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Mixed Skin and Soft Tissue Infection Caused by Rhodotorula glutinis and Enterococcus faecalis in a Diabetic Patient:
Petros Ioannou1, Despoina Chatzisymeon2, Sofia Maraki2
1Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece.
Abstract:
Rhodotorula is a widely distributed fungus that has evolved as an important pathogen, especially in immunocompromised individuals, causing fungemias, central nervous system infections, peritoneal dialysis-associated peritonitis and keratitis. Even though there are a few reports of skin and soft tissue infections caused by Rhodotorula, all these cases involve immunocompromised individuals. Enterococcus faecalis is a Gram-positive bacterium known to cause several infections such as bloodstream, urinary tract and skin and soft tissue infections. We report a mixed Rhodotorula glutinis and Enterococcus faecalis skin and soft tissue infection in a 63-year-old woman with well controlled type 2 diabetes mellitus and no other known history of immunosuppression, suffering from skin and soft tissue infection of the right lower extremity. The patient did not respond to treatment with broad spectrum antimicrobials, but had a successful outcome with fluconazole, after Rhodotorula glutinis was isolated from pus of the skin ulcer. The antifungal treatment led to eradication of the infection, while no recurrence was observed during a follow-up period of two years. Clinicians should be aware that R. glutinis can cause infection even in immunocompetent patients.
Insights
This study reports a rare skin infection caused by Rhodotorula glutinis and Enterococcus faecalis in a patient without known immunosuppression. Successful treatment with fluconazole highlights the potential for R. glutinis to infect immunocompetent individuals.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Dermatology
Background:
- Rhodotorula species are opportunistic fungi, typically causing infections in immunocompromised individuals.
- Skin and soft tissue infections (SSTIs) by Rhodotorula are rare, with existing reports exclusively involving immunocompromised patients.
- Enterococcus faecalis is a common Gram-positive bacterium associated with various infections, including SSTIs.
Discussion:
- This case presents a mixed SSTI caused by Rhodotorula glutinis and Enterococcus faecalis in a 63-year-old woman with well-controlled type 2 diabetes mellitus but no other immunosuppressive conditions.
- The patient's infection did not respond to broad-spectrum antimicrobials, underscoring the need for targeted therapy.
- Isolation of R. glutinis from the skin ulcer pus was crucial for guiding treatment.
Key Insights:
- Rhodotorula glutinis can cause significant skin and soft tissue infections even in patients without overt immunosuppression.
- Antifungal therapy, specifically fluconazole, proved effective in eradicating the R. glutinis infection.
- The successful treatment and two-year follow-up demonstrate the potential for complete recovery and absence of recurrence.
Outlook:
- Clinicians should consider R. glutinis as a potential pathogen in SSTIs, regardless of the patient's immune status.
- Further research may elucidate the specific factors contributing to R. glutinis infections in seemingly immunocompetent individuals.
- This case broadens the understanding of Rhodotorula's pathogenic potential beyond traditionally recognized risk groups.
