Peritonitis Due to
            <i>Blastobotrys proliferans</i>
            in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

Quirin, N.; Desnos‐Ollivier, Marie; Cantin, Jean-François; Valéry, Jean-Claude; Doussy, Y.; Goursaud, R; Dromer, Françoise; Tivollier, Jean-Michel

doi:10.1128/jcm.00967-07

Cited by 9 publications

(14 citation statements)

References 31 publications

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“…Although the patient was also treated with fluconazole, the isolate showed a high (64 g/ml) fluconazole MIC. Previously, Quirin et al reported that B. proliferans isolated from a case of peritonitis showed decreased susceptibility to all antifungals tested, except amphotericin B (11). Similarly to our experience, the removal of the Tenckhoff catheter and administration of oral fluconazole resulted in a successful outcome in the case reported by Quirin et al (11).…”

supporting

confidence: 83%

“…Previously, Quirin et al reported that B. proliferans isolated from a case of peritonitis showed decreased susceptibility to all antifungals tested, except amphotericin B (11). Similarly to our experience, the removal of the Tenckhoff catheter and administration of oral fluconazole resulted in a successful outcome in the case reported by Quirin et al (11). Notably, B. rhaffinosifermentans also had reduced susceptibility to fluconazole in a recently reported case (12).…”

supporting

confidence: 83%

“…Fungal infections due to species of Blastobotrys are extremely rare, and a solitary case of peritonitis due to B. proliferans in a patient undergoing continuous ambulatory peritoneal dialysis is on record (11). Recently, the role of B. rhaffinosifermentans causing a significant airway inflammation in a cystic fibrosis patient before lung transplant and pleural space infection post-lung transplant was highlighted (12).…”

mentioning

confidence: 99%

“…Of the 21 species of Blastobotrys previously described in a taxonomic study of yeasts (13), 12 were reported to grow at 37°C, and these three species, namely, B. proliferans, B. chiropterorum, and B. rhaffinosifermentans, have been isolated from humans (11)(12)(13)16). Notably, a report in the latest edition of a monograph describing yeasts (13) asserting that growth of the B. serpentis type strain (CBS 10541) is negative at 37°C is erroneous, as it, along with the two clinical strains (VPCI 568/P/13 and VPCI 569/P/13), showed luxuriant growth at 37°C in the present study.…”

mentioning

confidence: 99%

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Invasive Mycosis Due to Species of Blastobotrys in Immunocompromised Patients with Reduced Susceptibility to Antifungals

et al. 2014

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gCases of invasive mycosis due to Blastobotrys serpentis and B. proliferans identified by sequencing in a preterm patient and a rhabdomyosarcoma patient, respectively, are reported. Both species revealed elevated fluconazole and echinocandin MICs by the CLSI broth microdilution method. Additionally, B. serpentis exhibited high amphotericin B MICs, thus posing serious therapeutic challenges. CASE REPORTSC ase 1. A 29-week gestation preterm male infant at birth was admitted on 24 April 2013 because of respiratory distress. The infant was born by normal vaginal delivery to a 24-year-old primigravida mother. On admission at day 1, the child was not active and had tachypnoea with a respiratory rate of 68/min and his chest X-ray showed mild haziness. Examination of the cardiovascular system revealed no abnormal heart sounds and equal bilateral peripheral pulses. The abdomen was soft, with no organomegaly noted. On day 5, a loud murmur was detected and an echocardiography revealed a large patent ductus arteriosus of 2.2 mm in size which was surgically closed. His total leukocyte count was elevated (24,000 cells/l), and his C-reactive protein level was 0.1 mg/liter. Two days later, the infant developed abdominal distension and the X-ray revealed a pneumoperitoneum. This was managed with a peritoneal drainage followed by laparotomy. During surgery, a gangrenous gastric fundus with a sloughed greater curvature, leading to an approximately 40% to 45% loss of stomach volume, was seen. The necrotic tissues were removed; gastric anastomosis was done with placement of a gastrojejunal feeding tube via gastrotomy. The child underwent operation twice again, on days 14 and 29 of admission, because of anastomotic leakage and perforation due to a gangrenous bowel. Histopathological examination of tissue biopsy specimens of the distal ileum, terminal ileum, and stoma showed active inflammatory changes, but no granuloma and ganglion cells were present, ruling out Hirschsprung disease. The child was empirically treated with ampicillin and gentamicin starting from day 1 of admission along with prophylactic fluconazole (3 mg/kg of body weight twice weekly) due to a high risk for invasive candidiasis. Further during the course of treatment, meropenem therapy was included on day 3, cefoperazone-sulbactam therapy a week later, and ofloxacin therapy on day 17. The clinical course and the therapy instituted are depicted in Fig. 1. Cultures of the discharge from the laprotomy incision site on day 15 of admission grew yeasts identified as Stephanoascus ciferrii (identification, 86%) by the use of a Vitek2 yeast ID system (bioMérieux, Marcy l'Etoile, France) which exhibited a high fluconazole MIC (Ͼ64 g/ml) by AST-YS06 (bioMérieux). Blood cultures in Bactec Peds Plus/F vials taken on days 16, 18, 21, 23, and 26 of admission grew fluconazole-resistant S. ciferrii after 2 to 3 days of incubation at 37°C. The endotracheal aspirate collected on day 23 also grew S. ciferrii. The patient had already received fluconazole (6 mg/kg) for 17 days; the trea...

