Kodamaea Ohmeri Fungemia in an Immunocompetent Patient Treated with Micafungin: Case Report and Review of the Literature

Kodamaea (Pichia) ohmeri is an unusual yeast-form fungus that has recently been identified as an important etiology of fungemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We report a case of K. ohmeri fungemia in a 34-year-old hospitalized patient with thrombophlebitis. The patient was admitted to the hospital for evaluation and management of an acquired tracheo-esophageal fistula secondary to an impacted denture. Fever developed on hospital day 22, and physical exam revealed right arm superficial thrombophlebitis at the site of the peripheral venous catheter that was confirmed by Doppler ultrasound. The peripheral vein was removed and blood cultures from hospital day 22 and 23 grew yeast species. The yeast was subsequently identified to be K. ohmeri by Vitek II and API20C and was confirmed by 18S rRNA gene sequencing. The fungemia and right arm phlebitis was successfully treated with a 2-week course of micafungin therapy. This is the first case of K. ohmeri fungemia in a patient that was successfully treated with micafungin.     

Four new yeasts in the Candida mesenterica clade associated with basidiocarp-feeding beetles

We isolated five yeasts related to Candida mesenterica from the digestive tract, frass, and habitat of beetles in six families inhabiting basidiocarps. Based on rDNA sequence comparisons and phenotypic characters, the yeasts were identified as Kodamaea ohmeri and four undescribed taxa. Phylogenetic analysis of combined small and large subunit ribosomal DNA sequences placed the five taxa in a statistically well supported clade with C. mesenterica, Candida suecica and other yeast species known from basidiocarps, including 'Endomyces scopularum' (CBS154.92 and 155.92), Candida fukazawae, Candida fungicola and Candida sagamina. Only one of the new taxa produced ascospores; the other three reproduced only asexually. The yeasts appear to be less closely associated with beetles than with the beetle habitat. The new species and their type strains are Kodamaea laetipori (type strain NRRL Y-27713 T), Candida derodonti (type strain NRRL Y-2771 1 T), Candida arcana (type strain NRRL Y-27712 T) and Candida plutei (type strain NRRL Y-27715 T).     

Production of phytase by a marine yeast Kodamaea ohmeri BG3 in an oats medium: optimization by response surface methodology

Statistical experimental designs were applied for the optimization of phytase production by a marine yeast Kodamaea ohmeri BG3 in a cost-effective oats medium. Using Plackett-Burman design, oats, ammonium sulfate and initial pH were identified as significant factors and these factors were subsequently optimized using a central composite design (CCD). The optimum variables that supported maximum enzyme activity were oats 1.0%, ammonium sulfate 2.3%, glucose 2.0%, NaCl 2.0% and initial pH 6.3. The validity of the optimized variables was verified in shake-flasks level. An overall 9-fold enhancement in phytase activity (62.0-->575.5 U/ml) was attained due to the optimization.     

Candida hyderabadensis sp. nov., a novel ascomycetous yeast isolated from wine grapes

Three ascomycetous yeast strains were isolated from decaying green wine grapes, collected from Hyderabad city in India. Two strains, YS9 and YS21, were identified as Kodamaea ohmeri and Candida fermentati, respectively. The third strain, YS12(T), differs from Candida parapsilosis, Candida orthopsilosis and Candida metapsilosis, the nearest phylogenetic neighbours, by 1.6-1.9% with respect to the nucleotide sequence of the D1/D2 domain of the 26S rRNA gene and by 1.4-9.2% with respect to the nucleotide sequence of the internal transcribed spacer 1 (ITS1)-5.8S rRNA gene-ITS2 region. YS12(T) also differs from C. parapsilosis, C. metapsilosis and C. orthopsilosis by some phenotypic characteristics. Thus, based on the phenotypic differences and phylogenetic analysis, strain YS12(T) is assigned the status of a new species of Candida, for which the name C. hyderabadensis sp. nov. is proposed. The type strain is YS12(T) (NRRL Y-27953(T)=CBS10444(T)=IAM15334(T)).     

Pichia anomala (Candida pelliculosa) Fungemia in a Patient with Sickle Cell Disease

This case report discusses a patient with sickle cell disease who presented with fungemia from Pichia anomala (teleomorph: Candida pelliculosa). The organism was identified as P. anomala by MALDI-TOF VITEK mass spectrometry and VITEK 2 yeast identification card. Pichia anomala should be considered in sickle cell patients with recurrent fungemia.     

Specific antibody response in a patient with Candida dubliniensis fungemia

We report a case of fungemia caused by Candida dubliniensis in a non-HIV infected patient. Multiple cultures of blood performed over a period of 13 days were positive for this recently described yeast species. The C. dubliniensis isolates recovered were susceptible to fluconazole in vitro and the patient responded to intravenous therapy with this antifungal agent. It was possible to differentiate the fungemia caused by C. dubliniensis in this patient from that caused by C. albicans in other patients on the basis of the analysis of the antibody response since the C. dubliniensis-infected patient exhibited a characteristic and specific antibody response against a cell wall component of 160-170 kDa.     

