ISSN: 2345-3346
Summer 2022
Vol. 10 No. 3 (2022)
Coinfection of Toenail Onychomycosis Caused by Rhodotorula mucilaginosa and Candida glabrata in an Immunocompromised Adult: A Case Report and Literature Review
Novelty in Biomedicine,
Vol. 10 No. 3 (2022),
,
Page 199-205
https://doi.org/10.22037/nbm.v10i3.39170
Abstract
Background: Rhodotorula mucilaginosa and Candida glabrata have emerged as potential pathogens,
particularly in immunosuppressed hosts. This study aimed to present a case of coinfection of Candida glabrata
and Rhodotorula mucilaginosa in a 35-year-old immunosuppressed female with onychomycosis on the first and
second left toenails.
Cases Report: Causative agents were identified according to morphology, microscopic studies, culture, and
DNA molecular analysis. Candida glabrata demonstrated high minimum inhibitory concentrations against the
tested antifungals except itraconazole. Moreover, Rhodotorula mucilaginosa had shown low minimum
inhibitory concentrations against clotrimazole and ketoconazole at a dilution of 0.25 μg/ml. Itraconazole is
administered at 200 mg twice daily for one week for toenails and as pulse treatment (for one week a month) at
5 mg/kg daily with topical clotrimazole.
Conclusion: Clinical improvement was noted in the patient's clinical examination after ten months. Information
about the increasing resistance to antifungal agents helps decide antifungal prophylaxis and select the empirical
therapy for cancer patients.
Keywords:
- Onychomycosis, Rhodotorula mucilaginosa, Candida glabrata, Coinfection, Drug resistance, Antifungal agents
How to Cite
Ghasemi, R., Ansari, S., Lotfali, E., Shahnazian, Z., Madinehzad, S. A., Aliabadi, N., & Zahmatkesh, M. M. (2022). Coinfection of Toenail Onychomycosis Caused by Rhodotorula mucilaginosa and Candida glabrata in an Immunocompromised Adult: A Case Report and Literature Review. Novelty in Biomedicine, 10(3), 199-205. https://doi.org/10.22037/nbm.v10i3.39170
References
1. Campbell AW, Anyanwu EC, Morad M. Evaluation of the drug
treatment and persistence of onychomycosis.
ScientificWorldJournal. 2004;4:760-777.
2. Uludag Altun H, Meral T, Turk Aribas E, Gorpelioglu C,
Karabicak N. A Case of Onychomycosis Caused by Rhodotorula
glutinis. Case Rep Dermatol Med. 2014;2014:563261.
3. Pârvu M, Moţ CA, Pârvu AE, Mircea C, Stoeber L, RoşcaCasian O, et al. Allium sativum extract chemical composition,
antioxidant activity and antifungal effect against Meyerozyma
guilliermondii and Rhodotorula mucilaginosa causing
onychomycosis. Molecules. 2019;24(21).
4. Li DG, Cohen JM, Mikailov A, Williams RF, Laga AC,
Mostaghimi A. Clinical diagnostic accuracy of onychomycosis: A
multispecialty comparison study. Dermatol Res Pract.
2018;2018:2630176.
5. Alves N, Moreira TA, Malvino LDS, Rodrigues JJ, Ranza R, de
Araújo LB, et al. Onychomycosis in psoriatic patients with nail
disorders: Aetiological agents and immunosuppressive therapy.
Dermatol Res Pract. 2020;2020:7209518.
6. Jayatilake JA, Tilakaratne WM, Panagoda GJ. Candidal
onychomycosis: a mini-review. Mycopathologia. 2009;168(4):165-
173.
7. Zhou J, Chen M, Chen H, Pan W, Liao W. Rhodotorula minuta
as onychomycosis agent in a Chinese patient: first report and
literature review. Mycoses. 2014;57(3):191-5.
8. Ge G, Li D, Mei H, Lu G, Zheng H, Liu W, et al. Different
toenail onychomycosis due to Rhodotorula mucilaginosa and
Candida parapsilosis in an immunocompetent young adult. Med
Mycol Case Rep. 2019;24:69-71.
9. Makimura K, Tamura Y, Mochizuki T, Hasegawa A, Tajiri Y,
Hanazawa R, et al. Phylogenetic classification and species
identification of dermatophyte strains based on DNA sequences of
nuclear ribosomal internal transcribed spacer 1 regions. J Clin
Microbiol. 1999;37(4):920-4.
10. Ghajari A, Lotfali E, Norouzi M, Arab-Mazar Z. First report of
vulvovaginitis due to Cryptococcus magnus in Iran. Curr Med
Mycol. 2018;4(1):30-3.
11. Wayne P. Clinical and Laboratory Standards Institute Reference
Method for Broth Dilution Antifungal Susceptibility Testing of
Yeasts; Fourth International Supplement. CLSI document
2008;M27-S3.
