Two Cases of Fungemia due to Candida lusitaniae and a Literature Review

The U04 clinical isolate and its mrr1Δ and mdr1Δ derivatives grew equally well in the presence of P. When used as a control for nucleic acid tests, the same protocols as those used to amplify extracted clinical specimens should be employed. 125 µg/ml=50 4. Mean ± SD from three independent replicates is shown, a-b ****P < 0.

We report a case of a 33-year-old healthy woman, pregnant with triplets by in vitro fertilization, who experienced preterm premature rupture of membranes of fetus A at 16 weeks' gestation and subsequently developed oligohydramnios in all 3 fetuses. Cerqueira DF, et al. Although the respective ratios of each SNP changed between samples, SNPs indicative of FLZR isolates were present at low levels in all three samples, even in the absence of prior antifungal therapy. 1, from trunk rot of boojum tree (Idria columnaris, Fouquieriaceae), Baja California N. The shunt was externalized, and the peritoneal catheter tip grew Enterobacter. In the present study, C. The only other general guidelines are (a) durable cure of infected devices is very difficult to achieve without device removal (although infection can often be suppressed—see for example the section entitled “Candida Endocarditis, Pericarditis, and Suppurative Phlebitis”) and (b) an agent that penetrates well is needed for protected spaces (the eye and brain—see those sections for details).

  • Equivalent amounts of DNA were obtained from individual isolates then combined before sequencing.
  • The results of species-specific identification of all C.
  • (S5A) and schematic showing sample acquisition timeline including 4 mo of FLZ treatment and 5 mo off antifungals.
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The rarity of amphotericin B resistance among C. The ITS region of rDNA sequences from 11 bloodstream isolates from neonates (Gen Bank accession numbers LS999909 to LS999920) exhibited maximum identity with corresponding sequences from reference strains of C. In summary, Candida species are an increasingly recognized cause of meningitis, especially among neurosurgical patients and immunocompromised hosts who have received prior broad-spectrum antibacterial therapy. Figure 3 Infected prosthetic aortic valve. 5%) than other specimen types (109 of 6078, 1.

8-14 /100 episodes of peritonitis, but usually results in significant morbidity in chronic ambulatory peritoneal dialysis (CAPD) patients. 3% (n = 6) of invasive infections in PATH registry data [29]. He eventually died because of his underlying medical problems and ventilator-associated pneumonia. U04, and a mixture of equivalent amounts of all 74 UL isolates.

Daugirdas, University of Illinois in Chicago-USA for his valuable advice in preparing this manuscript. The data showed that 11 isolates exhibited seven different sequence types indicating that many isolates were clonally unrelated ( Fig 1 ). This is deleted when session is finished/expired. Agriculture and food:

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  • The percentage of the propidium iodide uptake was calculated as the difference in the percentage of the fluorescent cells between the negative control (no PEF treatment) and the value in the treated sample.
  • (072 μg/ml) (Table 3).
  • 3% as the three expired neonates also had bacterial septicemia.
  • PCR amplicons were run on 2% (w/v) agarose gels, as described previously [ 18 ].

Materials And Methods

The differences are within the standard deviation of the experiments. Here attention may be drawn to a recent study demonstrating loss of fungicidal or fungistatic activity of micafungin in the presence of serum proteins, which is not predicted by MICs in case of C. As it can be seen in Figure 6 the pulse shape influence on the experimental results is statistically insignificant ( ). A day later the laboratory identified yeast species from the initial peri­toneal fluid specimen confirmed to be C. Despite the discovery of an automictic strain, morphological identification of C. In our study the treatment of C. 0 µg/ml=4 16 µg/ml=3 0. Clavispora lusitaniae was the first member of the family Metschnikowiaceae to be subjected to whole genome sequencing – Candida lusitaniae Sequencing Project, Broad Institute of Harvard and MIT (http: )

Successful prophylaxis for fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: The crude mortality of C. Isolates did not cluster by the lavage or sputum sample of origin, indicating that genomic heterogeneity was not solely explained by spatial separation (UL vs. )

(5%) patients died. The ITS region of rDNA sequences from 2 other bloodstream isolates; C. (610, San Diego, USA).

  • Ceftazidime was added at 48 hours when repeat dialysate cell count showed an increase to 8000 cells/mm 3 ; gram stain was again negative.
  • The sequence data for C.
  • 5 and several others, from necrotic tissue of various cacti, P.
  • Also it has been experimentally shown that the electroporation pulse shape may influence the inhibitory effect; however, the amplitude of the electric field and the pulse energy remain the most important parameters for definition of the treatment outcome.
  • A total of 990 bloodstream isolates were recovered from 990 candidemia patients during the study period.
  • We found that high Mrr1-regulated Mdr1 activity protected against host and bacterial factors, suggesting drug resistance can be selected for indirectly and perhaps explaining the Mrr1 heterogeneity in this individual who had no prior azole exposure.
  • The average efficacy difference was within the standard deviation of the experiment.


