Candida haemulonii and Closely Related Species at 5 University Hospitals in Korea: Identification, Antifungal Susceptibility, and Clinical Features
Candida haemulonii and Closely Related Species at 5 University Hospitals in Korea: Identification, Antifungal Susceptibility, and Clinical Features
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DOI：
10.1086/597108
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发表时间：
2009-03-15
影响因子：
11.8
通讯作者：
Ryang, Dong Wook
中科院分区：
文献类型：
--
作者：
Kim, Mi-Na;Shin, Jong Hee;Ryang, Dong Wook
背景念珠菌haemulonii，一种酵母菌，往往表现出抗真菌药物耐药性，很少引起人类感染。在2004-2006年期间，与C.从韩国5家医院的23例患者（8例真菌血症患者和15例慢性中耳炎患者）中发现了Haemulonii。采用D1/D2结构域和ITS基因序列分析方法对分离菌株进行了鉴定，并进行了6种抗真菌药物的体外敏感性试验。血液分离物的基因测序证实了C。Haemulonii Ⅰ组（1例）和假Haemulonii念珠菌（7例），而从耳中回收的所有分离株均为新种，其中C. haemulonii是其最近的亲戚。对所有菌株的最小抑菌浓度（MIC）范围为0.5-32 μ g/mL，其中阿替霉素B、氟康唑、伊曲康唑和伏立康唑的MIC范围为0.5-32 μ g/mL（MIC50，1 μ g/mL）、2-128 μ g/mL（MIC50，4 μ g/mL）、0.125-4 μ g/mL（MIC50，0.25 μ g/mL）和0.03-2 μ g/mL（MIC50，0.06 μ g/mL）。所有分离株均对卡泊芬净（MIC，0.125-0.25 μ g/mL）和米卡芬净（MIC，0.03-0.06 μ g/mL）敏感。所有真菌血症病例均发生在有严重基础疾病并使用中心静脉导管的患者中。3例患者在接受抗真菌治疗时发生了突破性真菌血症，在2例患者中观察到与阿替霉素B的高MIC（32 μ g/mL）相关的阿替霉素B治疗失败。与C. Haemulonii是韩国新出现的感染源。这些种属对阿替霉素B和唑类抗真菌剂的敏感性表现出不同的模式。
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 mu g/mL (MIC50, 1 mu g/mL), 2-128 mu g/mL (MIC50, 4 mu g/mL), 0.125-4 mu g/mL (MIC50, 0.25 mu g/mL), and 0.03-2 mu g/mL (MIC50, 0.06 mu g/mL), respectively. All isolates were susceptible to caspofungin (MIC, 0.125-0.25 mu g/mL) and micafungin (MIC, 0.03-0.06 mu g/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 mu g/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.