Peritonitis terciaria por Candida famata: infección por una levadura atípica / Tertiary peritonitis due to Candida famata: Infection by an atypical yeast

ResumenLa Candida famata es una levadura halotolerante, sobreproductora de vitamina B2, asociada infrecuentemente a infecciones en seres humanos, cuyo uso es común en procesos industriales. En nuestro servicio, se había detectado un único caso en el contexto de mediastinitis con un desenlace mortal. Se carecía de experiencia en cuanto al manejo de la infección por este agente. Posterior a una exhaustiva revisión bibliográfica, se demuestra la ausencia de reportes de infecciones por este agente en el contexto de la peritonitis terciaria. Se reporta el caso de un paciente de 37 años de edad que sufrió una herida de arma blanca en abdomen, y que después de múltiples complicaciones asociadas a este evento, desarrolló una peritonitis terciaria por C. famata; fue tratado satisfactoriamente con caspofungina y un abdomen abierto con terapia de presión negativa e instilación. Se espera que esta experiencia sirva de referente al detectar algún paciente con esta condición en el futuro.

AbstractCandida famata is a halotoleran, vitamin B2 overproducing yeast that is rarely associated with infections in humans, but is commonly utilized in industrial processes. In our service, it had been detected only once before in a patient with mediastinitis. The outcome of that infection was fatal. Not only were we unfamiliar with the management of infection by this agent, but after performing a thorough literary review, we were unable to find published reports of infections by this pathogen as the cause of tertiary peritonitis. We report the case of a 37 year old male who after suffering a stab wound to his abdomen and having multiple complications associated with this event, developed tertiary peritonitis by C. famata, that was treated with casponfungin and an open abdomen utilizing negative pressure wound therapy with instillation which yielded a satisfactory response to the therapy. This report may be of use in the event that clinicians are confronted with this condition in the future.

Candida glabrata among Candida spp. from environmental health practitioners of a Brazilian Hospital

Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the second and third most commonly isolated species. Considering the total samples collected from the emergency room and from the inpatient and the pediatric sector, 19.10% were positive for Candida spp., with the predominance of non-albicans Candida species (89.42%). The high percentage of positivity occurred in the hands (24.32%) and the lab coats (21.88%) of the health care assistants. No sample of C. albicans presented a profile of resistance to the drugs. All the non-albicans Candida species presented a decreased susceptibility to miconazole and itraconazole, but they were susceptible to nystatin. Most of the isolates were susceptible to fluconazole and amphotericin B. As expected, a high resistance rate was observed in C. glabrata and C. krusei, which are intrinsically less susceptible to this antifungal agent. The contamination of environmental surfaces by Candida spp. through hand touching may facilitate the occurrence of Candida infections predominantly in immunocompromised patients. In addition to that, the antifungal agents used should be carefully evaluated considering local epidemiologic trends in Candida spp. infections, so that therapeutic choices may be better guided.

Species distribution & antifungal susceptibility pattern of oropharyngeal Candida isolates from human immunodeficiency virus infected individuals.

Background & objectives: The changing spectrum of Candida species in causation of oropharyngeal candidiasis and their antifungal susceptibility pattern among the HIV infected individuals has made the identification to species level mandatory and detection of drug resistance necessary for patient care. The present study was carried out to determine the species distribution and antifungal susceptibility profile of oral Candida isolates colonizing or infecting both HIV seropositive and seronegative individuals. Methods: A case-control study was conducted including 141 consecutive, non-repeat HIV-seropositive individuals and an equal number of sex and age matched HIV-seronegative control. Speciation of the oropharyngeal Candida isolates was done using standard yeast identification protocol. Antifungal susceptibility testing was done by the disk-diffusion method as well as by Fungitest method. Results: From the 59 culture positive HIV seropositive cases, 61 Candida isolates were recovered; Candida albicans (n=47, 77.0%), C. dubliniensis (n=9, 14.7%), C. parapsilosis (n=2, 3.2%), C. glabrata (n=2, 3.2%), and C. famata (n=1, 1.6%). Candida colonization in HIV-seropositive individuals was significantly higher than that of HIV-seronegative (control) group. Antifungal susceptibility testing revealed (n=6, 9.3%) C. albicans isolates resistant to voriconazole and fluconazole by disk-diffusion method whereas no resistance was seen by Fungitest method. Interpretation & conclusions: C. albicans was the commonest Candida species infecting or colonizing HIV seropositive individuals. Oropharyngeal Candida isolates had high level susceptibility to all the major antifungals commonly in use. Increased level of immunosuppression in HIV-seropositives and drug resistance of non-albicans Candida species makes identification and susceptibility testing of Candida species necessary in different geographical areas of the country.

