Journal List > Korean J Clin Microbiol > v.13(3) > 1038196

Korean J Clin Microbiol. 2010 Sep;13(3):140-143. Korean.
Published online September 30, 2010.  https://doi.org/10.5145/KJCM.2010.13.3.140
Copyright © 2010 The Korean Society of Clinical Microbiology
A Fatal Case of Candida orthopsilosis Fungemia
Hyun Jung Choi,1 Jong Hee Shin,1 Kyung Hwa Park,2 Myung Geun Shin,1 Soon Pal Suh,1 and Dong Wook Ryang1
1Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea.
2Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

Correspondence: Jong Hee Shin, Department of Laboratory Medicine, Chonnam National University Medical School, 671 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. (Tel) 82-62-220-5342, (Fax) 82-62-224-2518, Email: shinjh@chonnam.ac.kr
Received May 10, 2010; Revised July 23, 2010; Accepted August 20, 2010.

Abstract

Candida orthopsilosis is a recently described Candida species phenotypically indistinguishable from Candida parapsilosis. This new species can be identified only by using molecular methods. We describe here a fatal case of fungemia caused by C. orthopsilosis in a 75-year-old male patient who had panperitonitis after total gastrectomy with Roux-en-Y esophagojejunostomy. All 18 blood cultures obtained from admission day 16 to day 68 yielded the same Candida species. Both Vitek 2 (bioMerieux, Inc., Hazelwood, MO, USA) and API 20C (bioMerieux, Marcy-l'Etoile, France) failed to identify these isolates. However, DNA sequencing analysis of both D1/D2 domain and internal transcribed spacer region of rDNA showed 100% identity with C. orthopsilosis. The fungemia was persistent over 50 days despite of systemic antifungal therapy including fluconazole and caspofungin, and the patient expired on day 73 of his hospital stay. This represents the first reported case of fatal fungemia by C. orthopsilosis in Korea.

Keywords: C. orthopsilosis; Fungemia; DNA sequencing

References
1. Silva AP, Miranda IM, Lisboa C, Pina-Vaz C, Rodrigues AG. Prevalence, distribution, and antifungal susceptibility profiles of Candida parapsilosis, C. orthopsilosis, and C. metapsilosis in a tertiary care hospital. J Clin Microbiol 2009;47:2392–2397.
2. Tay ST, Na SL, Chong J. Molecular differentiation and antifungal susceptibilities of Candida parapsilosis isolated from patients with bloodstream infections. J Med Microbiol 2009;58:185–191.
3. Shin JH, Kee SJ, Shin MG, Kim SH, Shin DH, Lee SK, et al. Biofilm production by isolates of Candida species recovered from nonneutropenic patients: comparison of bloodstream isolates with isolates from other sources. J Clin Microbiol 2002;40:1244–1248.
4. van Asbeck EC, Clemons KV, Stevens DA. Candida parapsilosis: a review of its epidemiology, pathogenesis, clinical aspects, typing and antimicrobial susceptibility. Crit Rev Microbiol 2009;35:283–309.
5. Song JW, Shin JH, Shint DH, Jung SI, Cho D, Kee SJ, et al. Differences in biofilm production by three genotypes of Candida parapsilosis from clinical sources. Med Mycol 2005;43:657–661.
6. Tavanti A, Davidson AD, Gow NA, Maiden MC, Odds FC. Candida orthopsilosis and Candida metapsilosis spp. nov. to replace Candida parapsilosis groups II and III. J Clin Microbiol 2005;43:284–292.
7. Kocsubé S, Tóth M, Vágvölgyi C, Dóczi I, Pesti M, Pócsi I, et al. Occurrence and genetic variability of Candida parapsilosis sensu lato in Hungary. J Med Microbiol 2007;56:190–195.
8. Gomez-Lopez A, Alastruey-Izquierdo A, Rodriguez D, Almirante B, Pahissa A, Rodriguez-Tudela JL, et al. Prevalence and susceptibility profile of Candida metapsilosis and Candida orthopsilosis: results from population-based surveillance of candidemia in Spain. Antimicrob Agents Chemother 2008;52:1506–1509.
9. Tavanti A, Hensgens LA, Ghelardi E, Campa M, Senesi S. Genotyping of Candida orthopsilosis clinical isolates by amplification fragment length polymorphism reveals genetic diversity among independent isolates and strain maintenance within patients. J Clin Microbiol 2007;45:1455–1462.
10. Kim MN, Shin JH, Sung H, Lee K, Kim EC, Ryoo N, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis 2009;48:e57–e61.
11. Shin JH, Park MR, Song JW, Shin DH, Jung SI, Cho D, et al. Microevolution of Candida albicans strains during catheter-related candidemia. J Clin Microbiol 2004;42:4025–4031.
12. Nucci M, Anaissie E. Revisiting the source of candidemia: skin or gut? Clin Infect Dis 2001;33:1959–1967.
13. Cheung C, Guo Y, Gialanella P, Feldmesser M. Development of candidemia on caspofungin therapy: a case report. Infection 2006;34:345–348.
14. Brielmaier BD, Casabar E, Kurtzeborn CM, McKinnon PS, Ritchie DJ. Early clinical experience with anidulafungin at a large tertiary care medical center. Pharmacotherapy 2008;28:64–73.