Outbreak of <i>Dirkmeia churashimaensis</i> Fungemia in a Neonatal Intensive Care Unit, India

Chowdhary, Anuradha; Kothapalli, Sharada; Singh, Pradeep Kumar; Bhagwani, Dalip Kumar; Kumar, Nitin; Groot, Theun de; Meis, Jacques F.

doi:10.3201/eid2604.190847

Cited by 8 publications

(12 citation statements)

References 14 publications

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“…There is an extensive and expanding list of fungi that have been reported causing healthcare‐associated infections, including Pneumocytis jirovecii , 6 Mucor circinelloides , 7 Saprochaete clavata , 8 Exophiala jeanselmei , 9 Sarocladium kiliense 10 and Exserohilum rostratum 11 . Multi‐drug resistant yeasts including Candida blankii , 12 Dirkmeia churashimaensis 13 and Candida parapsilosis 14 have also caused outbreaks in intensive care units. Moreover, bronchoscope‐related fungal pseudo‐outbreaks have been previously reported mainly due to Fusarium species 15‐17 .…”

Section: Introductionmentioning

confidence: 99%

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

Abdolrasouli

Gibani

Groot

et al. 2020

Mycoses

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Outbreaks of fungal infections due to emerging and rare species are increasingly reported in healthcare settings. We investigated a pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, UK. We aimed to determine route of healthcare‐associated transmission and prevent additional infections. From July 2018 through February 2019, we detected a pseudo‐outbreak of R. similis isolated from bronchoalveolar lavage (BAL) fluid samples collected from nine patients who had undergone bronchoscopy in a multispecialty teaching hospital, during a period of 8 months. Isolates were identified by MALDI‐TOF mass spectrometry. Antifungal susceptibility testing was performed by EUCAST broth microdilution. To determine genetic relatedness among R. similis isolates, we undertook amplified fragment length polymorphism analysis. To determine the potential source of contamination, an epidemiological investigation was carried out. We reviewed patient records retrospectively and audited steps taken during bronchoscopy as well as the subsequent cleaning and decontamination procedures. Fungal cultures were performed on samples collected from bronchoscopes and automated endoscope washer‐disinfector systems. No patient was found to have an infection due to R. similis either before or after bronchoscopy. One bronchoscope was identified to be used among all affected patients with positive fungal cultures. Physical damage was found in the index bronchoscope; however, no fungus was recovered after sampling of the affected scope or the rinse water of automated endoscope washer‐disinfectors. Use of the scope was halted, and, during the following 12‐month period, Rhinocladiella species were not isolated from any BAL specimen. All pseudo‐outbreak isolates were identified as R. similis with high genetic relatedness (>90% similarity) on ALFP analysis. The study emphasises the emergence of a rare and uncommon black yeast R. similis, with reduced susceptibility to echinocandins, in a bronchoscope‐related pseudo‐outbreak with a potential water‐related reservoir. Our findings highlight the importance of prolonged fungal culture and species‐level identification of melanised yeasts isolated from bronchoscopy samples. Possibility of healthcare‐associated transmission should be considered when R. similis is involved in clinical microbiology samples.

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Section: Introductionmentioning

confidence: 99%

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

Abdolrasouli

Gibani

Groot

et al. 2020

Mycoses

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“…The therapy of three patients failed with fluconazole (2 cases) or caspofungin (1 case) until changing to the efficient medicines itraconazole, amphotericin B, or voriconazole ( Lin et al., 2008 ) ( Siddiqui et al., 2014 ) ( Liu et al., 2019 ). Furthermore, Chowdhary reported an outbreak of 12 case infections due to D. churashimanesis in a neonatal intensive care unit in Delhi India; all patients were treated with fluconazole at a loading dose of 12 mg/kg bodyweight and then 6 mg/kg for 10–14 days; 5 patients died, a case-fatality rate of 42% ( Chowdhary et al., 2020 ). In 2015, Orecchini et al.…”

Section: Resultsmentioning

confidence: 99%

“…In 2015, by multiloci phylogeny analysis, Wang et al proposed this fungus to be a new genus Dirkmeia gen. nov which only having this species up to now (Wang et al, 2015). In 2020, Anuradha et al reported 12 cases due to an outbreak of D. churashimaensis fungemia in a Neonatal Intensive Care Unit, India, which revealed its pathogenicity in immune suppressed population (Chowdhary et al, 2020). Here, we describe a case of rare subcutaneous infection caused by D. churashimaensis.…”

