ABSTRACT
This study aimed to evaluate the frequency of cryptic Candida species from candidemia cases in 22 public hospitals in São Paulo State, Brazil, and their antifungal susceptibility profiles. During 2017 and 2018, 144 isolates were molecularly identified as 14 species; C. parapsilosis (32.6%), C. albicans (27.7%), C. tropicalis (14.6%), C. glabrata (9.7%), C. krusei (2.8%), C. orthopsilosis (2.8%), C. haemulonii var. vulnera (2.1%), C. haemulonii (1.4%), C. metapsilosis (1.4%), C. dubliniensis (1.4%), C. guilliermondii (1.4%), C. duobushaemulonii (0.7%), C. kefyr (0.7%), and C. pelliculosa (0.7%). Poor susceptibility to fluconazole was identified in 6.4% of C. parapsilosis isolates (0.12 to >64 µg/mL), 50% of C. guilliermondii (64 µg/mL), 66.6% of C. haemulonii var. vulnera (16-32 µg/mL), and C. duobushaemulonii strain (MIC 64 µg/mL). Our results corroborated the emergence of C. glabrata in Brazilian cases of candidemia as previously reported. Importantly, we observed a large proportion of non-wild type C. glabrata isolates to voriconazole (28.6%; <0.015 to 4 µg/mL) all of which were also resistant to fluconazole (28.6%). Of note, C. haemulonii, a multidrug resistant species, has emerged in the Southeast region of Brazil. Our findings suggested a possible epidemiologic change in the region with an increase in fluconazole-resistant species causing candidemia. We stress the relevance of routine accurate identification to properly manage therapy and monitor epidemiologic trends.
Subject(s)
Candida , Antifungal Agents/pharmacology , Brazil , Microbial Sensitivity Tests , Drug Resistance, Fungal , HospitalsABSTRACT
La Candida haemulonii forma parte de la especie Candida no albicans. La candidemia por C. haemulonii es sumamente infrecuente, pero mortal, en los recién nacidos. Se informa sobre los dos primeros recién nacidos con candidemia por C. haemulonii en China tratados con fluconazol y se revisan dos artículos informados con anterioridad. Nuestro informe incrementa la sensibilización sobre la candidemia por C. haemulonii en recién nacidos críticos y resalta la importancia de un diagnóstico y un tratamiento tempranos de esta infección mortal.
Candida haemulonii forms part of the non-albicans Candida species. The candidemia caused by C. haemulonii is extremely rare but fatal in neonates. We reported the first two neonates with C. haemulonii candidemia in China which were treated with fluconazole and reviewed two papers previously reported. Our report adds further awareness on C. haemulonii candidemia in critical neonates and points out the importance of an early diagnosis and treatment of this fatal infection.
Subject(s)
Humans , Male , Female , Infant, Newborn , Fluconazole/therapeutic use , Catheter-Related Infections/drug therapy , Candidemia/drug therapy , Candida/isolation & purification , China , Treatment Outcome , Catheter-Related Infections/microbiology , Candidemia/etiology , Candidemia/microbiology , Antifungal Agents/therapeutic useABSTRACT
La peritonitis fúngica es la responsable del 3 a 6% de los casos de peritonitis asociada a diálisis. Es causa importante de morbimortalidad y de falla de la técnica. El microorganismo aislado con mayor frecuencia es la Candida albicans. Sin embargo, en los últimos años la incidencia de nuevos casos asociados a Candida no albicans y otros hongos, ha aumentado. De estas especies patógenas, Candida haemulonii es causal de infecciones humanas, siendo inusual en pacientes en diálisis, encontrándose un caso reportado en la literatura de peritonitis asociado a diálisis. C. haemulonii supone ciertos retos diagnósticos ya que es un complejo de tres especies que requieren métodos moleculares de laboratorio para su diferenciación. Adicionalmente, tiene un perfil de multirresistencia a los antimicóticos que constituye para el clínico, un reto en el oportuno tratamiento de estos pacientes. A continuación, se describe un caso de peritonitis asociado a diálisis peritoneal por C. haemulonii.
Fungal peritonitis represents 3 to 6% of peritonitis in dialysis patients. It is an important cause of morbidity, mortality and technique failure. The most frequently isolated microorganism is Candida albicans; however, in recent years there are an increasing number of cases of non Candida albicans and other fungal peritonitis. Candida haemulonii causes human infections, but it is unusual in dialysis patients. There is one reported case of peritonitis in a dialysis patient. C. haemulonii generates certain diagnostic and therapeutic challenges because it is a complex of three species that can only be differentiated by specialized molecular methods and additionally, has a multidrug resistance profile. We describe the case of a dialysis patient with C. haemulonii peritonitis.
Subject(s)
Humans , Male , Middle Aged , Peritonitis , Candida albicans , Peritoneal Dialysis , Indicators of Morbidity and Mortality , Mortality , Drug Resistance, Multiple , FungiABSTRACT
Background & objectives: During recent decades, there has been a change in the epidemiology of Candida infections, characterized by a progressive shift from a predominance of Candida albicans to non-albicans Candida species. This study was undertaken to analyze the change in the epidemiology of candidaemia and antifungal use at tertiary care hospital in New Delhi, India, over a period of 10 years. Methods: A retrospective review of candidaemia between 1999 and 2008 and antifungal use from 2000 to 2008 was performed at Sir Ganga Ram Hosptial, New Delhi. Initially (1999-2005), isolates were differentiated as C. albicans and non- albicans Candida species. Between 2006-2008, these were identified to the species level and antifungal susceptibility was performed. Results: The occurrence of candidaemia and total antifungal use increased significantly. Candidaemia due to non-albicans species increased and this was correlated with an increasing use of fluconazole. There was emergence and increased isolation of a novel species C. haemulonii with decreased susceptibility to both amphotericin B and azoles. Overall, sensitivities of 89.6, 90.9, 88.6, 68.8 and 54.3 per cent to amphotericin B, 5 flucytosine, voriconazole, fluconazole and itraconazole, respectively were observed. Cross-resistance or reduced susceptibility to both fluconazole (MIC >16 μg/ml) and voriconazole was observed in 11.3 per cent isolates. Interpretation & conclusions: The study demonstrates a shift to non-albicans Candida species causing fungaemia and the emergence of amphotericin B and azole resistant novel species, C. haemulonii. Decreased susceptibility to fluconazole, as well as the threat of emergence of cross-resistance to voriconazole in the background of high azole consumption may limit the use of these agents as a presumptive therapy for Candida blood stream infections (BSI).
ABSTRACT
Candida haemulonii, one of the non-albicans Candida species, is an emerging yeast pathogen that is known to be resistant to amphotericin B and other antifungal agents such as azoles. These anti-fungal agents have often been associated with clinical treatment failure, so no treatment regimen has been clearly established for invasive C. haemulonii infections. We investigated a catheter-related infection of C. haemulonii candidemia in an adult patient in long-term hospital care. In the early stages, the candidemia remained persistent despite treatment with fluconazole. However, after changing the antifungal agent to caspofungin, the candidemia was resolved. Fluconazole and amphotericin B are not reliable empirical antifungal agents for invasive C. haemulonii infections, as shown in previous case reports. An echinocandin such as caspofungin may be an appropriate empirical choice of antifungal agent for an invasive C. haemulonii infection.