Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features.

Abstract

Background. Candida haemulonii, a yeast species that often exhibits antifungal resistance, rarely causes human infection. During 2004-2006, unusual yeast isolates with phenotypic similarity to C. haemulonii were recovered from 23 patients (8 patients with fungemia and 15 patients with chronic otitis media) in 5 hospitals in Korea. Methods. Isolates were characterized using D1/D2 domain and ITS gene sequencing, and the susceptibility of the isolates to 6 antifungal agents was tested in vitro. Results. Gene sequencing of the blood isolates confirmed C. haemulonii group I (in 1 patient) and Candida pseudohaemulonii (in 7 patients), whereas all isolates recovered from the ear were a novel species of which C. haemulonii is its closest relative. The minimum inhibitory concentration (MIC) ranges of amphotericin B, fluconazole, itraconazole, and voriconazole for all isolates were 0.5-32 microg/mL (MIC(50), 1 microg/mL), 2-128 microg/mL (MIC(50), 4 microg/mL), 0.125-4 microg/mL (MIC(50), 0.25 microg/mL), and 0.03-2 microg/mL (MIC(50), 0.06 microg/mL), respectively. All isolates were susceptible to caspofungin (MIC, 0.125-0.25 microg/mL) and micafungin (MIC, 0.03-0.06 microg/mL). All cases of fungemia occurred in patients with severe underlying diseases who had central venous catheters. Three patients developed breakthrough fungemia while receiving antifungal therapy, and amphotericin B therapeutic failure, which was associated with a high MIC of amphotericin B (32 microg/mL), was observed in 2 patients. Conclusions. Candida species that are closely related to C. haemulonii are emerging sources of infection in Korea. These species show variable patterns of susceptibility to amphotericin B and azole antifungal agents.

• Authors: Mi-Na Kim, Jong Hee Shin, Heungsup Sung, Kyungwon Lee, Eui-Chong Kim, Namhee Ryoo, Jin-Sol Lee, Sook-In Jung, Kyung Hwa Park, Seung Jung Kee, Soo Hyun Kim, Myung Geun Shin, Soon Pal Suh, Dong Wook Ryang
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 48 Issue 6 Pg. e57-61 (Mar 15 2009) ISSN: 1537-6591 [Electronic] United States
• PMID: 19193113 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• DNA, Fungal
• DNA, Ribosomal
• DNA, Ribosomal Spacer

Topics

• Aged
• Antifungal Agents (pharmacology)
• Blood (microbiology)
• Candida (classification, drug effects, isolation & purification)
• Candidiasis (epidemiology, microbiology, pathology, physiopathology)
• Child
• Child, Preschool
• Cross Infection (epidemiology, microbiology, pathology, physiopathology)
• DNA, Fungal (chemistry, genetics)
• DNA, Ribosomal (chemistry, genetics)
• DNA, Ribosomal Spacer (chemistry, genetics)
• Female
• Hospitals, University
• Humans
• Infant
• Korea (epidemiology)
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Molecular Sequence Data
• Sequence Analysis, DNA