Epidemiology and outcome of Rhodotorula infection in haematological patients J. Garcı ´a-Sua ´ rez, 1 P. Go ´ mez-Herruz, 2 J. A. Cuadros 2 and C. Burgaleta 1 1 Haematology Department, Prı´ncipe Asturias Teaching Hospital, Medical Department, University of Alcala ´, Alcala ´ de Henares, Madrid, Spain and 2 Microbiology Department, Prı´ncipe Asturias Teaching Hospital, Alcala ´ de Henares, Madrid, Spain Summary Rhodotorula spp. are emergent opportunistic pathogens, particularly in haematological patients. However, no systematic review of this infection has been undertaken in this high-risk patient group. The aim of this study was to review all reported cases of Rhodotorula infection to determine the epidemiology and outcome of this infection in this high-risk population. The 29 reported cases were fungaemias. The most common underlying haematological disorder was the presence of acute leukaemia (65.5%). Rhodotorula mucilaginosa was the species found more frequently (79.3%). Most cases (58.6%) had several risk factors (‡3) simultaneously. The most common predisposing factors were the presence of central venous catheter (CVC, 100%) and neutropenia (62.1%). A substantial number of patients (81.5%) received antifungal treatment with amphotericin B. The overall mortality was higher (13.8%) than that described in non-haematological patients (5.8% in solid-organ neoplasms and 9% in AIDS or other chronic diseases). Patients with acute leukaemia had a higher mortality rate (15.7%) than patients with non-HodgkinÕs lymphoma (0%). Our data suggest that patients with acute leukaemia might be managed as high-risk patients and intensive measures might be taken. In addition, it appears that the subgroup of patients without acute leukaemia have a good outcome and might be managed as low-risk patients with a less intensive approach. Key words: Rhodotorula, haematological diseases, central venous catheter, fungaemia. Introduction Rhodotorula spp. are commensal yeast of the Cryptococc- aceae family that are present in the respiratory, gastro- intestinal and genital flora of humans, as well as in the environment (air, soil, water and dairy products). They are also found as contaminants in culture plates and medical equipment, and show a high affinity for plastics. 1,2 During the past two decades, this type of yeast has been gradually recognised as an emerging opportunistic pathogen, particularly in immunocom- promised patients. 1,3 The Rhodotorula genus includes eight species, of which R. mucilaginosa, R. glutinis and R. minuta can produce disease in humans. 3 There are three types of invasive infections: transient infections, uncom- plicated fungaemias, and potentially fatal cases of fungaemia caused by endocarditis, peritonitis, ventric- ulitis and meningitis [almost always related to central venous catheters (CVC)]. 1,3–5 Central venous catheter-related fungaemia caused by Rhodotorula is the most common form of infection associated with this yeast. Rhodotorula spp. account for <1% of all cases of nosocomial fungaemia. 6 Among the various species of Rhodotorula, R. mucilaginosa is the most common species in cases of fungaemia (74%), followed by R. glutinis (7.7%). 3,4 To date, most infections caused by Rhodotorula species have been observed in patients with immunosuppression or cancer. Although half the cases of infection caused by Rhodotorula have been described in haematological patients, 3 there is no specific review in the medical Correspondence: Dr Julio Garcı´a-Sua ´ rez, Haematology Department, Hospi- tal Universitario Prı ´ncipe de Asturias, Carretera Alcala ´ -Meco s ⁄ n (Campus Universitario), 28805 Alcala ´ de Henares, Madrid, Spain. Tel.: +34 91 887 8100. Fax: +34 91 881 2510. E-mail: jgarciasu.hupa@salud.madrid.org Accepted for publication 7 January 2010 Review article Ó 2010 Blackwell Verlag GmbH doi:10.1111/j.1439-0507.2010.01868.x mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases