ABSTRACT
Introduction. Given the limited number of candidaemia studies in Iran, the profile of yeast species causing bloodstream infections (BSIs), especially in adults, remains limited. Although biochemical assays are widely used in developing countries, they produce erroneous results, especially for rare yeast species.Aim. We aimed to assess the profile of yeast species causing BSIs and to compare the accuracy of the Vitek 2 system and 21-plex PCR.Methodology. Yeast blood isolates were retrospectively collected from patients recruited from two tertiary care training hospitals in Tehran from 2015 to 2017. Relevant clinical data were mined. Identification was performed by automated Vitek 2, 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2).Results. In total, 137 yeast isolates were recovered from 107 patients. The overall all-cause 30-day mortality rate was 47.7â%. Fluconazole was the most widely used systemic antifungal. Candida albicans (58/137, 42.3â%), Candida glabrata (30/137, 21.9â%), Candida parapsilosis sensu stricto (23/137, 16.8â%), Candida tropicalis (10/137, 7.3â%) and Pichia kudriavzevii (Candida krusei) (4/137, 2.9â%) constituted almost 90â% of the isolates and 10â% of the species detected were rare yeast species (12/137; 8.7â%). The 21-plex PCR method correctly identified 97.1â% of the isolates, a higher percentage than the Vitek 2 showed (87.6â%).Conclusion. C. albicans was the main cause of yeast-derived fungaemia in this study. Future prospective studies are warranted to closely monitor the epidemiological landscape of yeast species causing BSIs in Iran. The superiority of 21-plex PCR over automated Vitek 2 indicates its potential clinical utility as an alternative identification tool use in developing countries.
Subject(s)
Fungemia/diagnosis , Fungemia/epidemiology , Fungemia/microbiology , Multiplex Polymerase Chain Reaction , Sequence Analysis, DNA , Yeasts/classification , Yeasts/genetics , Aged , Aged, 80 and over , DNA, Intergenic , Female , Fungemia/history , History, 21st Century , Humans , Iran/epidemiology , Male , Middle Aged , Multiplex Polymerase Chain Reaction/methods , Multiplex Polymerase Chain Reaction/standards , Sequence Analysis, DNA/methods , Sequence Analysis, DNA/standardsABSTRACT
La tricosporinosis es una fungemia cada vez más frecuente en pacientes con neoplasias hematológicas; es producida por el Trichosporon asahii cuyo habitat es el suelo, agua y excreciones animales, aunque también forma parte de la flora normal de la piel y aparato respiratorio. En situaciones de neutropenia produce una diseminación con afectación pulmonar y renal de evolución fatal; en el 10 al 50% de los casos aparecen lesiones cutáneas. Se describe un caso de infección sistémica por Trichosporon asahii en una paciente de 40 años afecta de una leucemia mieloide aguda, de curso inicial poco sintomático y de una evolución rápida y fatal, con afectación cutánea, pulmonar y renal. La valoración clínica y el estudio histopatológico con cultivo de la piel fueron diagnósticas. Esta infrecuente fungemia debe tenerse en cuenta al valorar pacientes con neoplasias hematológicas en situación de neutropenia. Sólo el diagnóstico precoz puede evitar una diseminación mortal (AU)