Yeast diversity of Ghanaian cocoa bean heap fermentations

The fermentation of the Theobroma cacao beans, involving yeasts, lactic acid bacteria, and acetic acid bacteria, has a major influence on the quality of the resulting cocoa. An assessment of the microbial community of cocoa bean heap fermentations in Ghana resulted in 91 yeast isolates. These were grouped by PCR-fingerprinting with the primer M13. Representative isolates were identified using the D1/D2 region of the large subunit rRNA gene, internal transcribed spacer sequences and partial actin gene sequences leading to the detection of 15 species. Properties of importance for cocoa bean fermentation, namely sucrose, glucose, and citrate assimilation capacity, pH-, ethanol-, and heat-tolerance, were examined for selected isolates. Pichia kudriavzevii ( Issatchenkia orientalis ), Saccharomyces cerevisiae , and Hanseniaspora opuntiae formed the major components of the yeast community. Hanseniaspora opuntiae was identified conclusively for the first time from cocoa fermentations. Among the less frequently encountered species, Candida carpophila, Candida orthopsilosis, Kodamaea ohmeri, Meyerozyma ( Pichia ) caribbica, Pichia manshurica, Saccharomycodes ludwigii , and Yamadazyma ( Pichia ) mexicana were not yet documented from this substrate. Hanseniaspora opuntiae was preferably growing during the earlier phase of fermentation, reflecting its tolerance to low pH and its citrate-negative phenotype, while no specific temporal distribution was recognized for P. kudriavzevii and S. cerevisiae .     

<Emphasis Type="Italic">Paecilomyces variotii</Emphasis> Fungemia in a Patient with Lymphoma Needing Liver Transplant

Paecilomyces sp. are emerging pathogens in immunocompromised patients. We report here a case of Paecilomyces variotii fungemia, cured with amphotericin and anidulafungin, illustrating difficulties of early diagnosis and therapeutic choice in such rare fungal infection.     

Monitoring Aethina tumida (Coleoptera: Nitidulidae) with baited bottom board traps: occurrence and seasonal abundance in honey bee colonies in Kenya

The population dynamics of the honey bee pest Aethina tumida Murray (small hive beetle) have been studied in the United States with flight and Langstroth hive bottom board traps baited with pollen dough inoculated with a yeast Kodamaea ohmeri associated with the beetle. However, little is known about the population dynamics of the beetle in its native host range. Similarly baited Langstroth hive bottom board traps were used to monitor the occurrence and seasonal abundance of the beetle in honey bee colonies at two beekeeping locations in Kenya. Trap captures indicated that the beetle was present in honey bee colonies in low numbers all year round, but it was most abundant during the rainy season, with over 80% trapped during this period. The survival of larvae was tested in field releases under dry and wet soil conditions, and predators of larvae were identified. The actvity and survival of the beetle were strongly influenced by a combination of abiotic and biotic factors. Larval survival was higher during wet (28%) than dry (1.1%) conditions, with pupation occurring mostly at 0-15 cm and 11-20 cm, respectively, beneath the surface soil during these periods. The ant Pheidole megacephala was identified as a key predator of larvae at this site, and more active during the dry than wet seasons. These observations imply that intensive trapping during the rainy season could reduce the population of beetles infesting hives in subsequent seasons especially in places where the beetle is a serious pest.     

Mechanism of retroinhibition in e regulation of flavinogenesis in yeasts of genus Pichia]

The kinetics of the synthesis of a riboflavin (RF) precursor, 2,6-dihydroxy-5-amino-4-ribitylaminopyrimidine (DHARAP), was studied using the washed cells of RF-deficient mutants of Pichia guilliermondii R7G and Pichia ohmeri R32 with blocked lumasine synthetase. RF inhibited the synthesis of DHARAP while cycloheximide in the absence of RF had no effect on this process. The data suggest that flavins regulate the biosynthesis of RF in P. guillier mondii and P. ohmeri b7 means of feed-back inhibition mechanism.     

