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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5333_Библиотеки_им_академика_М_И_Перельмана
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20 ˜m
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Fig. 85.1. Rhizopus arrhizus culture and a sporangium with a collapsed columella and head of sporangiospores.
100 ˜m
Fig. 85.2. Rhizopus arrhizus sporangiophores, rhizoids and sporangia.
Descriptions of Medical Fungi 226
Antifungal susceptibility: (Table 85.1).
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Table 85.1. Rhizopus arrhizus (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 42 1 5 12 10 6 8
ISAV 11 1 2 2 4 1 1
VORI 41 1 2 12 21 5
POSA 40 6 13 14 7
ITRA 42 1 4 10 12 6 1 1 7
85.2. Rhizopus microsporus v. Tiegh
Synonymy: Rhizopus azygosporus Yuan & Jong; Rhizopus. microsporus var. microsporus Tiegh; Rhizopus
microsporus var. oligosporus (Saito) Schipper & Stalpers; Rhizopus microsporus var. rhizopodiformis (Cohn)
Schipper & Staples; Rhizopus microsporus var. chinensis (Saito) Schipper & Stalpers.
RG-2 organism
Morphological description: Colonies are dark greyish-brown, up to 10 mm high producing simple rhizoids.
Sporangiophores are brownish, up to 400 μm high and 10 μm wide, and may be produced in groups of 1-4,
usually in pairs. Sporangia are greyish-black, spherical, up to 100 μm in diameter. Columellae are subglobose
to globose to conical comprising 80% of the sporangium (Fig. 85.3). Sporangiospores are angular to broadly
ellipsoidal or subglobose, up to 5-9 μm in length and are distinctly striate. Chlamydospores may be present.
Zygospores, formed by crosses of compatible mating strains, are dark red–brown, spherical, up to 100 μm
in diameter, with stellate projections and unequal suspensor cells. Some strains may be homothallic and
produce azygospores. There is good growth at 45
o
C, with a maximum of 50-52oC.
Antifungal susceptibility: (Table 85.2).
Table 85.2. Rhizopus microsporus (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 109 12 31 45 12 8 1
ISAV 16 2 7 5 1 1
VORI 111 3 27 77 4
POSA 109 3 10 53 31 11 1
ITRA 109 1 3 24 54 9 5 12 1
Descriptions of Medical Fungi 227
15 ˜m
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Fig. 85.3. Rhizopus microsporus sporangia showing sporangiospores, columellae, sporangiophores and rhizoids.
DOI: 10.1079/9781800622340.0085
Descriptions of Medical Fungi 228
Rhodotorula species are common environmental basidiomycetous yeasts, which can be found in soil, ocean
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and lake water, fruit juice and milk, and on shower curtains and toothbrushes. Today, the genus contains 46
species of which three have been described as rare human pathogens: R. mucilaginosa (formerly R. rubra),
R. glutinis and R. minuta (Arendrup et al., 2014).
Rhodotorula mucilaginosa is a common airborne contaminant of skin, lungs, urine and faeces and is a
known cause of fungal peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). This is
usually due to saprophytic colonisation of catheters or dialysis machinery and removal of the source of contamination usually leads to clearing of the symptoms. This species accounts for the majority of infections
(74-79%) followed by R. glutinis (7.7%) (Tuon and Costa 2008; Arendrup et al., 2014).
Molecular identification: ITS or D1/D2 sequencing is recommended (Duboc de Almeida et al., 2008; Tuon
and Costa, 2008; Arendrup et al., 2014).
MALDI-ToF MS: Reliably identifies clinically relevant Rhodotorula species.
References: McGinnis (1980); Barnett et al. (1983); Rippon (1988);Duboc de Almeida et al. (2008); Tuon
and Costa (2008); Sampaio (2011); Spiliopoulou et al. (2012); Arendrup et al. (2014).
86.1. Rhodotorula glutinis (Fresenius) Harrison
RG-1 organism
Morphological description: Colonies are coral-red to salmon coloured or slightly orange, smooth to wrinkled, highly glossy to semi-glossy. Mucoid to pasty to slightly tough, yeast-like colonies. Ovoidal to globose
or more elongate budding yeast-like cells or blastoconidia, 2.3-5.0 × 4.0-10.0 μm.
India ink preparation: Small capsules present.
Germ tube formation: Negative.
Physiological tests: (+ Positive, – Negative, v Variable, w Weak, s Slow, n not done).
Fermentation: Absent.
