Sepsis Due to Rhodotorula Related to Use of Indwelling Central Venous Catheters

Kiehn, Timothy E.; Gorey, Eileen; Brown, Arthur E.; Edwards, F F; Armstrong, Donald

doi:10.1093/clinids/14.4.841

Cited by 98 publications

(99 citation statements)

References 7 publications

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“…1 In rare instances, Rhodotorula species have been reported to cause septicemia, 2 meningitis, 3 systemic infection, 4 and sepsis related to complications from indwelling central venous catheters. 5 Rhodotorula species have a rapid growth rate on culture and mature in four days. The colony is usually pink to coral, but can also be orange-red to yellow.…”

Section: Discussionmentioning

confidence: 99%

“…The case was successfully treated with miconazole and 5-flucytosine. 7 In 1992, Kiehn et al 5 reported 23 patients who had catheter-related Rhodotorula sepsis within five years at Sloan Kettering Cancer Center (New York). All 23 patients had indwelling central venous catheters that had been in place from one to 22 months (average 9.3 months).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rhodotorula Rubra Fungemia in an Immunocompromised Patient

Eltahawy

Khalaf

1999

Ann Saudi Med

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“…In addition to C. albicans, Rhodotorula sp. has been implicated as the etiologic agent of central venous catheter infection and fungemia [5][6][7][8][9] . In recent years, there has been an increasing search for new antifungal compounds due to the lack of efficacy, side effects and or resistance associated with some of the existing drugs [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

“…to antifungal and antiseptic agents [25,26] . This study was aimed to confirm the usage of Algeria honey as antifungal and antiseptic agents and evaluate this inhibitory action at different honey concentration against C. albicans and Rhodototorula sp.…”

Section: Introductionmentioning

confidence: 99%

Antifungal activity of four honeys of different types from Algeria against pathogenic yeast: Candida albicans and Rhodotorula sp.

Mustafa¹,

Djebli

Saad³

et al. 2012

Asian Pacific Journal of Tropical Biomedicine

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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). 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).…”

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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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Sepsis Due to Rhodotorula Related to Use of Indwelling Central Venous Catheters

Cited by 98 publications

References 7 publications

Rhodotorula Rubra Fungemia in an Immunocompromised Patient

Rhodotorula Rubra Fungemia in an Immunocompromised Patient

Antifungal activity of four honeys of different types from Algeria against pathogenic yeast: Candida albicans and Rhodotorula sp.

Activities of Available and Investigational Antifungal Agents against Rhodotorula Species

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