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Case Reports
. 2022 Oct;28(10):2091-2095.
doi: 10.3201/eid2810.220507.

Endofungal Mycetohabitans rhizoxinica Bacteremia Associated with Rhizopus microsporus Respiratory Tract Infection

Case Reports

Endofungal Mycetohabitans rhizoxinica Bacteremia Associated with Rhizopus microsporus Respiratory Tract Infection

Shangxin Yang et al. Emerg Infect Dis. 2022 Oct.

Abstract

We report Mycetohabitans rhizoxinica bacteremia in a 65-year-old woman in California, USA, who was undergoing chimeric antigen receptor T-cell therapy for multiple myeloma. Acute brain infarction and pneumonia developed; Rhizopus microsporus mold was isolated from tracheal suction. Whole-genome sequencing confirmed bacteria in blood as genetically identical to endofungal bacteria inside the mold.

Keywords: Burkholderia rhizoxinica; Mycetohabitans rhizoxinica; Rhizopus microspores; United States; bacteremia; bacteria; endofungal bacteria; fungi; mucormycosis; respiratory infection.

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Figures

Figure 1
Figure 1
Imaging studies from a 65-year-old woman with multiple myeloma undergoing chimeric antigen receptor T-cell therapy who was admitted to the hospital for worsening foot and ankle pain, California, USA. A) Chest radiograph image, showing a moderate right-sided pleural effusion and adjacent pulmonary opacities indicative of pneumonia. B) Magnetic resonance imaging of the patient’s brain, showing the infarct involving the left medial parietal lobe.
Figure 2
Figure 2
Whole-genome sequencing analysis of bacterial and fungal isolates (A) in a 65-year-old woman with multiple myeloma undergoing chimeric antigen receptor T-cell therapy, California, USA. The bacteria were identified as Mycetohabitans rhizoxinica with >99% identity in all 3 full-length marker genes compared with the reference organism (B, left side). The mold was identified as Rhizopus microsporus with >99% identity in the ITS gene and the D1–D2 region of the 28S gene compared with a reference organism (B, right side). Whole-genome sequences of the bacteria from blood (C, left side) revealed whole-genome coverage 94.0% and pairwise identity 95.5% with sufficient mean coverage of 298×. Whole-genome sequence of the mold from tracheal aspirate (C, right side) aligned to reference bacterial whole-genome sequence showed whole-genome coverage 94.1% and pairwise identity 95.8%, with sufficient mean coverage of 75×. The bacteria inside the mold from the trachea were genetically identical to the bacteria from the blood, as shown by the SNP analysis (D). ITS, internal transcribed spacer; SNP, single nucleotide polymorphism.

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