Rhodotorula septicemia: case report and minireview

Petrocheilou-Paschou, V.; Prifti, H.; Kostis, Evangelos; Papadimitriou, Constantine S.; Dimopoulos, Meletios Α.; Stamatelopoulos, Stamatios

doi:10.1046/j.1469-0691.2001.00203.x

Cited by 38 publications

(33 citation statements)

References 10 publications

(22 reference statements)

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“…All of the species encompassed by the genus Rhodotorula must be considered to be intrinsically resistant to both the azole and the echinocandin classes of antifungal agents (18,65). Recently, prophylaxis or treatment with fluconazole has been found to be a risk factor for Rhodotorula fungemia, in addition to the presence of a central venous catheter, hyperalimentation, broad-spectrum antibacterials, neutropenia, and surgery (22,35,44,45). Rhodotorula fungemia has been associated with a crude mortality of up to 20% (35) and can cause sepsis syndrome and other life-threatening complications (32).…”

Section: Discussionmentioning

confidence: 99%

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-Year Analysis of Susceptibilities of Noncandidal Yeast Species to Fluconazole and Voriconazole Determined by CLSI Standardized Disk Diffusion Testing

Pfaller

Diekema

Gibbs³

et al. 2009

J Clin Microbiol

212

132

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Fluconazole in vitro susceptibility test results determined by the CLSI M44-A disk diffusion method for 11,240 isolates of noncandidal yeasts were collected from 134 study sites in 40 countries from June 1997 through December 2007. Data were collected for 8,717 yeast isolates tested with voriconazole from 2001 through 2007. A total of 22 different species/organism groups were isolated, of which Cryptococcus neoformans was the most common (31.2% of all isolates). Overall, Cryptococcus (32.9%), Saccharomyces (11.7%), Trichosporon (10.6%), and Rhodotorula (4.1%) were the most commonly identified genera. The overall percentages of isolates in each category (susceptible, susceptible dose dependent, and resistant) were 78.0%, 9.5%, and 12.5% and 92.7%, 2.3%, and 5.0% for fluconazole and voriconazole, respectively. Less than 30% of fluconazoleresistant isolates of Cryptococcus spp., Cryptococcus albidus, Cryptococcus laurentii, Trichosporon beigelii/Trichosporon cutaneum, Rhodotorula spp., Rhodotorula rubra/Rhodotorula mucilaginosa, and Rhodotorula glutinis remained susceptible to voriconazole. Emerging resistance to fluconazole was documented among isolates of C. neoformans from the Asia-Pacific, Africa/Middle East, and Latin American regions but not among isolates from Europe or North America. This survey documents the continuing broad spectrum of activity of voriconazole against opportunistic yeast pathogens but identifies several of the less common species with decreased azole susceptibility. These organisms may pose a future threat to optimal antifungal therapy and emphasize the importance of prompt and accurate species identification.Although the majority of infections caused by yeasts are due to Candida (46,54,55,57), there are other yeast genera that may be considered to be "true pathogens" (i.e., Cryptococcus neoformans) or opportunists (e.g., Saccharomyces, Trichosporon, and Rhodotorula) that have taken advantage of immunocompromising conditions, indwelling devices, and broadspectrum antimicrobial use to colonize and infect at-risk patients (6, 7, 20, 26, 33, 39, 46, 55-57, 61, 62). Life-threatening infections caused by these less common fungi pose difficult management issues (1,7,55,61,62).Our knowledge of the epidemiology and antifungal susceptibilities of both Candida and C. neoformans has been enhanced through national, regional, and global surveillance (4,7,8,10,26,27,40,54,56,57,66); however, the same cannot be said for the other opportunistic yeast pathogens (46,55). Among the few surveillance programs that have monitored infection and resistance associated with noncandidal yeasts (15,21,(56)(57)(58), only the ARTEMIS Global Antifungal Surveillance Program has tracked this disparate group of organisms in a program that is both longitudinal and global in scope (29,51,56).The ARTEMIS program employs standardized Clinical Laboratory Standards Institute (CLSI) methods used for "routine" testing of fluconazole and voriconazole in participating laboratories (disk diffusion), uses electronic data capture and ...

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Section: Discussionmentioning

confidence: 99%

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-Year Analysis of Susceptibilities of Noncandidal Yeast Species to Fluconazole and Voriconazole Determined by CLSI Standardized Disk Diffusion Testing

Pfaller

Diekema

Gibbs³

et al. 2009

J Clin Microbiol

212

132

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“…Immunocompromised patients, particularly those with central venous catheters or other indwelling devices, are at highest risk for infection (10,14,18). While Rhodotorula strains appear to be less virulent than the more common yeast pathogens such as Candida and Cryptococcus neoformans, Rhodotorula infection has been associated with a crude mortality of up to 15% (12) and can cause sepsis syndrome and other life-threatening complications (4, 10, 13).…”

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confidence: 99%

Activities of Available and Investigational Antifungal Agents against Rhodotorula Species

