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

Clin Infect Dis. 2009 Mar 15;48(6):e57-61. doi: 10.1086/597108.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

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

Associated data

  • GENBANK/EU881946
  • GENBANK/EU881947
  • GENBANK/EU881948
  • GENBANK/EU881949
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  • GENBANK/EU884190