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Fatal Lodderomyces elongisporus Fungemia in a Premature, Extremely Low-Birth-Weight Neonate
Mohammad Asadzadeh1, Noura Al-Sweih1,2, Suhail Ahmad1
1Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya 46300, Kuwait.
Abstract:
Many rare yeasts are emerging as pathogens, causing invasive infections in susceptible hosts that are associated with poor clinical outcome. Here, we describe the first and fatal case of Lodderomyces elongisporus fungemia in a premature, extremely low-birth-weight neonate after spontaneous vaginal delivery. The bloodstream isolate was identified as C. parapsilosis by the VITEK 2 yeast identification system and as L. elongisporus by PCR-sequencing of the internal transcribed spacer (ITS) region of ribosomal DNA. Antifungal susceptibility testing data for the isolate, performed by the broth microdilution-based MICRONAUT-AM assay, showed susceptibility to all nine antifungal drugs tested. Despite the initiation of treatment with liposomal amphotericin B, the patient died on the same day that the blood culture yielded yeast growth. This is the first report of L. elongisporus bloodstream infection in a neonate as the previous nine cases reported in the literature occurred in adult patients. The crude mortality rate for invasive L. elongisporus infection is 50%, as only 5 of 10 patients survived.
Insights
This study reports the first fatal case of Lodderomyces elongisporus fungemia in a premature infant. Despite antifungal treatment, the neonate died, highlighting the challenges of rare yeast infections in vulnerable populations.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neonatal Care
Background:
- Rare yeasts are increasingly recognized as significant pathogens, particularly in immunocompromised or critically ill individuals.
- Invasive yeast infections in neonates, especially those with extremely low birth weight, carry a high risk of mortality.
- Accurate identification of yeast species is crucial for appropriate clinical management and epidemiological surveillance.
Observation:
- A premature, extremely low-birth-weight neonate developed a fatal bloodstream infection (fungemia) caused by Lodderomyces elongisporus.
- Initial identification using the VITEK 2 system misidentified the yeast as Candida parapsilosis; accurate identification was achieved via PCR-sequencing of the ribosomal DNA's internal transcribed spacer (ITS) region.
- Antifungal susceptibility testing revealed the isolate was susceptible to all nine tested antifungal agents, including liposomal amphotericin B.
Findings:
- This case represents the first documented instance of Lodderomyces elongisporus fungemia in a neonate.
- The patient succumbed to the infection on the same day yeast was detected in blood cultures, despite prompt initiation of liposomal amphotericin B therapy.
- The overall crude mortality rate for invasive Lodderomyces elongisporus infections stands at 50% based on this and previous adult cases.
Implications:
- This case underscores the potential for rare yeasts like Lodderomyces elongisporus to cause severe, fatal infections in vulnerable neonatal populations.
- It highlights the importance of advanced diagnostic techniques, such as molecular methods (ITS sequencing), for accurate identification of emerging fungal pathogens.
- The findings emphasize the need for increased awareness and further research into the clinical spectrum and management of invasive infections caused by rare yeasts in neonates.
