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CASE REPORT
Year : 1995  |  Volume : 43  |  Issue : 4  |  Page : 196-198

Rhodotorula causing chronic Dacryocystitis: A case report


Department of Microbiology, Bangalore Medical College, Bangalore, India

Correspondence Address:
Sumathi Muralidhar
"Kanthi Nivas", 8, 3rd Main Road, Ganganagar Extension, Bangalore 560 032
India
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Source of Support: None, Conflict of Interest: None


PMID: 8655200

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How to cite this article:
Muralidhar S, Sulthana C M. Rhodotorula causing chronic Dacryocystitis: A case report. Indian J Ophthalmol 1995;43:196-8

How to cite this URL:
Muralidhar S, Sulthana C M. Rhodotorula causing chronic Dacryocystitis: A case report. Indian J Ophthalmol [serial online] 1995 [cited 2020 Nov 24];43:196-8. Available from: https://www.ijo.in/text.asp?1995/43/4/196/25252

Infectious dacryocystitis may be caused by bacteria, fungi, viruses, parasites and rarely, insects (myiasis). Bacteria constitute the major causative agents of chronic dacryocystitis and include Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, Klebsiella, and Acinetobacter. Rarely, beta-haemolytic streptococci and Actinomyces species may be causative agents.[1][2][3]

Fungal aetiology is largely due to Candida, Aspergillus, and Cephalosporium, though, Blastomyces, Paecilomyces, Sporothrix, Rhinosporidium, and Trichophyton have also been incriminated.[3],[4]

The indiscriminate use of antibiotics and steroids have undoubtedly contributed to the increased incidence of fungal dacryocystitis.[5]

In the course of our routine evaluation of dacryocystitis, we encountered a case of chronic dacryocystitis caused by Rhodotorula rubra, a hitherto unreported causative fungus and herein report our findings.


  Case report Top


A 50-year-old male farmer came with a history of pain, redness, watering and diminished vision in the left eye of one month duration following an injury to the cornea of the same eye with a paddy stick. On interrogation, he gave a one-year history of watering and intermittent discharge from the same eye, prior to the injury.

On examination, his general condition was fair. The visual acuity in the affected eye was perception of light. Slit-lamp examination revealed a central, circular ulcer 7 to 8 mm in size, with localised whitish infiltrates raised above the surface of the cornea with small epithelial defects. Edges were frayed and there was no vascularisation. The surrounding cornea was hazy. There was hypopyon in the anterior chamber [Figure - 1].

Other clinical features included a 1 x 1-cm swelling in the medial canthus of the left eye with purulent discharge through the lower punctum, on applying pressure over the area; there were no signs of acute inflammation like pain or redness. The discharge was creamish-white and viscous. Lid oedema and conjunctival injection were the other noteworthy features.

Investigations: Corneal scrapings from the base and edge of the ulcer and the lacrimal sac discharge were subjected to microscopic evaluation using Gram's stain and KOH wet mount and culture. The culture media used were MacConkey's agar, chocolate agar, and Sabouraud's dextrose agar.

Both KOH wet mount and Gram's stain showed pus cells and budding yeast forms. While growth on MacConkey's agar and chocolate agar were negative, Sabouraud's dextrose agar showed bright, coral red, mucoid colonies [Figure - 2].

Identification of Rhodotorula rubra: Gram's stain showed gram-positive budding yeast forms, 3 to 5 u long with thin capsules. No pseudomycelia were seen [Figure - 3]. Corn meal agar showed no pseudomycelia. Fermentation tests were negative. Assimilation tests with various carbohydrates were positive for glucose, raffinose, sucrose, maltose, galactose, trehalose, and negative for lactose, inositol, starch, D-xylose, nitrate. Intraperitoneal inoculation of the fungus into white mice produced no adverse effects even at the end of one week. Based on these findings it was concluded that the yeast was Rhodotorula rubra. However, sensitivity tests were not done because antifungal drugs were not available in disk forms.