12. Moț AC, Pârvu M, Pârvu AE, Roşca-Casian O, Dina NE,
Leopold N, et al. Reversible naftifine-induced carotenoid
depigmentation in Rhodotorula mucilaginosa (A. Jörg.) F.C.
Harrison causing onychomycosis. Sci Rep. 2017;7(1):11125.
13. Yue X, Li Q, Wang H, Sun Y, Wang A, Zhang Q, et al.
Scanning electron microscopy of the nail plate in onychomycosis
patients with negative fungal culture. Scanning. 2016;38(2):172-6.
14. Khosravi AR, Shokri H, Mansouri P, Katiraee F, Ziglari T.
Candida species isolated from nails and their in vitro susceptibility
to antifungal drugs in the department of Dermatology (University of
Tehran, Iran). J Mycol Méd. 2008;18(4):210-5.
15. Brilhante RS, Cordeiro RA, Medrano DJ, Rocha MF, Monteiro
AJ, Cavalcante CS, et al. Onychomycosis in Ceará (Northeast
Brazil): epidemiological and laboratory aspects. Mem Inst Oswaldo Cruz. 2005;100(2):131-5.
16. Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF,
Hordinsky MK, et al. Guidelines of care for superficial mycotic
infections of the skin: Pityriasis (tinea) versicolor.
Guidelines/Outcomes Committee. American Academy of
Dermatology. J Am Acad Dermatol. 1996;34(2 Pt 1):287-9.
17. Idris NFB, Huang G, Jia Q, Yuan L, Li Y, Tu Z. Mixed
Infection of Toe Nail Caused by Trichosporon asahii and
Rhodotorula mucilaginosa. Mycopathologia. 2020;185(2):373-6.
18. Fidel PL, Jr., Vazquez JA, Sobel JD. Candida glabrata: review
of epidemiology, pathogenesis, and clinical disease with
comparison to C. albicans. Clin Microbiol Rev. 1999;12(1):80-96.
19. Lotfali E, Fattahi A, Sayyahfar S, Ghasemi R, Rabiei MM,
Fathi M, et al. A review on molecular mechanisms of antifungal
resistance in Candida glabrata: Update and recent advances.
Microb Drug Resist. 2021.
20. Lotfali E, Firooz A, Fattahi A, Borzouie M, Chalaki B,
Ghasemi R, et al. Multidrug resistant Candida glabrata in an oral
lichen planus patient. Iranian Journal of Dermatology.
2020;23(3):120-4.
21. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Meis JF,
Gould IM, et al. Results from the ARTEMIS DISK Global
Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of
susceptibilities of Candida species and other yeast species to
fluconazole and voriconazole determined by CLSI standardized disk
diffusion testing. J Clin Microbiol. 2007;45(6):1735-45.
22. Khosravi AR, Mansouri P. Onychomycosis in Tehran, Iran:
prevailing fungi and treatment with itraconazole. Mycopathologia.
2001;150(1):9-13.
23. da Cunha MM, dos Santos LP, Dornelas-Ribeiro M, Vermelho
AB, Rozental S. Identification, antifungal susceptibility and
scanning electron microscopy of a keratinolytic strain of
Rhodotorula mucilaginosa: a primary causative agent of
onychomycosis. FEMS Immunol Med Microbiol. 2009;55(3):396-
403.
24. Manzano-Gayosso P, Méndez-Tovar LJ, Arenas R, HernándezHernández F, Millán-Chiu B, Torres-Rodríguez JM, et al.
Onychomycosis-causing yeasts in four Mexican dermatology
centers and their antifungal susceptibility to azolic compounds. Rev
Iberoam Micol. 2011;28(1):32-5.
treatment and persistence of onychomycosis.
ScientificWorldJournal. 2004;4:760-777.
2. Uludag Altun H, Meral T, Turk Aribas E, Gorpelioglu C,
Karabicak N. A Case of Onychomycosis Caused by Rhodotorula
glutinis. Case Rep Dermatol Med. 2014;2014:563261.
3. Pârvu M, Moţ CA, Pârvu AE, Mircea C, Stoeber L, RoşcaCasian O, et al. Allium sativum extract chemical composition,
antioxidant activity and antifungal effect against Meyerozyma
guilliermondii and Rhodotorula mucilaginosa causing
onychomycosis. Molecules. 2019;24(21).
4. Li DG, Cohen JM, Mikailov A, Williams RF, Laga AC,
Mostaghimi A. Clinical diagnostic accuracy of onychomycosis: A
multispecialty comparison study. Dermatol Res Pract.
2018;2018:2630176.
5. Alves N, Moreira TA, Malvino LDS, Rodrigues JJ, Ranza R, de
Araújo LB, et al. Onychomycosis in psoriatic patients with nail
disorders: Aetiological agents and immunosuppressive therapy.
Dermatol Res Pract. 2020;2020:7209518.
6. Jayatilake JA, Tilakaratne WM, Panagoda GJ. Candidal
onychomycosis: a mini-review. Mycopathologia. 2009;168(4):165-
173.
