Journal Article

<i>Candida haemulonii</i> and Closely Related Species at 5 University Hospitals in Korea: Identification, Antifungal Susceptibility, and Clinical Features

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 and Dong Wook Ryang

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 6, pages e57-e61
Published in print March 2009 | ISSN: 1058-4838
Published online March 2009 | e-ISSN: 1537-6591 | DOI: https://dx.doi.org/10.1086/597108
Candida haemulonii and Closely Related Species at 5 University Hospitals in Korea: Identification, Antifungal Susceptibility, and Clinical Features

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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 µg/mL (MIC>50, 1 µg/mL), 2–128 µg/mL (MIC>50, 4 µg/mL), 0.125–4 µg/mL (MIC>50, 0.25 µg/mL), and 0.03–2 µg/mL (MIC>50, 0.06 µg/mL), respectively. All isolates were susceptible to caspofungin (MIC, 0.125–0.25 µg/mL) and micafungin (MIC, 0.03–0.06 µg/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 µg/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.

Journal Article.  2642 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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