Candidiasis and Aspergillosis

Ikeda¹,

Wakai²,

Matsumoto³

et al. 2000

Antimicrob Agents Chemother

140

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The efficacy of intravenous injection of FK463, a novel water-soluble lipopeptide, was evaluated in mouse models of disseminated candidiasis and aspergillosis and was compared with those of fluconazole (FLCZ) and amphotericin B (AMPH-B). In the candidiasis model, FK463 significantly prolonged the survival of intravenously infected mice at doses of 0.125 mg/kg of body weight or higher. In disseminated candidiasis caused by Candida species, including FLCZ-resistant Candida albicans, FK463 exhibited an efficacy 1.4 to 18 times inferior to that of AMPH-B, with 50% effective doses (ED 50 s) ranging from 0.21 to 1.00 mg/kg and 0.06 to 0.26 mg/kg, respectively, and was much more active than FLCZ. The protective effect of FK463 was not obviously influenced by the fungal inoculum size, the starting time of the treatment, or the immunosuppressed status of the host. The reduction in efficacy was less than that observed with FLCZ or AMPH-B. The efficacy of FK463 was also evaluated in the disseminated candidiasis target organ assay and was compared with those of FLCZ and AMPH-B. Efficacies were evaluated on the basis of a comparison between the mean log 10 CFU in kidneys in the groups treated with antifungal agents and that in control group. A single dose of FK463 at 0.5 mg/kg or higher significantly reduced the viable counts in kidneys compared with the numbers of yeast cells before treatment, and its efficacy was comparable to that of AMPH-B, while FLCZ at 4 mg/kg showed only a suppressive effect on the growth of C. albicans in the kidneys. In the disseminated aspergillosis model, FK463 given at doses of 0.5 mg/kg or higher significantly prolonged the survival of mice infected intravenously with Aspergillus fumigatus conidia. The efficacy of FK463 was about 2 times inferior to that of AMPH-B, with ED 50 s ranging from 0.25 to 0.50 mg/kg and 0.11 to 0.29 mg/kg, respectively. These results indicate that FK463 may be a potent parenterally administered therapeutic agent for disseminated candidiasis and aspergillosis.People who have impaired immune systems are susceptible to fungal infections which can be life-threatening. Immune deficiencies resulting from AIDS, aggressive cancer treatment, the growing use of organ transplants, and other nosocomial situations have greatly increased the incidence of serious fungal infections (2,3,4,6) and have created a critical need for new, safe fungicidal agents that can be used to treat disseminated infections. Systemic mycoses are not easily diagnosed, and the patient usually has been infected for quite some time before symptoms appear. Thus, empiric therapy needs to begin immediately, but currently available treatments have problems with toxicity or resistance. Amphotericin B (AMPH-B) is the first-line therapy for systemic infections because of its broadspectrum and fungicidal activity. However, significant side effects limit its clinical utility to controlled intravenous administration (16). Lipid AMPH-B formulations have recently attracted much attention due to significantly lower toxic...

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New Spectrum of Fungal Infections in Patients with Cancer

Cited by 246 publications

References 42 publications

Fungal Diversity in Gut Microbiota in Patients with Cancer

Fungal Diversity in Gut Microbiota in Patients with Cancer

Rhodotorula Rubra Fungemia in an Immunocompromised Patient

Efficacy of FK463, a New Lipopeptide Antifungal Agent, in Mouse Models of Disseminated Candidiasis and Aspergillosis

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