Growth reactions:
Glucose + L-Sorbose + myo-Inositol –
Sucrose + L-Rhamnose – DL-Lactate –
Raffinose +,s D-Xylose s D-Gluconate +
Melibiose – L-Arabinose + 2-Keto-D-gluconate n
Galactose + D-Arabinose + D-Glucosamine –
Lactose – D-Ribose + N-Acetyl-D-glucosamine n
Trehalose + Glycerol + D-Glucuronate –
Maltose + Erythritol – Nitrate –
Melezitose + Ribitol + Urease +
Methyl-α-D-glucoside + Galactitol – 0.1% Cycloheximide +
Soluble starch – D-Mannitol + Growth at 35oC –
Cellobiose + D-Glucitol + Growth at 37oC –
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis)
229
Molecular identification: Requires sequencing of the ITS and/or D1/D2 regions.
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Key features: Germ tube negative yeast, sugar assimilation pattern. Growth on nitrate is positive (R. mucilagi-
nosa growth on nitrate is negative). Common saprophyte, however cases of fungaemia have been reported.
Antifungal susceptibility: (Table 86.1).
Table 86.1. Rhodotorula glutinis (Diekema et al., 2005; and Australian national data); MIC μg/mL. Note: Rhodotorula
species are intrinsically resistant to echinocandins and fluconazole (Arendrup et al., 2014).
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 38 1 2 4 3 28
FLU 38 38
VORI 36 1 1 12 12 9 1
POSA 34 2 9 18 4 1
ITRA 38 1 1 3 9 11 2 3 8
5FC 38 17 12 8 1
86.2. Rhodotorula mucilaginosa (Jorgensen) Harrison
Synonymy: Rhodotorula rubra (Demme) Lodder.
RG-1 organism
Morphological descriptions: Colonies are coral-pink, usually smooth, sometimes reticulate, rugose or corrugated, moist to mucoid, yeast-like colonies (Fig. 86.1). Spherical to elongate budding yeast-like cells or
blastoconidia, 2.5-6.5 x 6.5-14.0 μm.
Fig. 86.1. Rhodotorula mucilaginosa culture.
Descriptions of Medical Fungi 230
India ink preparation: Small capsules present.
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Germ tube formation: Negative.
Physiological tests: (+ Positive, – Negative, v Variable, w Weak, s Slow, n not done).
Fermentation: Absent.
Growth reactions:
Glucose + L-Sorbose v myo-Inositol –
Sucrose + L-Rhamnose – DL-Lactate v
Raffinose + D-Xylose + D-Gluconate +
Melibiose – L-Arabinose + 2-Keto-D-gluconate n
Galactose +,s D-Arabinose + D-Glucosamine –
Lactose – D-Ribose + N-Acetyl-D-glucosamine n
Trehalose + Glycerol + D-Glucuronate –
Maltose + Erythritol – Nitrate –
Melezitose + Ribitol + Urease +
Methyl-α-D-glucoside v Galactitol – 0.1% Cycloheximide –
Soluble starch – D-Mannitol v Growth at 35oC v
Cellobiose +,s,w D-Glucitol v Growth at 37oC –
Molecular identification: Requires sequencing of the ITS and/or D1/D2 regions.
Key features: Germ tube negative yeast and sugar assimilation pattern. Growth on nitrate is negative
(R. glutinis growth on nitrate is positive). Common saprophyte however cases of peritonitis and fungaemia
have been reported.
Antifungal susceptibility: (Table 86.2).
Table 86.2. Rhodotorula mucilaginosa (Diekema et al., 2005; and Australian national data; MIC μg/mL. Note:
Rhodotorula species are intrinsically resistant to echinocandins and fluconazole (Arendrup et al., 2014).
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 77 2 3 29 39 3 1
FLU 77 1 8 68
ISAV 18 1 1 1 5 1 4 3 2
VORI 76 9 2 6 11 15 23 9 1
POSA 76 1 5 7 15 34 2 8 4
ITRA 77 1 9 11 28 10 2 2 14
5FC 77 24 31 17 4 1
DOI: 10.1079/9781800622340.0086
Descriptions of Medical Fungi 231
Meyenex Hansen
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Saccharomyces cerevisiae, commonly known as baker’s yeast, may be found as a harmless and transient
digestive commensal and coloniser of mucosal surfaces of normal individuals. The anamorphic state of
S. cerevisiae is sometimes referred to as Candida robusta. This species is phylogenetically closely related to
Candida glabrata and shares many clinical and microbiological characteristics to this species (Arendrup
et al., 2014). S. cerevisiae may be involved in mucosal infections like vaginitis, and in bloodstream infections,
particularly in fluconazole-exposed patients.
Note: Saccharomyces boulardii, a genetically similar subtype that is used as a probiotic for prevention and
treatment of various sorts of diarrhoea and recurrent Clostridium difficile-associated diarrhoea should be
avoided in immunocompromised hosts (Enache-Angoulvant and Hennequin, 2005; Arendrup et al., 2014).