Sensitivities of the organism showed a minimum inhibitory concentration to amphotericin B of 0. All positive cultures were Gram-stained and subcultures were made on blood agar and/or Sabouraud dextrose agar. 0001, a-c and b-c P < 0. In clinical specimens C. It is also supported by amphotericin B MIC values of 129 C. During the 8 kV/cm pulse the number of the permeabilized cells was in the range of %. The enrichment of nonsynonymous mutations in MRR1 greatly exceeded the heterogeneity at any other locus. Glucose and mannose (Suzuki and Nakase 1998).

Thus, the prevalence of C. Alburquenque C, et al. Thus, we proposed that Mrr1 variants that confer high Mdr1 activity could have been selected for in response to immune system components or by factors produced by coinfecting microbes. All bloodstream isolates were also subjected to identification by matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), performed as described previously [ 16 ]. Although the first case of Candida meningitis was reported in 1933, Candida species have increasingly been described as important causes of central nervous system (CNS) infections. Peritonitis caused by Candida lusitaniae in patient on continuous ambulatory peritoneal dialysis (CAPD). 1, from fruit fly (Drosophila carbonaria) collected on mesquite (Prosopis juliflora, Fabaceae), Arizona, USA; UWOPSWN9-8 and UWOPSWN9-20, both from effluents of chocolate factory, Ontario, Canada; UWOPS92-209. Vitamin shoppe, if you have an account, please sign in. Zaruba K, Peters J, Jungbluth H.

28 Most experts recommend performing susceptibility testing on an initial Candida isolate causing a CNS infection.


Wanger A, et al. The growth inhibition dynamics of the C. (15, subject A here). The 8 kV/cm and 4 kV/cm PEF asymmetrical bipolar pulses (700 μs positive, 300 μs negative (Figure 1)) were applied.

Since the aim of the study was to analyze the nonthermal effects of the electrical pulses, the study was limited to high impedance cell buffer (D-sorbitol, ROTH, Germany). Complementary mating types: 06 µg/ml=2 < 0. Chen SC, et al. The total delivered energy of the bipolar pulses was equal to the energy of the respective duration of monopolar pulse ( ).

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Seven of eight neonates (including twins, Case 1 and Case 2) were preterm with gestational age varying between 24 to 36 weeks. Clavispora lusitaniae is regularly recovered in clinical specimens, but is not regarded as a true human pathogen (Hurley et al. )While many other species of Candida have been isolated from clinical specimens (307) , their significance is unclear. After improvement of the diarrhea, the patient was again treated with intravenous cefotaxime and remained in a stable, but bedridden, condition, with the ability to follow some commands. A (square), C (triangle), G (circle), and T (diamond).

Seven neonates had bacteremia 1 to 44 (5. Hardin md, you can get it in your mouth and other parts of the body. )Another approach for growth inhibition of the pathogens, which allows addressing the side effect problem, is the photodynamic therapy [15, 16]. The research of the effective treatment protocols should be performed. After the pulsed treatment the cells were stained and analyzed using fluorescence microscopy. Candida obtusa (Dietrichson) van Uden & do Carmo-Sousa ex van Uden & H.

This study describes prevalence and susceptibility profile of clinical isolates of C. Fungal peritonitis in a large chronic peritoneal dialysis population: The ability to determine drug susceptibility in single-species infections can be complicated by heterogeneity within the infecting population.

In this work we investigated the dynamics of the growth inhibition and membrane permeabilization of C.


The numbers on the node branches are bootstrap frequencies. All applicable international, national, and/or institutional ethical guidelines were followed. Candida lusitaniae van Uden & do Carmo-Sousa (1959) Candida parapsilosis (Ashford) Langeron & Talice var. While candins or azole resistance followed monotherapy, multidrug antifungal resistance emerged during combined therapy.

Therapy with caspofungin was initiated prior to obtaining results of susceptibility testing on the initial isolate and was continued based on the minimal inhibitory concentration (MIC).

The susceptibility of C.

Candida Lusitaniae

Woodgyer, New Zealand; MTCC 1001, from citrus, G. Case 1 and Case 2 were twins, both developed C. Multiple sequence alignments were performed with Clustal omega and the phylogenetic tree was constructed with MEGA 6. 1, from leaf rot of Agave sp. 2, both from fruit fly (Drosophila bromeliae, Diptera, Drosophilidae) collected on morning glory (Ipomoea sp. )

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This mutant strain exhibited a growth defect, was resistant to amphotericin B, and was hypersensitive to other sterol inhibitors. 4% in controls in one study, [12] while another study failed to show similar beneficial effect. An ideal antifungal agent should have a wide spectrum antifungal activity and must not cause toxicity to the host [11]. Despite eventual clearance of her fungemia, the patient died from multi-organ failure in June 2020. As it can be seen in Figure 5 the increase of the electric field strength resulted in the increase of the number of the PI stained cells. Eight of 9 neonates received liposomal amphotericin B, which was followed by fluconazole in 7 and additionally by caspofungin in 2 cases as salvage therapy. The remaining 26 C.


