Cryptococcus laurentii Fungemia

In the last few years there has been an increasing incidence of infection due to non-neoformans Cryptococcus spp. especially in immunocompromised host. Cryptococcus laurentii is a non-neoformans Cryptococcus which has rarely been known to cause bacteremia and pulmonary infection in humans. Here we report a case of fungemia due to Cryptococcus laurentii.     

早产儿真菌血症42例临床分析

目的:探讨早产儿真菌感染的临床特征,提高早期识别与诊治。方法:对42例真菌血症早产儿的母孕史、出生史、临床表现特征、实验室检查和治疗转归等资料进行回顾性分析。结果:42例早产儿中,胎龄≤34周38例,出生体质量≤1 500 g 25例。临床表现主要为频繁呼吸暂停16例,肤色发灰11例,喂养不耐受8例及不明原因的病情迅速恶化13例。发病因素为发病前使用抗生素>10 d 32例,静脉营养35例,应用外周中心静脉导管18例。实验室指标异常主要表现为血小板减少45.2%,C反应蛋白升高38.1%。结论:早产儿胎龄小、体质量低、使用抗生素、静脉营养及中心静脉导管均是早产儿真菌血症高危因素,且临床表现不典型,需要早期高度重视和及时诊治。     

Asymptomatic Fungemia Due to Rhodotorula spp. Caused by a Subcutaneously Implanted Central Venous Port Catheter

A 66-year-old man was admitted to our hospital for gastrointestinal perforation. He had a history of surgery and chemotherapy for colorectal cancer and had a subcutaneously implanted central venous port catheter. After surgery for gastrointestinal tract perforation, he developed an intra-abdominal abscess, which was treated with broad-spectrum antimicrobial agents and improved. Following this improvement, Rhodotorula spp. was detected in a blood culture and at the catheter tip. He was asymptomatic despite having fungemia. His condition improved after the removal of the catheter and the administration of antifungal drugs. Fungemia due to Rhodotorula spp. is rare, and asymptomatic fungemia is even rarer.     

早产儿真菌血症临床特点

目的了解早产儿真菌血症患儿临床特点。方法回顾性分析2011年1月—2015年12月某儿童医院重症监护病房早产儿真菌血症的临床特点,比较早产儿的一般情况、实验室相关指标及药敏结果。结果 2011年1月—2015年12月该院收治确诊的真菌血症早产儿42例,其中白假丝酵母菌22例(占52.38%),近平滑假丝酵母菌13例(占30.95%),克柔假丝酵母菌3例,其他4例。按感染的主要病原菌进行分组,分为近平滑假丝酵母菌组和白假丝酵母菌组。白假丝酵母菌组母亲泌尿生殖系感染率、真菌性脑膜炎的发生率均为27.27%,高于近平滑假丝酵母菌组(分别为7.69%、0.00%),白假丝酵母菌组经外周静脉置入中心静脉导管(PICC)置管率低于近平滑假丝酵母菌组(22.73%vs 69.23%),近平滑假丝酵母菌组血小板计数低于白假丝酵母菌组,差异均有统计学意义(均P0.05)。结论早产儿真菌血症感染病原菌以近平滑假丝酵母菌和白假丝酵母菌为主,母亲孕期生殖系感染易导致白假丝酵母菌血症的发生,白假丝酵母菌血症早产儿更易患真菌性脑膜炎;PICC置管更易导致近平滑假丝酵母菌血症的发生,血小板的下降更明显。     