7. Zhou J, Chen M, Chen H, Pan W, Liao W. Rhodotorula minuta
as onychomycosis agent in a Chinese patient: first report and
literature review. Mycoses. 2014;57(3):191-5.
8. Ge G, Li D, Mei H, Lu G, Zheng H, Liu W, et al. Different
toenail onychomycosis due to Rhodotorula mucilaginosa and
Candida parapsilosis in an immunocompetent young adult. Med
Mycol Case Rep. 2019;24:69-71.
9. Makimura K, Tamura Y, Mochizuki T, Hasegawa A, Tajiri Y,
Hanazawa R, et al. Phylogenetic classification and species
identification of dermatophyte strains based on DNA sequences of
nuclear ribosomal internal transcribed spacer 1 regions. J Clin
Microbiol. 1999;37(4):920-4.
10. Ghajari A, Lotfali E, Norouzi M, Arab-Mazar Z. First report of
vulvovaginitis due to Cryptococcus magnus in Iran. Curr Med
Mycol. 2018;4(1):30-3.
11. Wayne P. Clinical and Laboratory Standards Institute Reference
Method for Broth Dilution Antifungal Susceptibility Testing of
Yeasts; Fourth International Supplement. CLSI document
2008;M27-S3.
12. Moț AC, Pârvu M, Pârvu AE, Roşca-Casian O, Dina NE,
Leopold N, et al. Reversible naftifine-induced carotenoid
depigmentation in Rhodotorula mucilaginosa (A. Jörg.) F.C.
Harrison causing onychomycosis. Sci Rep. 2017;7(1):11125.
13. Yue X, Li Q, Wang H, Sun Y, Wang A, Zhang Q, et al.
Scanning electron microscopy of the nail plate in onychomycosis
patients with negative fungal culture. Scanning. 2016;38(2):172-6.
14. Khosravi AR, Shokri H, Mansouri P, Katiraee F, Ziglari T.
Candida species isolated from nails and their in vitro susceptibility
to antifungal drugs in the department of Dermatology (University of
Tehran, Iran). J Mycol Méd. 2008;18(4):210-5.
15. Brilhante RS, Cordeiro RA, Medrano DJ, Rocha MF, Monteiro
AJ, Cavalcante CS, et al. Onychomycosis in Ceará (Northeast
Brazil): epidemiological and laboratory aspects. Mem Inst Oswaldo Cruz. 2005;100(2):131-5.
16. Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF,
Hordinsky MK, et al. Guidelines of care for superficial mycotic
infections of the skin: Pityriasis (tinea) versicolor.
Guidelines/Outcomes Committee. American Academy of
Dermatology. J Am Acad Dermatol. 1996;34(2 Pt 1):287-9.
17. Idris NFB, Huang G, Jia Q, Yuan L, Li Y, Tu Z. Mixed
Infection of Toe Nail Caused by Trichosporon asahii and
Rhodotorula mucilaginosa. Mycopathologia. 2020;185(2):373-6.
18. Fidel PL, Jr., Vazquez JA, Sobel JD. Candida glabrata: review
of epidemiology, pathogenesis, and clinical disease with
comparison to C. albicans. Clin Microbiol Rev. 1999;12(1):80-96.
19. Lotfali E, Fattahi A, Sayyahfar S, Ghasemi R, Rabiei MM,
Fathi M, et al. A review on molecular mechanisms of antifungal
resistance in Candida glabrata: Update and recent advances.
Microb Drug Resist. 2021.
20. Lotfali E, Firooz A, Fattahi A, Borzouie M, Chalaki B,
Ghasemi R, et al. Multidrug resistant Candida glabrata in an oral
lichen planus patient. Iranian Journal of Dermatology.
2020;23(3):120-4.
21. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Meis JF,
Gould IM, et al. Results from the ARTEMIS DISK Global
Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of
susceptibilities of Candida species and other yeast species to
fluconazole and voriconazole determined by CLSI standardized disk
diffusion testing. J Clin Microbiol. 2007;45(6):1735-45.
22. Khosravi AR, Mansouri P. Onychomycosis in Tehran, Iran:
prevailing fungi and treatment with itraconazole. Mycopathologia.
2001;150(1):9-13.
23. da Cunha MM, dos Santos LP, Dornelas-Ribeiro M, Vermelho
AB, Rozental S. Identification, antifungal susceptibility and
scanning electron microscopy of a keratinolytic strain of
Rhodotorula mucilaginosa: a primary causative agent of
onychomycosis. FEMS Immunol Med Microbiol. 2009;55(3):396-
403.
24. Manzano-Gayosso P, Méndez-Tovar LJ, Arenas R, HernándezHernández F, Millán-Chiu B, Torres-Rodríguez JM, et al.
Onychomycosis-causing yeasts in four Mexican dermatology
centers and their antifungal susceptibility to azolic compounds. Rev
Iberoam Micol. 2011;28(1):32-5.
- Abstract Viewed: 69 times
- pdf Downloaded: 70 times