国内首例皮瘤丝孢酵母真菌血症分离株的表型及rDNA序列鉴定

目的通过对1例“脂膜炎”患者外周血分离株的表型及分子生物学鉴定,报道国内首例皮瘤丝孢酵母菌血症。方法采集患者的血及鼻咽结节组织标本通过真菌培养获得分离株,经沙氏培养基、马铃薯培养基、科玛嘉念珠菌显色培养后形态学观察及API 20C AUX系统鉴定,最后经PCR扩增rDNA基因测序证实。采用CLSI制定的M27-A2微量稀释法对病原菌株进行7种药物的体外药敏试验。结果分离株通过表型和分子生物学鉴定为“皮瘤丝孢酵母”。药敏结果显示菌株对两性霉素B耐药,氟康唑、伏立康唑、伊曲康唑、5-氟胞嘧啶敏感。卡泊芬净的抑菌浓度较低,而米卡芬净的抑菌浓度相对较高。患者因多种并发症死亡。结论皮瘤丝孢酵母引起的真菌血症为我国首例报道。API 20C AUX酵母鉴定系统可作为鉴定皮瘤丝孢酵母快速而简便的方法。通过分子生物学DNA序列检测分析能鉴定皮瘤丝孢酵母。     

Kodamaea kakaduensis and Candida tolerans, two new ascomycetous yeast species from Australian Hibiscus flowers.

Two new yeast species were isolated from flowers of Hibiscus species in Eastern and Northern Australia. Kodamaea kakaduensis is heterothallic, haploid, and similar to other Kodamaea species and to Candida restingae. Buds are often produced on short protuberances, and a true mycelium is formed. The new species differs from others by the assimilation of trehalose, melezitose, and xylitol, and is reproductively isolated. The cells of Candida tolerans are small and a pseudomycelium is formed. The carbon and nitrogen assimilation pattern is reminiscent of that of Zygosaccharomyces rouxii but the two are not closely related. Sequences of the D1/D2 domain of large subunit ribosomal DNA confirm the membership of K. kakaduensis in the genus Kodamaea and indicate that C. tolerans belongs to the Clavispora-Metschnikowia clade, with a moderate relatedness to Candida mogii. The type strains are: K. kakaduensis, UWO(PS)98-119.2 (h+, holotype, CBS 8611) and UWO(PS)98-117.1 (h-, isotype, CBS 8612); and C. tolerans, UWO(PS)98-115.5 (CBS 8613).     

Could Candida dubliniensis be involved in lung fungus balls?

We describe a case of cavitary pneumonia due to Candida dubliniensis along with fungemia due to Candida kefyr in a leukemic patient. This is the first case of C. dubliniensis isolated in our laboratory. The identification was performed by phenotypic and molecular methods such as thermotolerance test, carbohydrate fermentation and polymerase chain reaction.     

Rhodotorula Fungemia of an Intensive Care Unit Patient and Review of Published Cases

Rhodotorula species are commensal yeasts that have emerged as a cause of life-threatening fungemia in severely immunocompromised patients. A case of Rhodotorula mucilaginosa fungemia in a 48-year-old woman that had undergone consecutive abdominal surgeries due to ovarian cancer and bowel necrosis while she was receiving fluconazole prophylaxis is presented. Several risk factors were identified such as presence of central venous catheters, solid organ neoplasm, abdominal surgery and administration of antibiotics. Identification was performed using commercial systems. The yeast was resistant to fluconazole, posaconazole and voriconazole and to echinocandins, whereas MIC to amphotericin B was 1.5?mg/L. Furthermore, published cases of Rhodotorula spp fungemia during the last decade are reviewed. In conclusion, Rhodotorula spp must be considered a potential pathogen in patients with immunosupression and central venous catheters. Correct identification is mandatory for appropriate management, as Rhodotorula spp are resistant to antifungal agents, such as fluconazole and echinocandins.     

Uncommon Fungi Isolated from Diabetic Patients Toenails With or Without Visible Onychomycoses

Kodamaea ohmeri and Prototheca wickerhamii are rare pathogens for humans, and even more rare as cause of onychomycosis. This work reports the second case of onychomycosis by K. ohmeri and the fourth of onycoprotothecosis; it was made in public health institutions in the Hidalgo State, Mexico, studying 261 diabetic patients during 2005 and 2006. Kodamaea ohmeri was isolated from toenails of a 51-year-old female patient, and P. wickerhamii from three female patients of 48, 49, and 61 years old, respectively, all of them with type 2 diabetes mellitus (DM 2). Identifications were done by standard microbiological methods and a commercial system. Only one patient infected with P. wickerhamii showed mixed infection with dermatophytes. Out of the total studied DM 2 patients, 1.15% presented onycoprotothecosis and 0.38% onychomycosis by K. ohmeri, high percentages if it is considered that few cases have been reported of K. ohmeri and P. wickerhamii as onychomycosis causal agents.     

