Candida norvegensis fungemia in a liver transplant recipient.

Abstract

BACKGROUND:

The incidence of candidemia due to non-Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient.

CASE REPORT:

A 61-year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses. He received multiple antibiotic schemes, and after 3 months he was discharged, maintaining parenteral antibiotic at home. While he was on fluconazole prophylaxis, a breakthrough candidemia due to C. norvegensis occurred. In vitro susceptibilities of the isolate to several antifungal agents were as follows: amphotericin B MIC 0.5 mg/l, flucytosine 64 mg/l, fluconazole 64 mg/l, itraconazole 4 mg/l, voriconazole 0.75 mg/l, and caspofungin 0.047 mg/l. He was treated with anidulafungin with resolution of candidemia.

CONCLUSIONS:

The use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazole-resistant Candida infections, with C. norvegensis being a possible emerging pathogen in organ transplant recipients.

• Authors: Gemma Sanclemente, Francesc Marco, Carlos Cervera, Irma Hoyo, Jordi Colmenero, Cristina Pitart, Manuel Almela, Miquel Navasa, Asunción Moreno
• Journal: Revista iberoamericana de micologia (Rev Iberoam Micol) 2015 Apr-Jun Vol. 32 Issue 2 Pg. 115-7 ISSN: 2173-9188 [Electronic] Spain
• PMID: 24794213 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Antifungal Agents
• Echinocandins
• Fluconazole
• Anidulafungin

Topics

• Abdominal Abscess (drug therapy, microbiology)
• Anidulafungin
• Anti-Bacterial Agents (therapeutic use)
• Antifungal Agents (pharmacology, therapeutic use)
• Bacterial Infections (complications)
• Candida (classification, drug effects, isolation & purification)
• Candidemia (drug therapy, microbiology)
• Candidiasis, Invasive (drug therapy, microbiology)
• Cholangitis (complications)
• Communicable Diseases, Emerging (microbiology)
• Drug Resistance, Multiple, Fungal
• Echinocandins (therapeutic use)
• Fluconazole (adverse effects, therapeutic use)
• Fungemia (drug therapy, microbiology)
• Gallbladder (blood supply)
• Humans
• Ischemia (complications)
• Liver Abscess (complications, microbiology)
• Liver Transplantation
• Male
• Middle Aged
• Postoperative Complications (drug therapy, microbiology)
• Reoperation
• Superinfection