RG-1 organism
Morphological description: Colonies are white to cream, smooth, glabrous and yeast-like. Large globose to
ellipsoidal budding yeast-like cells or blastoconidia, 3.0-10.0 × 4.5-21.0 μm. No capsules present on India
Ink preparation.
Germ tube formation: Negative.
Physiological tests: (+ Positive, – Negative, v Variable, w Weak, s Slow, n not done).
Fermentation:
Glucose + Sucrose + Lactose –
Galactose v Maltose + Trehalose –
Growth reactions:
Glucose + L-Sorbose – myo-Inositol –
Sucrose + L-Rhamnose – DL-Lactate v
Raffinose + D-Xylose – D-Gluconate v
Melibiose – L-Arabinose – 2-Keto-D-gluconate –
Galactose v D-Arabinose – D-Glucosamine –
Lactose – D-Ribose – N-Acetyl-D-glucosamine –
Trehalose + Glycerol v D-Glucuronate –
Maltose + Erythritol – Nitrate –
Melezitose v Ribitol – Urease –
Methyl-α-D-glucoside – Galactitol – 0.1% Cycloheximide –
Soluble starch – D-Mannitol – Growth at 30oC +
Cellobiose – D-Glucitol – Growth at 37oC v
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 232
Molecular identification: ITS and D1/D2 sequencing is recommended (McCullough et al., 1988).
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Antifungal susceptibility: (Table 87.1).
Table 87.1. Saccharomyces cerevisiae (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 85 1 1 9 20 28 33 3
FLU 96 4 7 17 16 11 24 13 4
ISAV 12 3 1 2 3 1 2
VORI 92 4 12 23 12 27 10 3 1
POSA 89 1 6 21 19 29 11 2
ITRA 96 2 15 25 26 22 2 1 3
ANID 86 2 4 7 47 20 6
MICA 86 1 4 55 24 2
5FC 96 8 78 7 1 1 1
References: McGinnis (1980); Barnett et al. (1983); Rippon (1988); Vaughan-Martini and Martini (2011);
de Hoog et al. (2015).
DOI: 10.1079/9781800622340.0087
Descriptions of Medical Fungi 233
The genus Saksenaea is characterised by the formation of flask-shaped sporangia with columellae and simple,
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darkly pigmented rhizoids. It is an emerging human pathogen (Holland, 1997) that is most often associated
with cutaneous or subcutaneous lesions after trauma. Until recently, Saksenaea vasiformis was the only
known species and appears to have a worldwide distribution in association with soil.
However, recent phylogenetic studies have identified additional species, namely, S. erythrospora, S. dorisiae,
S. loutrophoriformis, S. oblongispora and S. trapezispora (Alvarez et al., 2010b; Crous et al., 2016, 2017;
Labuda et al., 2019). So far, all species (except S. dorisiae) have been isolated from clinical samples.
88.1. Saksenaea vasiformis Saksena
RG-2 organism
Morphological description: Colonies are fast growing, downy, white with no reverse pigment made up of
broad, non-septate hyphae typical of a mucormycetous fungus. Sporangia are typically flask-shaped with a
distinct spherical venter and long-neck, arising singly or in pairs from dichotomously branched, darkly pigmented rhizoids. Columellae are prominent and dome-shaped (Fig. 88.1). Sporangiospores are small, oblong,
1-2 x 3-4 μm, and are discharged through the neck following the dissolution of an apical mucilaginous plug.
Good growth at 42
Key features: Unique flask-shaped sporangia, failure to sporulate on primary isolation media.
Molecular identification: ITS sequencing typically required for identification and differentiation between
species due to lack of sporulation on routine media (Alvarez et al., 2010b; Walther et al., 2012; Halliday
et al., 2015).
Comment: Laboratory identification of this fungus may be difficult or delayed because of the mould’s failure
to sporulate on primary isolation media or on subsequent subculture onto potato dextrose agar. Sporulation
may be stimulated by using the agar block method described by Ellis and Ajello (1982), Ellis and Kaminski
(1985) and Padhye and Ajello (1988), although this may still take a period of days to weeks. Failure to sporulate also prohibits antifungal susceptibility testing (Fig. 88.2).
o
C; no growth at 50oC.
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 234
30 ˜m
m 3
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30 ˜
0 ˜m
Fig. 88.1. Saksenaea vasiformis sporangia.
(a) (b)
Fig. 88.2. Saksenaea vasiformis cultures showing (a) rapid non-sporulating growth on potato dextrose agar, and
(b) the agar block method to induce sporulation. A small block of agar is cut from the culture grown on potato dextrose
agar and is placed in the centre of petri dish containing 1% agar in distilled water and incubated at 26
o
C. Sporangia
may be found by examining growth at the periphery of the petri dish at intervals of up to 4 weeks.
Descriptions of Medical Fungi 235
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