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Indian Pediatr 2016;53: 840 |
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Saccharomyces kluyveri Fungemia in an
Infant with Severe Combined Immunodeficiency
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*Shakil Shaikh and Ira Shah
Department of Pediatrics, BJ Wadia Hospital for
Children, Mumbai, India.
Email:
[email protected]
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Saccharomyces kluyveri is budding yeast related to Saccharomyces
cerevisiae [1]. In literature, we could locate only one case report
of disseminated fungemia in an adult patient with AIDS due to S.
kluyveri [2]. We report S. kluyveri fungemia in a child who
had severe combined immunodeficiency (SCID).
A 5-month-old boy presented to us with fever and
cough for 15 days and one episode of generalized tonic clonic
convulsion. He had oral thrush at 1 month and otitis media at 2 months
of age. Birth weight was 2.9 kg. His elder brother died at 11 months of
age due to some respiratory illness. On presentation, he was lethargic,
and had tachycardia and tachypnea. He had oral thrush, diffuse greyish
rash all over body, and hepatosplenomegaly. Investigations showed
lympho-cytopenia and thrombo-cytpoenia. HIV ELISA was negative. Chest
X-ray showed ill-defined patch in left upper zone. Blood bacterial
culture did not grow any organism. Serum immunoglobulins and lymphocytes
subset analysis revealed low levels of IgG, IgA, CD3 + T lymphocytes,
CD4 + th lymphocytes, CD8 + Tc lymphocytes, and CD 16 + 56+ Natural
Killer Cells. Child was started on broad spectrum antibiotics and
fluconazole. Computed tomography of chest revealed small cavitating
nodule of 9 X 8 mm in anterior segment of left upper lobe suggestive of
aspergillosis. Serum galactomannan was positive. A simultaneous blood
fungal culture grew S. Kluyveri, which was sensitive to
Amphotericin B and resistant to flucytosine and fluconazole. He was
started on Liposomal Amphotericin B, and fluconazole was stopped. On Day
10 of liposomal amphotericin B, his blood culture still grew fungus, and
thus caspofungin was added as salvage therapy. Supportive treatment was
given in form of irradiated packed red blood cells and platelet
transfusion along with intravenous immunoglobulin. After one week
patient was transferred to a transplant centre for bone marrow
transplant (BMT).
S. kluyveri is a widespread plant pathogen
infecting strawberries and is also found in exudates of trees, soil,
fruit flies and fruit juices [1]. The role of this microorganism as a
human pathogen is unknown. Saccharomyces cerevisiae (also known
as brewer’s or baker’s yeast) has been reported as a cause of fungemia,
peritonitis, pleural effusion, esophagitis, endocarditis and arthritis
in immunocompromised patients. Deep mycoses in immunosuppressed patients
are acquired by inhalation, through paranasal sinuses, or by enteric
invasion [3]. Main risk factor of severe fungal infection in our patient
was profound immune deficiency.
Although S. kluyveri fungemia is rare, this
opportunistic organism should not be ignored as non-pathogenic. The
emergence of new fungal pathogens i.e S. kluyveri in cases of
fungemia, particularly those with reduced susceptibility to azole anti-fungals
reinforces the importance of proper mycological examination of these
samples [4].
Acknowledgement: Dr YK Amdekar, Medical
Director, Bai Jerbai Wadia Hospital for Children.
Funding: None; Competing interest: None
stated.
References
1. Lachancea kluyveri. Available from:
http://en.wikipedia. org/wiki/Lachancea kluyveri. Accessed February
13, 2016.
2. Pynka M, Wnuk A, Bander D, Syczewska M, Boron A,
Prost B, et al. Disseminated infection with Saccharomyces
kluyveri in a patient with AIDS. Infection. 1998;26:184-6.
3. Curry CR, Quie PG. Fungal septicemia in patients
receiving parenteral hyperalimentation. N Engl J Med. 1971;285: 1221-5.
4. Tiballi RN, Spiegel JE, Zarins LT, Kauffman CA.
Saccharomyces cerevisiae infections and antifungal susceptibility
studies by colorimetric and broth macrodilution methods. Diagn Microbiol
Infect Dis. 1995;23:135-40.
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