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Lee, Yu, Park, Joo, Shin, and Kwon: Successful Treatment of Fungemia Caused by Cyberlindnera fabianii with Anidulafungin: A Case Report
Original Article

Ann Clin Microbiol 2015;18(3):94-97.

Published online: 5 September 2015

DOI: https://doi.org/10.5145/ACM.2015.18.03.94

Successful Treatment of Fungemia Caused by Cyberlindnera fabianii with Anidulafungin: A Case Report

Jeong In Lee1, Shinae Yu2, Jong Sin Park1, Eun-Jeong Joo1, Jong Hee Shin3, Min-Jung Kwon2

1Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea

2Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

3Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea

Correspondence: Min-Jung Kwon, Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea. (Tel) 82-2-2001-5211, (Fax) 82-2-757-0711, (E-mail) mjkkmd@gmail.com

Received 10 April 201515 June 2015       Accepted 25 June 2015

Copyright © 2015 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Cyberlindnera fabianii (previously known as Hansenula fabianii, Pichia fabianii, and Lindnera fabianii) is a yeast species that forms a biofilm, allowing it to re-sist azole drugs. In this study, we report a case of fungemia with C. fabianii that was successfully treated with anidulafungin. In this case, the organism was initially misidentified as Candida utilis (with a high pro-bability of 93%, suggesting good identification) using the VITEK 2 yeast identification card (YST ID; bio-Mérieux, USA). The species responsible for the patient's fungemia was correctly identified after sequencing the internally transcribed spacer region and the D1/D2 domain of the large subunit (26S) rDNA gene. The CLSI M27-A3 broth microdilution method was used to determine the in vitro antifungal activity of anidulafungin and fluconazole against C. fabianii. The MICs of anidulafungin and fluconazole were found to be 0.03 μ g/mL and 2 μ g/mL, respectively. The patient recovered after 14 days of anidulafungin treatment.

Keywords: Anidulafungin, Cyberlindnera fabianii

REFERENCES

1.Kurtzman CP., Robnett CJ., Basehoar-Powers E. Phylogenetic relationships among species of Pichia, Issatchenkia and Williopsis determined from multigene sequence analysis, and the proposal of Barnettozyma gen. nov., Lindnera gen. nov. and Wickerhamomyces gen. nov. FEMS Yeast Res. 2008. 8:939–54.
2.Dooley DP., Beckius ML., McAllister CK., Jeffery BS. Prostatitis caused by Hansenula fabianii. J Infect Dis. 1990. 161:1040–1.
3.Yun JW., Park KS., Ki CS., Lee NY. Catheter-related bloodstream infection by Lindnera fabianii in a neutropenic patient. J Med Microbiol. 2013. 62:922–5.

Fig. 1.
Colony morphology on sub-inoculation and microscopic morphology. (A) Small white colonies identified after incubation on a blood agar plate at 35oC in the presence of 5% CO2. (B) Microscopic analysis revealed variably sized Gram-positive yeast-like structures in the colonies (Gram stain,×1,000).
acm-18-94f1.tif
Table 1.
Antifungal susceptibilities of C. fabianii
Antifungal agent MIC (μ g/mL)
Broth microdilution* (24 h) VITEK 2
Amphotericin B 0.5 0.5
Fluorocytosine Not done ≤1
Voriconazole 0.03 ≤0.12
Fluconazole 2 ≤1
Caspofungin 0.5 ≤0.25
Micafungin 0.125 0.12
Anidulafungin 0.03 Not done

∗ Performed by the CLSI M27-A3 broth microdilution method.

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