Case Report

Rhodotorula mucilaginosa Catheter-related Fungemia in a Patient with Sickle Cell Disease: Case Presentation and Literature Review

Authors: Dionissios Neofytos, MD, David Horn, MD, FACP, Joseph A. De Simone Jr, MD

Abstract

Rhodotorula mucilaginosa (formerly Rhodotorula rubra) is a ubiquitous, environmental, urease-positive yeast that does not ferment sugars and can assimilate various carbohydrates. Characterized by the salmon-pink to coral-red color of its colonies,Rhodotorula mucilaginosa can disseminate and cause significant disease. We present a case of sustained Rhodotorula mucilaginosa catheter-related fungemia in a patient with sickle cell anemia who refused removal of the implanted port. The patient remained clinically stable, with blood cultures persistently growing Rhodotorula mucilaginosa, despite appropriate antifungal therapy. An extensive literature review revealed a wide range of clinical manifestations in immunocompromised patients. Susceptibility patterns to different antifungal agents and therapeutic considerations are thoroughly discussed. Rhodotorula mucilaginosacan be a significant, recalcitrant pathogen in immunocompromised patients and prompt treatment should be instituted.


Key Points


Rhodotorula mucilaginosa can be a significant, recalcitrant pathogen in immunocompromised patients.


* Susceptibilities to different antifungal agents should be obtained and administration of antifungal therapy combined with catheter removal is the recommended approach in patients who present with R mucilaginosa catheter-related fungemia.

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References

1. Larone DH. Medically Important Fungi: A Guide to Identification. Fourth ed. Vol 1. Washington, DC, American Society of Microbiology Press, 2002.
 
2. Anaissie EJ, McGinnis MR, Pfaller MA. Clinical Mycology. First ed. Vol 1. Philadelphia, Churchill Livingstone, The Curtis Center, 2003.
 
3. Samonis G, Anatoliotaki M, Apostolakou H, et al. Transient fungemia due to Rhodotorula rubra in a cancer patient: case report and review of the literature. Infection 2001;29:173–176.
 
4. Chung JW, Kim BN, Kim YS. Central venous catheter-related Rhodotorula rubra fungemia. J Infect Chemother 2002;8:109–110.
 
5. Kiehn TE, Gorey E, Brown AE, et al. Sepsis due to Rhodotorula related to use of indwelling central venous catheters. Clin Infect Dis 1992;14:841–846.
 
6. Lo Re V, Fishman NO, Nachamkin I. Recurrent catheter-related Rhodotorula rubra infection. Clin Microbiol Infect 2003;9:897–900.
 
7. Lifshitz T, Levy J. Rhodotorula rubra keratitis and melting after repeated penetrating keratoplasty. Eur J Ophthalmol 2005;15:135–137.
 
8. Eisenberg ES, Alpert BE, Weiss RA, et al. Rhodotorula rubra peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. Am J Med 1983;75:349–352.
 
9. Gyaurgieva OH, Bogomolova TS, Gorshkova GI. Meningitis caused by Rhodotorula rubra in an HIV-infected patient. J Med Vet Mycol 1996;34:357–359.
 
10. Goldani LZ, Craven DE, Sugar AM. Central venous catheter infection with Rhodotorula minuta in a patient with AIDS taking suppressive doses of fluconazole. J Med Vet Mycol 1995;33:267–270.
 
11. Diekema DJ, Petroelje B, Messer SA, et al. Activities of available and investigational antifungal agents against Rhodotorula species. J Clin Microbiol 2005;43:476–478.
 
12. Naveh Y, Friedman A, Merzbach D, et al. Endocarditis caused by Rhodotorula successfully treated with 5-fluorocytosine. Br Heart J 1975;37:101–104.
 
13. Louria DB, Greenberg SM, Molander DW. Fungemia caused by certain nonpathogenic strains of the family Cryptococcaceae: report of two cases due to Rhodotorula and Torulopsis glabrata. N Engl J Med1960;263:1281–1284.
 
14. Maeder M, Vogt PR, Schaer G, et al. Aortic homograft endocarditis caused by Rhodotorula mucilaginosa. Infection 2003;31:181–183.
 
15. Pore RS, Chen J. Meningitis caused by Rhodotorula. Sabouraudia 1976;14:331–335.
 
16. Donald FE, Sharp JF, Firth JL, et al. Rhodotorula rubra ventriculitis. J Infect 1988;16:187–191.
 
17. Gregory JK, Haller JA. Chronic postoperative Rhodotorula endophthalmitis. Arch Ophthalmol1992;110:1686–1687.
 
18. Hagan ME, Klotz SA, Bartholomew W, et al. A pseudoepidemic of Rhodotorula rubra: a marker for microbial contamination of the bronchoscope. Infect Control Hosp Epidemiol 1995;16:727–728.
 
19. Leeber DA, Scher I. Rhodotorula fungemia presenting as ‘endotoxic’ shock. Arch Intern Med1969;123:78–81.
 
20. Pien FD, Thompson RL, Deye D, et al. Rhodotorula septicemia: two cases and a review of the literature. Mayo Clin Proc 1980;55:258–260.
 
21. Braun DK, Kauffman CA. Rhodotorula fungaemia: a life-threatening complication of indwelling central venous catheters. Mycoses 1992;35:305–308.
 
22. Gomez-Lopez A, Mellado E, Rodriguez-Tudela JL, et al. Susceptibility profile of 29 clinical isolates of Rhodotorula spp. and literature review. J Antimicrob Chemother 2005;55:312–316.
 
23. Rusthoven JJ, Feld R, Tuffnell PG. Systemic infection by Rhodotorula spp in the immunocompromised host. J Infect 1984;8:241–246.