Species distribution and antifungal susceptibility profile of Candida isolated from urine samples.

Background: Candiduria is a common finding in hospitalized patients. The isolation of Candida from urine is challenging for both clinician and microbiologist as to whether the candiduria represents colonization or, lower or upper urinary tract infection including ascending pyelonephritis and renal candidiasis with sepsis. Although Candida albicans is the major cause of candiduria, non-albicans Candida (NAC) has emerged as an important opportunist pathogen. The NAC spp. are not only well adapted to the urinary tract but also are difficult to eradicate than C. albicans. Aims & Objective: The present study aimed to determine the clinico-mycological profile of candiduria in a tertiary care hospital. Material and Methods: A total of 218 Candida spp. isolated from urine samples were included in the study. Speciation of Candida was done by conventional methods and colony colour on HICHROM Candida agar. Antifungal susceptibility testing of the isolates was performed by disc diffusion method on glucose methylene Mueller- Hinton agar (GM-MH). Results: In both the sexes maximum patients belong to age group >50 years. Urinary catheterization, use of broad spectrum antibiotics and diabetes mellitus were the major risks. Isolation of NAC spp. was more. Maximum resistance was seen to fluconazole. Conclusion: The shift towards the NAC spp. as the causative agent of candiduria has generated the concern. Since several NAC spp. are inherently resistant to common antifungal agents, the rapid identification of Candida isolates upto species level along with its in-vitro antifungal susceptibility pattern is important for treatment and management of candiduria.

Evaluation of Phospholipase Activity in Biofilm Forming Candida Species Isolated from Intensive Care Unit Patients.

Aims: To evaluate phospholipase activity in biofilm forming Candida spp. isolated from patients admitted in intensive care unit of rural tertiary care hospital. Study Design: A total of 135 biofilm forming Candida spp. isolated from various clinical specimens of patients admitted in ICU were included in the study. Place and Duration of Study: Department of Microbiology, Pravara Institute of Medical Science’s Rural Medical College India, between January 2010 and December 2012. Methodology: The Candida isolates were identified upto species level by conventional standard mycological techniques. The biofilm formation was assessed by inoculating the isolates in conical polystyrene test tube containing Sabouraud’s dextrose broth supplemented with glucose. Phospholipase activity of biofilm forming Candida isolates was detected by using egg yolk agar. Results: Out of 135 biofilm forming Candida spp. included in the study, 60 (44.4%) isolates were C. albicans. Among non-albicans Candida (NAC) spp. C. tropicalis was the major isolate followed by C. glabrata and C. parapsilosis. Phospholipase production was seen in 85 (62.9%) isolates. A total 49 (81.6%) isolates of C. albicans showed phospholipase activity. Among NAC spp. maximum phospholipase activity was seen in C. tropicalis and C. glabrata. Conclusion: Biofilm formed by the Candida spp. tend to be more resistant to antifungal drugs. Though C. albicans the most common species associated with Candida biofilms, the emergence of NAC spp. is of concern. NAC spp. shows varying degree of resistance either intrinsic or acquired or both to commonly used antifungal drugs. The isolation of NAC spp. from clinical specimens is no longer overlooked as these organisms are emerging pathogens. The virulence factors like biofilm formation and phospholipase activity is also noted in NAC spp. The study of these virulence factors would help in understanding the pathogenic role of NAC spp.

Non-albicans Candida species in blood stream infections in a tertiary care hospital at New Delhi, India.

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).