Fluconazole-resistant Kodamaea ohmeri fungemia associated with cellulitis: case report and review of the literature.
Kodamaea (Pichia) ohmeri was formerly considered a contaminant, but is now known to be a significant human pathogen that has been shown to cause fungemia, endocarditis, funguria, and peritonitis in immunocompromised patients. We report a case of fungemia caused by K. ohmeri in a 71-year-old man with cellulitis. The patient was sent to the emergency room due to leg edema, fever, and change of consciousness. During hospitalization, a series of examinations including blood cultures were performed. On hospital day 8, blood culture yielded a yeast colony. Fluconazole was given empirically, but had no effect. The pathogen was identified as K. ohmeri by Vitek YBC card, API 20C, sequencing of the 18S rRNA gene, and the D1/D2 domains of the 26S rRNA gene and the internally transcribed spacer (ITS) regions. Antifungal susceptibility testing was performed with the ATB-Fungus system, and a high minimum inhibitory concentration (level up to 64 mg/l) for fluconazole was found. Fluconazole was replaced with amphotericin B deoxylate, and the fever and cellulitis inflammation gradually subsided. The patient was discharged in a stable condition. This is the first case of K. ohmeri fungemia in Taiwan.
Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
Bing-Heng
BH
Yang
Ming-Yieh
MY
Peng
Shu-Jin
SJ
Hou
Jun-Ren
JR
Sun
Shih-Yi
SY
Lee
Jang-Jih
JJ
Lu
D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D002481:Cellulitis / Q000150:complications / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000494:pharmacology*; D016469:Fungemia / Q000382:microbiology*; D006801:Humans; D008297:Male; D009181:Mycoses / Q000150:complications / Q000382:microbiology; D010843:Pichia / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D013624:Taiwan
D000935:Antifungal Agents; D015725:Fluconazole