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Infection of an intravenous port system with Metschnikowia pulcherrima Pitt et Miller
1Department of Internal Medicine II, University of the Saarland, Homburg, Germany.
Abstract:
A patient with short bowel syndrome as a consequence of multiple intestinal resections for Crohn's disease, had a port system implanted to improve her nutritional status. One year later she presented with fever, weakness and nighttime sweating. Metschnikowia pulcherrima Pitt et Miller was grown in blood cultures from the port system. After antifungal chemotherapy using fluconazole and removal of the implant, the patient's condition improved markedly and her fever and sweating disappeared. We conclude that Metschnikowia pulcherrima can turn into a human pathogen in patients with indwelling catheters for parenteral nutrition. Chemotherapy with fluconazole and, whenever possible, removal of the implant, appear to be adequate treatment.
Insights
Metschnikowia pulcherrima, a yeast, can cause infections in patients with indwelling catheters for parenteral nutrition. Antifungal treatment with fluconazole and catheter removal effectively treated the infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Short bowel syndrome (SBS) necessitates parenteral nutrition (PN) via indwelling catheters.
- Crohn's disease patients with SBS often require multiple intestinal resections.
- Indwelling catheters for PN are associated with an increased risk of bloodstream infections.
Observation:
- A patient with SBS secondary to Crohn's disease developed fever, weakness, and night sweats.
- Blood cultures from the patient's port system grew Metschnikowia pulcherrima.
- The patient had an indwelling port system for PN for one year prior to symptom onset.
Findings:
- Metschnikowia pulcherrima fungemia was diagnosed in the patient.
- Treatment with fluconazole and removal of the PN catheter led to significant clinical improvement.
- Fever and sweating resolved after treatment and catheter removal.
Implications:
- Metschnikowia pulcherrima should be considered a potential human pathogen in immunocompromised patients with indwelling catheters.
- Prompt diagnosis and treatment, including antifungal therapy and device removal, are crucial for managing Metschnikowia pulcherrima infections.
- This case highlights the importance of vigilance for opportunistic fungal infections in patients reliant on long-term PN.