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Rhodotorula dairenensis fungemia in a patient with cancerFungemia por Rhodotorula dairenensis en un paciente con cáncer

https://doi.org/10.1016/j.riam.2020.03.006Get rights and content

Abstract

Background

Rhodotorula species were traditionally considered non-virulent environmental microorganisms, but are nowadays considered important human pathogens, especially in immunocompromised individuals.

Case report

We present the case of a 73 year-old man with diarrhea, anorexia and fever. In the blood analyses, both aerobic blood culture bottles yielded the growth of Rhodotorula dairenensis. The MALDI-TOF MS score was inadequate to provide an identification, which was achieved by means of molecular techniques. Treatment with an echinocandin was started, but the patient died.

Conclusions

Basidiomycetous yeast genera such as Rhodotorula can cause invasive and severe infections, e.g., fungemia, especially in patients with central venous catheter or another indwelling device.

Resumen

Antecedentes

Las especies de Rhodotorula han sido tradicionalmente consideradas huéspedes ambientales no virulentos, pero hoy día han demostrado ser importantes patógenos humanos, sobre todo en individuos inmunocomprometidos.

Caso clínico

Se presenta el caso clínico de un varón de 73 años con diarrea, anorexia y fiebre. En los frascos de hemocultivos aerobios creció Rhodotorula dairenensis. El sistema MALDI-TOF MS no proporcionó un buen score, por lo que la identificación se realizó finalmente mediante técnicas moleculares. Se instauró tratamiento con una equinocandina, pero finalmente el paciente falleció.

Conclusiones

Las levaduras de géneros pertenecientes a los basidiomicetos, como Rhodotorula, pueden producir infecciones invasivas y graves como fungemia, especialmente en pacientes con catéteres venosos centrales u otros dispositivos invasivos.

Section snippets

Case report

A 73 year-old man came to our Emergency Department on February 27th 2019 due to diarrhea, anorexia, and fever. He was under treatment with corticosteroids and chemotherapy (CPT-11 and cetuximab) for a colon adenocarcinoma. Blood analysis showed anemia, leukopenia, neutropenia, and high concentration (85.6 mg/l) of C-reactive protein (CRP), hemoglobin of 10.7 mg/dl, and white blood cell count of 2000/mm3 (480 neutrophils/mm3). He was admitted to the Department of Oncology, where an empirical

Discussion

Rhodotorula species are common airborne microorganisms considered saprophytes or contaminants.7 Over the past few years, some Rhodotorula species have emerged as opportunistic pathogens, particularly R. mucilaginosa.7 R. dairenensis was first described by Gadanho and Sampaio in 2002 as a new species5 but has not been found in human infections to date. To our best knowledge, this is the first report of a fungemia caused by this yeast.

Immunocompromised individuals are at high risk of infection

Funding

None.

Conflict of interest

Authors declare no conflict of interest.

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