ABSTRACT
A case report of ventriculoperitoneal shunt infection caused by Candida lusitaniae in a 6-year-old patient with cerebral astrocytoma and obstructive hydrocephalus is presented briefly with emphasis on the course of antifungal treatment. Seven isolates recovered subsequently from the cerebrospinal fluid were studied retrospectively. To confirm identity, isolates were typed using pulsed-field gel electrophoresis and melting curve of random amplified polymorphic DNA (McRAPD). Further, the ability to form biofilm and its susceptibility to systemic antifungals were evaluated. Using McRAPD, identity of C. lusitaniae isolates showing slight microevolutionary changes in karyotypes was undoubtedly confirmed; successful application of numerical interpretation of McRAPD for typing is demonstrated here for the first time. The strain was also recognized as a strong biofilm producer. Moreover, minimum biofilm inhibitory concentrations were very high, in contrast to low antifungal minimum inhibitory concentrations of isolates. It can be concluded that McRAPD seems to be a simple and reliable method not only for identification but also for typing of yeasts. A ventriculoperitoneal shunt colonized by C. lusitaniae was revealed as the source of this nosocomial infection, and the ability of the strain to form biofilm on its surface likely caused treatment failure.
Subject(s)
Astrocytoma/microbiology , Brain Neoplasms/microbiology , Candida/isolation & purification , Candidiasis/microbiology , Cross Infection/microbiology , Hydrocephalus/microbiology , Random Amplified Polymorphic DNA Technique , Antifungal Agents/pharmacology , Astrocytoma/cerebrospinal fluid , Astrocytoma/complications , Astrocytoma/drug therapy , Astrocytoma/pathology , Astrocytoma/surgery , Biofilms/drug effects , Biofilms/growth & development , Brain Neoplasms/cerebrospinal fluid , Brain Neoplasms/complications , Brain Neoplasms/drug therapy , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Candida/drug effects , Candida/genetics , Candidiasis/cerebrospinal fluid , Candidiasis/complications , Candidiasis/drug therapy , Candidiasis/pathology , Candidiasis/surgery , Child , Cross Infection/cerebrospinal fluid , Cross Infection/complications , Cross Infection/drug therapy , Cross Infection/pathology , Cross Infection/surgery , Electrophoresis, Gel, Pulsed-Field , Humans , Hydrocephalus/cerebrospinal fluid , Hydrocephalus/complications , Hydrocephalus/drug therapy , Hydrocephalus/pathology , Hydrocephalus/surgery , Male , Microbial Sensitivity Tests , Mycological Typing Techniques , Nucleic Acid Denaturation , Treatment Failure , Ventriculoperitoneal Shunt/adverse effectsABSTRACT
The crude extract of Mahonia aquifolium (Berberidaceae) stem bark and its components berberine, palmatine and jatrorrhizine were screened for their inhibitory activity against a variety of dermatophytes and two Candida species of human origin using the in vitro dilution agar plate method. Jatrorrhizine was found to be the most effective against all fungal species tested (MIC ranges from 62.5 to 125 micro g/mL), while the crude extract, berberine, and palmatine exhibited only marginal activity (MIC 500 to >/= 1000 micro g/mL). Dermatophytes were more susceptible to jatrorrhizine than yeasts, and Scopulariopsis brevicaulis appeared the least sensitive species to all the compounds tested. The effects of the alkaloids were compared with those of fluconazole and bifonazole for which the MIC ranges were 12.5 to >100 micro g/mL. Our results suggest that jatrorrhizine may serve as a leading compound for further studies to develop new antifungal agents with highly potent antifungal activity and low host toxicity.
