Introduction
Rhodotorula spp are emerging pathogens in immunocompromised hosts, as they represent the most frequent yeast species responsible for rare opportunistic yeast blood stream infection (ROYBSIs). Such infections are usual breaktrough infections as they develop in course of either azole or echinocandine prophilaxis/treatment.
In literature, no more than 180 cases have so far been reported. Rhodotorula infections present mainly as fungemia. Cancer patiens, either solid or hematologic, are the category at the highest risk. Other known risk factors include central venous catheter (CVC), neutropenia, treatment with steroids, exposure to broad spectrum antibiotics and/or azole prophylaxis. Mortality rates range from 12% to 42%.
We have retrospectively collected cases of Rhodotorula infections in hematologic patients from several hematologic tertiary care hospitals all around the world, including Italy, Germany, Russia and the Americas.
25 cases were identified (6 proven, 17 probable and 2 indeterminate). The median age of the patients was 43 (range 6-74). 80% were affected by leukemia and 20% by lymphoma. 40% of the patients underwent allogeneic stem cell transplantation. 16 (64%) out of 25 were under antifungal prophylaxis with azoles. 22 (88%) out of 25 patients had a CVC, 15 (60%) patients were severely neutropenic and were treated with steroids at the time of the onset of the infection. The antifungal agent most frequently used was liposomal amphotericin B (14 out of 25 pts). 6 (24%) out of 25 patients died of the infection.
In conclusion, our study shows that in patients with hematologic neoplasia infections by Rhodotorula spp are most frequently associated with the presence of CVC, neutropenia, azole prophylaxis and steroid treatment. Such infections, although rare, are still characterize by mortality rates unacceptably high at least in hematologic patients. For such a reason, further prospective studies are required to address the most influential risk factors and the most appropriate antifungal treatments.