Diekema¹,

Petroelje²,

Messer³

et al. 2005

J Clin Microbiol

106

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Rhodotorula species are emerging pathogens in immunocompromised patients. We report the in vitro activities of eight antifungals against 64 Rhodotorula isolates collected in surveillance programs between 1987 and 2003. Rhodotorula strains are resistant in vitro to fluconazole (MIC at which 50% of the isolates tested are inhibited [MIC 50 ], >128 g/ml) and caspofungin (MIC 50 , >8 g/ml). Amphotericin B (MIC 50, 1 g/ml) and flucytosine (MIC 50 , 0.12 g/ml) are both active in vitro, and the new and investigational triazoles all have some in vitro activity, with ravuconazole being the most active (MIC 50 , 0.25 g/ml).Rhodotorula species, yeasts that belong to the family Cryptococcaceae, have been increasingly recognized as important human pathogens (1, 4, 7, 8, 10-12, 14, 18, 21, 23). Immunocompromised patients, particularly those with central venous catheters or other indwelling devices, are at highest risk for infection (10,14,18). While Rhodotorula strains appear to be less virulent than the more common yeast pathogens such as Candida and Cryptococcus neoformans, Rhodotorula infection has been associated with a crude mortality of up to 15% (12) and can cause sepsis syndrome and other life-threatening complications (4, 10, 13). Rhodotorula bloodstream infections have been successfully managed with line removal alone, antifungal therapy without line removal, and with a combination of these approaches (7, 10). Regarding choice of antifungal therapy, previously reported data have shown amphotericin B and flucytosine (5-FC) to have good in vitro activities and fluconazole and the echinocandins to have poor in vitro activities (2,5,6,20,23). However, most reports describe fewer than 10 organisms, not all utilize standard NCCLS methodology, and only a few report data on the newer extended-spectrum triazoles (2,5,6,23).For these reasons, we decided to examine the in vitro activities of agents against over 60 Rhodotorula isolates we have collected as part of antifungal resistance surveillance surveys since the late 1980s, utilizing standardized NCCLS methods and including new and investigational antifungal agents. To our knowledge, this represents the largest collection of clinical Rhodotorula isolates for which susceptibility test results obtained by standard NCCLS methods have been reported.Sixty-four isolates of Rhodotorula were collected between 1987 and 2003 as part of several antifungal surveillance surveys (19). Sixty (94%) were human clinical isolates, the majority (n ϭ 36 [56%]) from bloodstream (n ϭ 28) or other sterile sites (n ϭ 8). All isolates were stored as suspensions in sterile distilled water at room temperature until used in the study.Prior to testing, each isolate was subcultured at least twice on potato dextrose agar plates (Remel, Lenexa, Kans.) to ensure purity and optimal growth. We confirmed species identification by using the Vitek and API yeast identification systems (bioMerieux, Inc., Hazelwood, Mo.) supplemented by conventional methods as needed (9). Voriconazole (Pfizer), fluconazole (Pfizer...

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“…Recently, infections caused by less common yeast species such as Pichia, Rhodotorula, Trichosporon, and Saccharomyces spp. and other rarely encountered species have been reported (2,16,31,44,49,51). More than 100 yeast species have been identified as human pathogens and have been isolated from virtually all body sites (14).…”

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confidence: 99%

Identification of Medically Important Yeast Species by Sequence Analysis of the Internal Transcribed Spacer Regions

et al. 2006

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Infections caused by yeasts have increased in previous decades due primarily to the increasing population of immunocompromised patients. In addition, infections caused by less common species such as Pichia, Rhodotorula, Trichosporon, and Saccharomyces spp. have been widely reported. This study extensively evaluated the feasibility of sequence analysis of the rRNA gene internal transcribed spacer (ITS) regions for the identification of yeasts of clinical relevance. Both the ITS1 and ITS2 regions of 373 strains (86 species), including 299 reference strains and 74 clinical isolates, were amplified by PCR and sequenced. The sequences were compared to reference data available at the GenBank database by using BLAST (basic local alignment search tool) to determine if species identification was possible by ITS sequencing. Since the GenBank database currently lacks ITS sequence entries for some yeasts, the ITS sequences of type (or reference) strains of 15 species were submitted to GenBank to facilitate identification of these species. Strains producing discrepant identifications between the conventional methods and ITS sequence analysis were further analyzed by sequencing of the D1-D2 domain of the large-subunit rRNA gene for species clarification. The rates of correct identification by ITS1 and ITS2 sequence analysis were 96.8% (361/373) and 99.7% (372/373), respectively. Of the 373 strains tested, only 1 strain (Rhodotorula glutinis BCRC 20576) could not be identified by ITS2 sequence analysis. In conclusion, identification of medically important yeasts by ITS sequencing, especially using the ITS2 region, is reliable and can be used as an accurate alternative to conventional identification methods.

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Rhodotorula septicemia: case report and minireview

Cited by 38 publications

References 10 publications

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-Year Analysis of Susceptibilities of Noncandidal Yeast Species to Fluconazole and Voriconazole Determined by CLSI Standardized Disk Diffusion Testing

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-Year Analysis of Susceptibilities of Noncandidal Yeast Species to Fluconazole and Voriconazole Determined by CLSI Standardized Disk Diffusion Testing

Activities of Available and Investigational Antifungal Agents against Rhodotorula Species

Identification of Medically Important Yeast Species by Sequence Analysis of the Internal Transcribed Spacer Regions

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