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In addition, it is the most studied eukaryotic microorganism, and has been used as a biological model in research in the field of cell physiology (metabolic pathways, genome and genetic rearrangement). It has gained significance in recent years as an opportunistic pathogen associated with the use of broad spectrum antibiotics, intravascular catheters and probiotics (marketed as <span class="elsevierStyleItalic">Saccharomyces boulardii</span>).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We present a case report that extends the current scientific evidence proving its infectious potential in an immunocompetent individual.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient is a 27-year-old man, baker by profession, with a history of asthma and sinusitis. He went to the emergency room for a progressive 6-month-development diplopia and right eyelid ptosis. He also associated right frontoparietal headache, which occasionally woke him up at night, and gave in with regular painkillers.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination showed a discrete right exophthalmos, right ptosis and limited abduction and infraversion of the right eye with maximum binocular diplopia in dextroversion and supraversion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In cranial CT and MRI of eye-sockets (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) we noted an heterogenous right intraconal solid mass 46<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>26<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm, with central necrosis; It involves the inferior rectus muscle and causes an upper and lateral displacement of the eyeball. The histological study of a mass biopsy showed signs of non-necrotizing granulomatous inflammation, positive staining for periodic acid Schiff (PAS) and fungal structures. <span class="elsevierStyleItalic">S. cerevisiae</span> grew in the culture of said sample.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the supplementary study, congenital and acquired immunodepression were ruled out. At the patient interview, the patient acknowledged being an ex-consumer of intranasal cocaine.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S. cerevisiae</span> is a common colonizer of the vaginal, digestive and respiratory mucous membranes. The microbial translocation through the oral and intestinal mucosa, as well as the exposure to a high fungal load are the major factors involved in its pathogenic potential.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In recent decades there has been a significant increase in invasive fungal infections caused by this fungus, related to immunosuppression. It can cause a very varied infectious symptomatology, fungemia being the most serious clinical manifestation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Cocaine along with its adulterants, is a drug of abuse that, applied directly to the mucous membranes, can cause swelling, ulceration and necrosis due to chemical burn.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It also associates local ischemia through a mechanism of vasoconstriction.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Cases of immune-mediated vasculitis with positive anti-neutrophil cytoplasmic antibodies have been reported.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Likewise, some users have been reported to have some alterations in cells and mucous layer in users of this drug, even with an apparently normal macroscopic aspect.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In order to know the scientific evidence regarding infections by this yeast in immunocompetent individuals, we looked up some references in MEDLINE/PubMed database from 01/01/1980 to 31/01/2018 in Spanish and English, with the following descriptors: “<span class="elsevierStyleItalic">Saccharomyces cerevisiae</span>” [Mesh Terms] <span class="elsevierStyleItalic">AND</span> “immunocompetence” [Mesh Terms] <span class="elsevierStyleItalic">AND</span> “humans” [MeSH Terms]. We found 3 articles that included case reports of infection by this yeast in immunocompetent patients, but with predisposing factors of invasive fungal infection, being the use of intravenous catheter and previous treatment with antibiotics the most common. In our case, the occupational exposure to yeast associated with intranasal cocaine consumption was the predisposing factors of fungal infection: changes in the primary immunological barrier of the nasal mucosa favored the migration of the yeast to the orbit.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González Nafría N, Redondo Robles L, Lara Lezama LB. Infección por <span class="elsevierStyleItalic">Saccharomyces cerevisiae</span> en un individuo inmunocompetente. Med Clin (Barc). 2019;152:122–123.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 580 "Ancho" => 803 "Tamanyo" => 42346 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sagittal CT scan of the orbit, with contrast, showing intraconal mass in the right eye (asterisk), with no compression to the optic disc.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por <span class="elsevierStyleItalic">Saccharomyces cerevisiae</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. 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Journal Information
Vol. 152. Issue 3.
Pages 122-123 (February 2019)
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Vol. 152. Issue 3.
Pages 122-123 (February 2019)
Letter to the Editor
Saccharomyces cerevisiae infection in an immunocompetent host
Infección por Saccharomyces cerevisiae en un individuo inmunocompetente
Noelia González Nafría
, Laura Redondo Robles, Lidia Binela Lara Lezama
Corresponding author
Servicio de Neurología, Complejo Asistencial Universitario de León, León, Spain
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