The World’s first reported case of Rhodotorula infection, coupled with Cytomegalovirus (CMV) Meningitis that infected a 2-month-old infant, was successfully treated by a team of doctors at a private hospital in Noida. This is the second reported case of CMV meningitis diagnosed via `Biofire` in the world as per the available medical records. Notably, Rhodotorula is a genus of pigmented yeasts, and Biofire is an infection and inflammation of the lining of the brain, caused by a virus named CMV-Cytomegalovirus.
The hospital said, “The infant, a resident of Mathura, UP was admitted to a private hospital in Noida with fever, increased irritability, and two episodes of abnormal movements, including up-rolling of eyes, bulging in the top of the head and irritable cry. Several medical tests such as MRI, and CSF (cerebrospinal fluid) were conducted to identify any underlying infection, which revealed that the baby had meningitis. Owing to the uncontrolled seizures, the baby was intubated and administered antibiotics.
Clinically, the baby showed improvement with satisfactory feeding and activity, but his high-grade fever was not getting better”. “He was having 3-4 episodes of fever every day, thus a CSF examination was repeated and sent for a Biofire test which was CMV positive. Injection Ganciclovir was administered for the following six weeks. However, the fever did not subside even after 10 days of IV ganciclovir being administered.
The CSF fungal culture revealed the presence of Rhodotorula infection, reported for the First time across the globe,” the hospital stated. Dr Ashutosh Sinha, Director and Head, Paediatrics, Fortis Hospital, Noida further elaborating on the case said, “The baby was initially treated with IV antibiotics and IV antiepileptics. However, he had multiple episodes of seizure, for which he was electively intubated and put on mechanical ventilation and IV midazolam infusion. The baby was extubated after 48 hours of being seizure-free. Clinically, the baby showed improvement but high-grade fever was not getting better. Subsequently, Cytomegalovirus meningitis (CMV) was detected.”
“The baby was then injected with Ganciclovir which continued for six weeks. However, the fever continued for 10 days. A repeat CSF fungal culture revealed the presence of a rare yeast – Rhodotorula species, which has not been identified or observed in CMV anywhere in the world. Then Amphotericin B was started and continued for four weeks, which helped the baby recover and his fever also subsided. Without immediate and correct treatment, the chances of survival were meager,” he added.
He said that if the patient is left untreated in that condition, there are chances of high mortality, neuro disability, and other complications. “Initial MRI showed changes in the brain but subsequent MRI of the brain showed improvement and we discharged the baby in normal condition without any complications. The condition has risk factors – high mortality, neuro disability, and other related complications if left undiagnosed 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 don’t know they have CMV because it rarely causes problems in healthy people. This infection generally happens in immunocompromised and HIV patients or those undergoing chemotherapy. There have been cases reported of CMV infection in babies acquired before birth from the mother or after birth through breast milk but infection of the brain is very rare. Some babies can acquire it after birth via breast milk. However, in this case, it was not possible to ascertain if breast milk was the carrier, although we stopped breast milk to limit the exposure.”
Dr Shubham Garg, Senior Consultant – Surgical Oncology, Fortis Noida who evaluated and advised for a chemo port in this case, said that finding a vein to administer IV medications is always a challenge in infants. “This was a 2-month-old child and we needed immediate administration of Intravenous medications for more than a month. Chemoport is usually used in patients who require multiple cycles of chemotherapy. It is placed in the skin below the clavicle and is connected to a large vein using a catheter. In this case, this was a challenge as the diameter of the catheter might not fit the small vessels/veins. Thus, we ordered a special small-sized port (6F) and were able to place it successfully with the help of anesthesia,” he said.