Rhodotorula minuta fungemia in a ewe lamb

An 8‐month‐old crossbred ewe, normal upon physical examination, was humanely euthanized for tissue collection. After approximately 3 weeks in tissue culture, fungi began budding out of cells obtained from the choroid plexus. After an additional 3 weeks, budding was observed in kidney cell cultures and eventually in monocyte cultures as well. Serum from the lamb was submitted to the Veterinary Diagnostic Laboratory at Colorado State University for fungal diagnosis and was found negative for Aspergillus, Blastomyces, Coccidioidomycosis and Histoplasmosis. DNA was isolated from fungi collected from tissue culture supernatants and used in a set of pan‐fungal PCR assays with DNA from Candida acting as a positive control. PCR products were sequenced and BLAST analysis performed. The unknown fungal sequence aligned with 100% identity to Rhodotorula minuta an emerging opportunistic pathogen. Samples were submitted to The Fungal Testing Laboratory at The University of Texas Health Science Center at San Antonio for additional validation. We believe this to be the first report of Rhodotorula fungemia in a sheep in the United States.     

Successful treatment of Trichosporon fungemia in a patient with refractory acute myeloid leukemia using voriconazole combined with liposomal amphotericin B

Trichosporon fungemia is a rare and fatal fungal infection that occurs in patients with prolonged neutropenia associated with hematologic malignancies. A 21-year-old male developed Trichosporon fungemia during remission induction therapy for acute myeloid leukemia (AML). Although two courses of induction therapy failed to induce a remission of AML, combination therapy with voriconazole and liposomal amphotericin B (L-AmB) followed by monocyte colony-stimulating factor ameliorated the Trichosporon fungemia and enabled the patient to receive reduced-intensity bone marrow transplantation (BMT) from his human leukocyte antigen-A one-locus mismatched mother. The patient achieved a durable remission after BMT without exacerbation of Trichosporon fungemia. The combination therapy with voriconazole and L-AmB may therefore be useful in controlling Trichosporon fungemia associated with prolonged neutropenia after remission induction therapy for AML.     

Invasive Saccharomyces cerevisiae in a liver transplant patient: case report and review of infection in transplant recipients

Saccharomyces cerevisiae, an ascosporogenous yeast commonly used in the production of food, is an emerging infection in immunocompromised patients. We report the case of a 60‐year‐old man whose orthotopic liver transplant was complicated by S. cerevisiae fungemia and peritoneal abscess, successfully treated with caspofungin and drainage. We also review the literature of invasive saccharomycoses in recipients of hematologic and solid organ transplants.     

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Evidence to inform the management of systemic fungal infections in the setting of a cardiac implantable electronic devices (CIED), such as a permanent pacemaker or implantable cardioverter‐defibrillator, is scant and limited to case reports and series. The available literature suggests high morbidity and mortality. To better characterize the shared experience of these cases and their outcomes, we performed a systematic review. We investigated all published reports of systemic fungal infections—fungemia and fungal vegetative disease—in the context of CIED, drawing from PubMed, EMBASE, and the Cochrane database of systematic reviews, inclusive of patients who received treatment between January 2000 and May 2020. Exclusion criteria included presence of ventricular assist device and concurrent bacteremia, bacterial endocarditis, bacterial vegetative infection, or viremia. Among 6261 screened articles, 48 cases from 41 individual studies were identified. Candida and Aspergillus species were the most commonly isolated fungi. There was significant heterogeneity in antifungal medication selection and duration. CIED extraction—either transvenous or surgical—was associated with increased survival to hospital discharge (92%) and clinical recovery at latest follow‐up (81%), compared to cases where CIED extraction was deferred (56% and 40%, respectively). Importantly, there were no prospective data, and the data were limited to individual case reports and one small case series. In summary, CIED extraction is associated with improved fungal clearance and patient survival. Reported antifungal regimens are heterogeneous and nonuniform. Prospective studies are needed to verify these results and define optimal antifungal regimens.     

New Clonal Strain of Candida auris,Delhi, India: New Clonal Strain of Candida auris,Delhi, India

A new clonal strain of Candida auris is an emerging etiologic agent of fungemia in Delhi, India. In 12 patients in 2 hospitals, it was resistant to fluconazole and genotypically distinct from isolates from South Korea and Japan, as revealed by M13 and amplified fragment length polymorphism typing.