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supporting

confidence: 83%

supporting

confidence: 83%

mentioning

confidence: 99%

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confidence: 99%

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Invasive Mycosis Due to Species of Blastobotrys in Immunocompromised Patients with Reduced Susceptibility to Antifungals

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“…It has previously been characterized as an anamorphic, nonpathogenic, halotolerant, and dimorphic yeast isolated from environmental sources such as soil, maize silage, and wood hydrolysates and has been studied to determine its usefulness in biotechnological applications (reviewed in reference 43). As mentioned above, it is not thought to be a pathogen, though recently a case of Blastobotrys proliferans was reported as the causative agent of peritonitis in a human (35). However, currently the clinical significance of these isolates is not known, but the ability to identify them may allow for future understanding of their relevance to veterinary medicine.…”

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confidence: 99%

Molecular Identification of Veterinary Yeast Isolates by Use of Sequence-Based Analysis of the D1/D2 Region of the Large Ribosomal Subunit

et al. 2010

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Conventional methods of yeast identification are often time-consuming and difficult; however, recent studies of sequence-based identification methods have shown promise. Additionally, little is known about the diversity of yeasts identified from various animal species in veterinary diagnostic laboratories. Therefore, in this study, we examined three methods of identification by using 109 yeast samples isolated during a 1-year period from veterinary clinical samples. Comparison of the three methods-traditional substrate assimilation, fatty acid profile analysis, and sequence-based analysis of the region spanning the D1 and D2 regions (D1/D2) of the large ribosomal subunit-showed that sequence analysis provided the highest percent identification among the three. Sequence analysis identified 87% of isolates to the species level, whereas substrate assimilation and fatty acid profile analysis identified only 54% and 47%, respectively. Less-stringent criteria for identification increased the percentage of isolates identified to 98% for sequence analysis, 62% for substrate assimilation, and 55% for fatty acid profile analysis. We also found that sequence analysis of the internal transcribed spacer 2 (ITS2) region provided further identification for 36% of yeast not identified to the species level by D1/D2 sequence analysis. Additionally, we identified a large variety of yeast from animal sources, with at least 30 different species among the isolates tested, and with the majority not belonging to the common Candida spp., such as C. albicans, C. glabrata, C. tropicalis, and the C. parapsilosis group. Thus, we determined that sequence analysis of the D1/D2 region was the best method for identification of the variety of yeasts found in a veterinary population.In both veterinary and human diagnostic laboratories, correct identification of yeasts is important for the care of patients. Traditionally, yeast identification has been performed using biochemical analysis, substrate assimilation methods, morphological examination, or various combinations of the three. To increase the ease of identification, commercial tests that use these methods have been created, but despite the convenience provided by these methods, identification of yeasts by these conventional applications can still be timeconsuming and difficult. In addition, considerable variability in the efficacy of these methods has been reported for identification of clinically important yeast (11; also reviewed in references 12, 32, 36, and 42), attributed primarily to the limitations of the databases used for the comparison of clinical isolates, as well as the subjectivity involved in the interpretation of results. Recent studies have also examined the effectiveness of various molecular identification methods for yeasts by the use of rRNA genes, with the internal transcribed spacer 1 (ITS1) and ITS2 regions and the region spanning the D1 and D2 regions (D1/ D2) shown to be the most useful for species-level identification of yeasts, as a result of the variability within...

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Emerging Systemic Yeast Pathogens

Mathews

Ashbee

2009

Pathogenic Yeasts

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Peritonitis Due to Blastobotrys proliferans in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

Abstract: Blastobotrys proliferans is an ascomycetous yeast never previously reported as a human pathogen. Here we report a case of peritonitis due to Blastobotrys proliferans in a 46-year-old man undergoing peritoneal dialysis.

Cited by 9 publications

References 31 publications

Invasive Mycosis Due to Species of Blastobotrys in Immunocompromised Patients with Reduced Susceptibility to Antifungals

Invasive Mycosis Due to Species of Blastobotrys in Immunocompromised Patients with Reduced Susceptibility to Antifungals

Molecular Identification of Veterinary Yeast Isolates by Use of Sequence-Based Analysis of the D1/D2 Region of the Large Ribosomal Subunit

Emerging Systemic Yeast Pathogens

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