Leonardo Potenza1, Maria N Chitasombat2, Nikolay Klimko3, Francesca Bettelli1, Giulia Dragonetti4, Maria Ilaria Del Principe5, Marcio Nucci6, Alessandro Busca7, Nicola Fracchiolla8, Mariarita Sciumè8, Angelica Spolzino9, Mario Delia10, Valentina Mancini11, Gian Paolo Nadali12, Michela Dargenio13, Olga Shadrivova3, Federico Bacchelli14, Franco Aversa9, Maurizio Sanguinetti15, Mario Luppi1, Dimitrios P Kontoyiannis16, Livio Pagano4. 1. Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy. 2. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 3. Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russia. 4. Institute of Hematology, Fondazione Policlinico A. Gemelli - IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy. 5. Hematology, Department of Biomedicine e Prevention, Tor Vergata University, Rome, Italy. 6. University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 7. Stem Cell Transplant Center, AOU Citta' della Salute e Della Scienza, Turin, Italy. 8. Department of Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 9. Haematology, University of Parma, Parma, Italy. 10. Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. 11. Department of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy. 12. Haematology, University of Verona, Verona, Italy. 13. Hematology and Stem Cell Transplantation Unit, 'Vito Fazzi' Hospital, Lecce, Italy. 14. Statistics Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Modena, Italy. 15. Institute of Microbiology, Fondazione Policlinico A. Gemelli - IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy. 16. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: Rhodotorula spp are uncommon yeasts able to cause infections with high mortality rates. Rhodotorula infections have been associated with the presence of central venous catheter (CVC), immunosuppression, exposure to antifungals and the presence of either solid or haematologic malignancies. However, in this latter setting, only a few cases have so far been reported. OBJECTIVES: We have conducted a survey for Rhodotorula infections in haematologic patients. METHODS: Patients' clinical and microbiological data were collected and correlated to the outcome. RESULTS: A total of 27 cases were detected from 13 tertiary care hospitals. About 78% and 89% of patients had acute leukaemia and CVC. About 70% of patients were exposed to prophylaxis with azoles, mainly posaconazole (37%), 59% were severely neutropenic and 37% underwent allogeneic stem cell transplantation (alloSCT). The most frequent treatments were liposomal amphotericin B (L-AmB) and CVC removal in 17 and 16 patients, respectively. One month post-diagnosis, mortality was 26% and was associated with the presence of mucositis (P = 0.034). CONCLUSIONS: Our study shows that Rhodotorula spp should be considered as aetiologic agents of breakthrough infections in acute leukaemia patients with a CVC, mucositis, who receive prophylaxis with azoles, including posaconazole, and/or undergo alloSCT. Prompt measures, such as L-AmB administration and CVC removal, should be carried out to avoid the high mortality risk of Rhodotorula infections.
BACKGROUND: Rhodotorula spp are uncommon yeasts able to cause infections with high mortality rates. Rhodotorula infections have been associated with the presence of central venous catheter (CVC), immunosuppression, exposure to antifungals and the presence of either solid or haematologic malignancies. However, in this latter setting, only a few cases have so far been reported. OBJECTIVES: We have conducted a survey for Rhodotorula infections in haematologic patients. METHODS:Patients' clinical and microbiological data were collected and correlated to the outcome. RESULTS: A total of 27 cases were detected from 13 tertiary care hospitals. About 78% and 89% of patients had acute leukaemia and CVC. About 70% of patients were exposed to prophylaxis with azoles, mainly posaconazole (37%), 59% were severely neutropenic and 37% underwent allogeneic stem cell transplantation (alloSCT). The most frequent treatments were liposomal amphotericin B (L-AmB) and CVC removal in 17 and 16 patients, respectively. One month post-diagnosis, mortality was 26% and was associated with the presence of mucositis (P = 0.034). CONCLUSIONS: Our study shows that Rhodotorula spp should be considered as aetiologic agents of breakthrough infections in acute leukaemiapatients with a CVC, mucositis, who receive prophylaxis with azoles, including posaconazole, and/or undergo alloSCT. Prompt measures, such as L-AmB administration and CVC removal, should be carried out to avoid the high mortality risk of Rhodotorula infections.
Authors: Ana Isabel Ferreira; Hugo Cruz; Ridhi Ranchor; Bruno S Silva; Joana Serôdio; Virgínia Lopes; Maria Helena Ramos Journal: IDCases Date: 2022-03-07
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