Section: Introductionmentioning

confidence: 82%

“…However, our strains presented as cream-colored yeast colony without blackish to brownish powdery spores whose synthesis perhaps was blocked by unappropriated environment in skin tissue. Chowdhary et al reported an outbreak of 12 cases due to this fungus in NICU, in India last year (Chowdhary et al, 2020). All the patients were preterm neonates with other risk factors, including central venous catheter, persistent hypoglycemia, severe asphyxia, sepsis, and mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…In 2020, Anuradha et al. reported 12 cases due to an outbreak of D. churashimaensis fungemia in a Neonatal Intensive Care Unit, India, which revealed its pathogenicity in immune suppressed population ( Chowdhary et al., 2020 ). Here, we describe a case of rare subcutaneous infection caused by D. churashimaensis .…”

Section: Introductionmentioning

confidence: 99%

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First Case of Subcutaneous Mycoses Caused by Dirkmeia churashimaensis and a Literature Review of Human Ustilaginales Infections

Hu¹,

Wang²,

Wang³

et al. 2021

Front. Cell. Infect. Microbiol.

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ObjectiveDirkmeia churashimaensis, belonging to Ustilaginales fungi, has never been reported as clinical pathogenic until very recently. In this study, we report an unusual subcutaneous infection with Dirkmeia churashimaensis and reviewed all human Ustilaginales infections. The aim is to better understand their epidemiology, infection type, risk factors, and the sensitivity to antifungal agents.MethodsAn 80-year-old female farmer developed extensive plaques and nodules on her left arm within 2 years. Pathological and microbiological examinations identified a new pathological agent, Dirkmeia churashimaensis, as the cause of this infection. The patient was successfully cured by oral itraconazole. We reviewed a total of 31 cases of Ustilaginales cases, among of which only three were skin infections.ResultsLocal barrier damage (i.e., surgery, trauma, and basic dermatosis) and systemic immunodeficiency (i.e., preterm and low birthweight, Crohn’s disease, malignant cancer, and chemotherapy) are risk factors for Ustilaginales infection. The D1/D2 and ITS regions are the frequently used loci for identifying the pathogens together with phenotype. Most patients could survive due to antifungal treatment, whereas seven patients died. Amphotericin B, posaconazole, itraconazole, and voriconazole showed good activity against these reported strains, whereas fluconazole, 5-flucytosine, and echinocandins usually showed low susceptibility. Itraconazole had good efficiency for subcutaneous infections.ConclusionsThe present case study and literature review reveal that Ustilaginales can be opportunistic pathogenic normally in immunocompromised and barrier damage people. A proper identification of fungi can be crucial for clinical treatment, and more data of antifungal are needed for choice of medication against this kind of infections.

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Fungal Nomenclature: Managing Change is the Name of the Game

Kidd

Abdolrasouli

Hagen

2023

Open Forum Infectious Diseases

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Fungal species have undergone and continue to undergo significant nomenclatural change, primarily due to the abandonment of dual species nomenclature in 2013 and the widespread application of molecular technologies in taxonomy allowing correction of past classification errors. These have effected numerous name changes concerning medically important species, but by far the group causing most concern are the Candida yeasts. Among common species, Candida krusei, Candida glabrata, Candida guilliermondii, Candida lusitaniae, and Candida rugosa have been changed to Pichia kudriavzevii, Nakaseomyces glabrata, Meyerozyma guilliermondii, Clavispora lusitaniae, and Diutina rugosa, respectively. There are currently no guidelines for microbiology laboratories on implementing changes, and there is ongoing concern that clinicians will dismiss or misinterpret laboratory reports using unfamiliar species names. Here, we have outlined the rationale for name changes across the major groups of clinically important fungi and have provided practical recommendations for managing change.

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Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India

Cited by 8 publications

References 14 publications

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

First Case of Subcutaneous Mycoses Caused by Dirkmeia churashimaensis and a Literature Review of Human Ustilaginales Infections

Fungal Nomenclature: Managing Change is the Name of the Game

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