The first fatal case ofFereydounia khargensisperitonitis

Abstract

Rationale: Fereydounia (F.) khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.

Patient concerns: A 61-year-old male with end-stage renal failure on continuous ambulatory peritoneal dialysis, who presented with generalized abdominal pain, turbid dialysate and fever.

Diagnosis: Peritoneal fluid culture revealed the presence of yeast cells. F. khargensis was identified by polymerase chain reaction method.

Interventions: Removal of Tenckhoff catheter and intravenous fluconazole.

Outcomes: He succumbed after two weeks of hospitalization.

Lessons: This case report highlights the significance of a rare fungal pathogen, F. khargensis, which has been implicated in the mortality of an immunocompromised patient. Due to its rarity, F. khargensis poses significant challenges associated with its identification and has profound implications for clinical practice.

Keywords

Peritonitis / Rare / Fungal / Fatal

References

[1] Nasr S, Soudi MR, Shahzadeh Fazeli SA, Nguyen HDT, Lutz M, Piątek M. Expanding evolutionary diversity in the Ustilaginomycotina: Fereydouniaceae fam. nov. and Fereydounia gen. nov., the first urocystidalean yeast lineage. Mycol Progress 2014; 13(4): 1012.

[2] Wang QM, Begerow D, Groenewald M, Liu XZ, Theelen B, Bai FY, et al. Multigene phylogeny and taxonomic revision of yeasts and related fungi in the Ustilaginomycotina. Stud Mycol 2015; 81(1): 55-83.

[3] Monapathi M, Horn S, Vogt T, Van Wyk D, Mienie C, Ezeokoli OT, et al. Antifungal agents, yeast abundance and diversity in surface water: Potential risks to water users. Chemosphere 2021; 274: 129718.

[4] Do Nascimento JPM, Dos Santos R, Dos Santos Silva MS, De Araújo MA, Anhezini L, Dos Santos DÉ, et al. Indoor air contamination by yeasts in healthcare facilities: Risks of invasive fungal infection. Aerobiology 2023; 1(1): 3-18.

[5] Tap RM, Ramli NY, Sabaratnam P, Hashim R, Bakri ARA, Bee LB, et al. First two cases of fungal infections associated with multi-drug resistant yeast, Fereydounia khargensis. Mycopathologia 2016; 181: 531-537.

[6] Zhang Q, Xie M, Liu Y, Chen D, Xie W, Zhang M, et al. First reported case of catheter-related bloodstream infection (CRBSI) caused by Fereydounia khargensis in an end-stage kidney disease patient. medRixv 2024. doi: https://doi.org/10.1101/2024.11.20.24317364.

[7] Taylor PM. Image-guided peritoneal access and management of complications in peritoneal dialysis. Semin Dial 2002; 15(4): 250-258.

[8] Lu JJ, Lo HJ, Lee CH, Chen MJ, Lin CC, Chen YZ, et al. The use of MALDI-TOF mass spectrometry to analyze commensal oral yeasts in nursing home residents. Microorganisms 2021; 9(1): 142.

[9] Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42(2): 110-153.

[10] Otto WR, Arendrup MC, Fisher BT. A practical guide to antifungal susceptibility testing. J Pediatr Infect Dis Society 2023; 12(4): 214-221.