The world’s first case of Rhodotorula infection combined with Cytomegalovirus (CMV) meningitis, which infected a 2-month-old infant, was successfully treated by a team of doctors at a private hospital in Noida. As per available medical records this is the second case of CMV meningitis diagnosed through ‘Biofire’ in the world. Specifically, Rhodotorula is a genus of pigmented yeast, and biofire is an infection and inflammation of the lining of the brain, caused by a virus called CMV-cytomegalovirus.
The hospital said, “The infant, a resident of Mathura, UP, was admitted to a private hospital in Noida with fever, irritability and two episodes of abnormal movement, including bulging eyes, bulging of the head and irritable crying. Any Several medical tests such as MRI, and CSF (cerebrospinal fluid) were done to identify the underlying infection, which revealed that the child had meningitis. Due to uncontrollable seizures, the child was intubated and administered antibiotics.
Clinically, the child showed improvement with satisfactory feeding and activity, but her high-grade fever was not improving. CMV was positive. Ganciclovir injections were given for the next six weeks. However, the fever did not subside even after 10 days of giving ganciclovir IV.
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CSF fungal culture revealed the presence of Rhodotorula infection, the first reported worldwide. Initially treated with IV antibiotics and IV antiepileptics. However, she had several episodes of seizure, for which she was electively intubated and placed on mechanical ventilation and IV midazolam infusion. The child was extubated 48 hours after being free of seizures. Clinically, the child showed improvement but the high grade fever was not getting better. Subsequently, cytomegalovirus meningitis (CMV) was diagnosed.”
“The child was then injected with ganciclovir which continued for six weeks. However, the fever persisted for 10 days. Repeat CSF fungal culture revealed the presence of a rare yeast – Rhodotorula species, which has not been identified anywhere in CMV or have not been observed. Then amphotericin B was started and continued for four weeks, which helped the child recover and his fever also came down. Without immediate and correct treatment, the chances of survival were slim,” he Said.
He added that if the patient is left untreated in that condition, there is a possibility of high mortality, neuro disability and other complications. “Early MRI showed brain changes but later MRI of brain showed improvement and we discharged the child in normal condition without any complications. The risk factors in this condition are – high mortality rate, neuro disability, and other associated complications If left unchecked and untreated,'” he said.
Dr Sinha further added, “Cytomegalovirus is a common virus and once infected, the body retains the virus for life. Most people do not know they have CMV as it rarely causes problems in healthy people. This infection usually occurs in immunocompromised and HIV patients. Or those undergoing chemotherapy. Cases of CMV infection in infants acquired through breast milk from the mother before birth or after birth have been reported but infection of the brain is very rare. Some babies can get it through breast milk after birth. However, in this case, it was not possible to ascertain whether breast milk was the carrier, although We withheld breast milk to limit the risk.”
Dr. Shubham Garg, Senior Consultant – Surgical Oncology, Fortis Noida, who evaluated and advised for chemo port in this case, said that finding a vein to administer IV drugs is always a challenge in infants. “It was a 2-month-old baby and we needed immediate administration of intravenous drugs for more than a month. Chemoport is commonly used in patients who need multiple cycles of chemotherapy. It is given below the collarbone. is placed into the skin and connected to a large vein using a catheter. In this case, this was a challenge as the diameter of the catheter could not fit into smaller vessels/veins. Thus, we developed a special smaller size K port (6F) and were able to set it up successfully with the help of anesthesia,” he said.