渤海海水中酵母菌的种类

本文报道了渤海海水中酵母菌种类的调查结果,从31个站位中,共分离鉴定了228株酵母菌,这些酵母菌分别属于8属40种:红酵母属(Rhodotorula)5个种,隐球酵母属(Cryptococcus)8个种,德巴利酵母属(Debaryomyces)2个种,毕赤酵母属(Pichia)8个种,酵母属(Saccharomyces)2个种,短梗霉属(Aureobasidium)1个种,球孢酵母属(Torulaspora)1个种,假丝酵母属(candida)13个种。40个种中,有13种是中国新记录,即:黑隐球酵母(Cryptococcus ater),大型隐球酵母(Cr.magnus),多型德巴利酵母(Debaryomyces polymorphus),克鲁维酵母(Saccharomyces kluyveri),伯顿毕赤酵母(Pichia burtonii),卡森毕赤酵母(P.carsonii),埃切毕赤酵母(P.etchellsii),季也蒙毕赤酵母(P.guilliermondii),海梅尔毕赤酵母(P.heimii),嗜土毕赤酵母(P.philogaea),奥默毕赤酵母(P.ohmeri),棘胫小蠹毕赤酵母(P.scolyti),和戴尔有孢圆酵母(Torulaspora delbrueckii),在这13种中,除埃切毕赤酵母和奥默毕赤酵母外,其余11种在海水里也是首次报道。     

Successful Outcome of Disseminated Fusarium musae Fungemia with Skin Localization Treated with Liposomal Amphotericin B and Voriconazole in a Patient with Acute Myeloid Leukemia

Fusarium spp. may cause invasive disseminated infections in immunocompromised patients, associated with significant morbidity and mortality. We describe a case of disseminated fusariosis with fungemia and skin localization caused by Fusarium musae in a patient with acute myeloid leukemia successfully treated using liposomal amphotericin B and voriconazole.

     

Successful Surgical Intervention for the Management of Endocarditis due to Multidrug Resistant <Emphasis Type="Italic">Candida parapsilosis</Emphasis>: Case Report and Literature Review

Candida parapsilosis is an uncommon cause of invasive endocarditis. This pathogen induces severe complications and carries a high mortality rate. We describe a case of C. parapsilosis endocarditis in a 54-year-old man with a history of HIV and Hepatitis C infection who previously underwent prosthetic valve replacement due to bacterial endocarditis. The patient presented with prolonged febrile episodes and fungemia with repeat blood cultures positive for C. parapsilosis. The patient failed multiple regimens of antifungal therapy and the C. parapsilosis isolate progressively acquired resistance to a number of drugs. Due to the multidrug resistant nature of the isolate, replacement of the infected valve was required to resolve his fungemia, and the patient remained asymptomatic for two years. This case is unusual due to the multidrug resistant nature of the isolate requiring both combined medical and surgical intervention. A review of published reports indicates that endocarditis due to C. parapsilosis responds well to a combination of medical and surgical interventions; the latter is particularly suitable for immunocompromised hosts.     

胶红酵母致真菌血症1例：临床及实验研究

目的报道1例由胶红酵母感染引起的真菌血症。方法通过对患者血培养分离致病菌,并作API 20C AUX及DNA序列测定鉴定菌种,采用抗真菌药敏纸片法对菌株进行体外药敏试验。结果患者,女性,38岁,因反复出现右乳肿块5个月行右乳肿块穿刺活检术,术后高热,发生于每日下午至夜间。2次查血真菌培养均为阳性,经菌落观察、API 20C AUX鉴定及基因测序,鉴定为胶红酵母。体外药敏试验显示对两性霉素B敏感,对伊曲康唑、氟康唑、伏立康唑耐药。未予治疗,24d后自愈。结论胶红酵母菌血症在国内罕见报道,其菌株毒力相对较低,在免疫功能正常患者中,部分病例可自愈。     

Rhodotorula infection. A systematic review of 128 cases from literature

Rhodotorula is an emerging opportunistic pathogen, particularly in immunocompromised patients. Many cases of fungemia associated with catheters, endocarditis, peritonitis, meningitis, and endophthalmitis are infections incited by this yeast. The main purpose of this study was to review all cases of Rhodotorula infection reported in the literature and to describe risk factors, underlying conditions and outcome. From 128 cases, 79% were fungemia (103 cases), 7% eye infections (nine cases) and 5% (six cases) peritonitis associated with continuous ambulatory peritoneal dialysis. Eighty seven percent of Rhodotorula infections are associated with underlying immunosuppression or cancer. The most common isolated risk factor associated with Rhodotorula infection was the use of a central venous catheter, which was found in 83.4% of Rhodotorula fungemia (86 cases). Rhodotorula mucilaginosa was the most common species of fungemia (74% of cases), followed by Rhodotorula glutinis with 7.7%. The species was not identified in 17% of the cases of fungemias. Amphotericin was the drug of choice in the treatment of fungemia and most of the eye infections were treated with topical amphotericin, although all patients lost their vision. All peritonitis cases associated with continous ambulatory peritoneal dialysis needed to have the Tenckoff catheter changed. The overall mortality of Rhodotorula infection was 12.6%.