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Published on: June 24, 2020
Peritonitis in a neonate due to Cyberlindnera fabianii, an ascomycetic yeast
1MVZ Labor Limbach, Im Breitspiel 16, 69126, Heidelberg, Germany. herbert.hof@labor-limbach.de.
Abstract:
The ascomycetous yeast Cyberlindera fabianii is not only present in the environment, but is also occasionally pathogenic. Especially, neonates seem to be prone to infection. Here, we describe a case of peritoneal infection of a neonate after congenital heart surgery. The correct identification of this peculiar species is made by MALDI-TOF and especially by molecular biology methods, whereas the standard biochemical identification methods fail.The neonate with a hypoplastic left heart syndrome had a Norwood palliation followed by transient ECMO therapy for 3 days. The patient developed a renal insufficiency, so that peritoneal dialysis was initiated. After a few days, a peritoneal infection due to C. fabianii emerged. The proper source of this rare and particular yeast remains obscure. In spite of a reasonable antimycotic therapy, the patient developed a capillary leak syndrome and died finally in septic shock with multiorgan failure. One reason is probably that the yeast population, which was highly susceptible to all common antimycotic drugs at the beginning of therapy with fluconazole (and for a short period with caspofungin and liposomal amphotericin B), became rapidly resistant.
Insights
A rare yeast, Cyberlindera fabianii, caused a fatal peritoneal infection in a neonate post-heart surgery. The yeast rapidly developed resistance to antifungal drugs, leading to septic shock and multiorgan failure.
Area of Science:
- Medical Mycology
- Infectious Diseases
Background:
- The ascomycetous yeast Cyberlindera fabianii is an environmental organism with occasional pathogenic potential, particularly in neonates.
- Standard biochemical identification methods often fail for this yeast species.
Observation:
- A neonate with hypoplastic left heart syndrome developed a peritoneal infection with C. fabianii following congenital heart surgery and transient extracorporeal membrane oxygenation (ECMO).
- Peritoneal dialysis was initiated due to renal insufficiency, preceding the yeast infection.
- The source of the C. fabianii infection remained undetermined.
Findings:
- Accurate identification of C. fabianii was achieved through MALDI-TOF and molecular methods, not standard biochemical tests.
- Despite initial susceptibility, the yeast rapidly developed resistance to fluconazole, caspofungin, and liposomal amphotericin B during treatment.
- The patient experienced capillary leak syndrome, septic shock, and multiorgan failure, ultimately succumbing to the infection.
Implications:
- This case highlights the diagnostic challenges and potential pathogenicity of C. fabianii in vulnerable neonates.
- Rapid antifungal resistance development in C. fabianii poses a significant therapeutic challenge.
- Improved diagnostic strategies and understanding of C. fabianii pathogenesis are crucial for managing such rare infections.