The patient was initially treated with topical antibiotics (chloramphenicol), antifungal drugs (miconozole, natamycin), cycloplegics, and systemic anti-inflammatory drugs. The patient finally underwent dacryocystectomy.

The excised sac tissue also grew Rhodotorula rubra when processed.

With these measures the patient showed some improvement, with decrease in inflammation, conjunctival congestion and lid oedema. His visual acuity improved to counting fingers at 3 metres. Assessment of further improvement was not possible because the patient was lost to follow-up.


  Discussion Top


Rhodotorula is a yeast frequently isolated from air, soil, water, dairy products, and other substrates of the environment. It is also a frequent inhabitant of hospital equipment. It has been identified in the flora of humans and has been cultured from skin, urine, stool, sputum, respiratory secretions, gastric washings, blood, vagina, and cerebrospinal fluid of hospitalised patients.[6]

The genus comprises of eight species, but Rhodotorula rubra is the only species in human infection reported conclusively.[6] Infections include fungaemia, endocarditis, peritonitis, meningitis, ventriculitis, keratitis,[7],[8] and rarely, endophthalmitis.[9]

Macroscopically, Rhodotorula is an asporogenous, non-fermenting yeast with carotenoid pigment, and is glistening, mucoid, deep coral to salmon pink in colour on most mycological media.

Microscopically, the cells are round, oval or elongate, thin-walled and reproduce by budding. Pigment granules, a rudimentary pseudomycelium and short chains or clusters may sometimes be seen.

Rhodotorula can be differentiated from the other red yeast, Sporobolomyces by the absence of ballistospore formation.[6]

While ocular infections caused by yeasts respond well to amphotericin B and flucytocine, our patient with Rhodotorula infection apparently responded reasonably well to natamycin and miconozole.

The possible source of infection in the present case could be one of the environmental substrates like air, soil or water, which may have caused the chronic inflammatory changes in the lacrimal sac. The cornea appeared to be secondarily infected following injury with the paddy stick.

 
  References Top

1.
Duke-Elder S. System of Ophthalmology, Vol. XIII. The Ocular Adnexa, Part II. St. Louis, CV Mosby Co., 1974, pp. 699-714.  Back to cited text no. 1
    
2.
Mahajan VM. Acute bacterial infections of the eye. Br J Ophthalmol 67:191-194, 1983.  Back to cited text no. 2
    
3.
Chandler JW, Sugar J, Edelhauser HF. Textbook of Ophthalmology. External Diseases: Cornea, Conjunctiva, Sclera, Eyelids, Lacrimal System, Vol. 8. Philadelphia, CV Mosby Co., 1994, pp. 1417-1418.  Back to cited text no. 3
    
4.
Rippon JW. Medical Mycology: The Pathogenic Fungi and the Pathogenic Actinomycetes. Philadelphia, WB Saunders Co., 1974, pp. 475-487.  Back to cited text no. 4
    
5.
Rippon JW. Medical Mycology: The Pathogenic Fungi and the Pathogenic Actinomycetes. Philadelphia, WB Saunders Co., 1974, pp. 226-227.  Back to cited text no. 5
    
6.
Kwan Chung KJ, Bennett JE. In: Lea, Febiger, eds., Medical Mycology. 1992, pp. 170-172-772.  Back to cited text no. 6
    
7.
Baron EJ, Finegold SM. Bailey & Scott's Diagnostic Microbiology, 8th Ed. Philadelphia, CV Mosby Co, 1990, pp. 764.  Back to cited text no. 7
    
8.
Guerra R, Cavallini GM, Longanesia L, et al. Rhodotorula glutinis keratitis. Int ophthalmol 16:187-190, 1992.  Back to cited text no. 8
    
9.
Gregory JK, Haller JA. Chronic postoperative Rhodotorula endophthalmitis. Arch Ophthalmol 110:1686-1687, 1992.  Back to cited text no. 9
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


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