Etest generally yielded lower MICs than Vitek 2, particularly for amphotericin B ( Table 2 ). Purchase a subscription to gain access to this and all other articles in this journal. Can antibiotic use cause a yeast infection?, vaginal yeast infections are common among teen girls, and about 75% of all females will have one at some point. 22 In addition, culturing the organism from a catheter tip, rather from the spinal fluid itself, also may represent colonization versus a true infection. Her initial chemistry profile showed normal Amylase, negative serum ketones and mildly elevated liver enzymes; her peripheral white blood count (WBC) was 25,000 with 93% Neutrophils. The patient was started on intraperitoneal vanco­mycin and gentamicin. Pfaller et al.


0 µg/ml=1 >64 µg/ml=1 8. Some haploid strains are heterogeneous for the variant sequences, indicating that this is a rare case where a species is substantially polymorphic for this normally conserved marker. Their age ranged between 7 days to 8 months.

All blood culture isolates were obtained using BACTEC 9240 system or BACTEC Peds Plus/F culture bottles (Becton Dickinson, Paramus, NJ, USA). The dialysate WBC count was 3000 cells/mm 3 with neutro­phils 90%. Lusitaniae is named after a ship that was unsinkable; frequent presence of resistance to amphotericin B led to name this species accordingly.

  • None of our isolates showed MIC value for caspofungin above >0.
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  • All patients received antifungal therapy, mainly with amphotericin B (n = 10) or liposomal amphotericin B (n = 5).
  • Pairwise analyses of the 20 clinical isolate genomes found 24–131 SNPs between any two isolates, with 404 high-confidence interisolate SNPs (45% nonsynonymous) in total (SI Appendix, Fig.)
  • All clinical C.
  • 9% compared to a 6.
  • Analysis of bronchoalveolar lavage (BAL) fluid from a subject with CF detected >105 cfu/mL of C.

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The results summarizing the dependence of the propidium iodide uptake on the pulse shape are shown in Figure 6. The wet mount examination showed ovoid to sub-globose budding cells with abundant pseudohyphae. The therapies tested were VRC at 10, 25, or 40. All isolates were identified as C.


Europe PMC requires Javascript to function effectively. We love hearing from our customers, but if you prefer doing your own research first, here's a list of answers to our customer's most commonly asked questions. None of the isolates appeared resistant to amphotericin B. Overall, however, the number of differences between the isolates is much smaller than that which is reported for differences between fungal strains within a species (19, 20) (Fig. )Using the 5% threshold for previously confirmed SNPs, we found 11 of the 13 SNPs identified by single-isolate WGS within the pools. Membership of the species is supported by the D1/D2 sequence, which is identical to that of the allotype. 125 µg/ml=41 < 0. 3 μg/mL, fluconazole of 0.

The results contribute both ( ) to the electroporation field due to the comparison and analysis of the various pulse shapes and also ( ) to the study of the C. Drug-resistant subpopulations of microbes or tumor cells are difficult to detect but can confound disease treatment. As a load the electroporation cuvette with 1 mm gap between the aluminum electrodes has been used (BTX, Cuvette plus, Nr. )The effect may range from temporary permeabilization of cell membrane to irreversible electroporation resulting in a nonthermal ablation of tissue [21]. Bone marrow transplantation and high dose cytoreductive chemotherapy have both been identified as risk factors for infections with this organism. CBS 1944, clinical specimen, E. These strains could be assigned, on the basis of their electrokaryotypes, to 15 groups corresponding to the 15 patients from which they had been isolated.

Spine J 11(10): All isolates appeared susceptible to amphotericin B. Currently, the number of works focusing on electroporation of pathogens, especially Candida, is very limited [24, 25]. 03 µg/ml=6 < 0. Interestingly, these samples did not yield any C. 80 μL of the suspension was used for the pulsed treatment. The acquired PEF treatment efficacy increase was nonlinear for both treatment intensities.

Supporting Information

A representation of Illumina reads from pooled and single isolate sequencing is shown in comparison with the reference sequence (REF) from ATCC 42720. All doses of both antifungals were able to significantly reduce (1→3)-β- d-glucan serum levels with no significant differences between treatments and between the same doses of both drugs. The geometric mean ± MIC values for amphotericin B, fluconazole, voriconazole (n = 102), and caspofungin were as follows: In the 4 kV/cm instance a maximum treatment efficacy of % was achieved ( % for the monopolar pulse). Candida infection: thrush, ✔️ If whatever caused the thrush can be brought under control, the infection is likely to go away after a few days of treatment with a fungicide. Culti-Loops are individually sealed in a foil pouch and packaged five loops per package.

We performed search of MEDLINE (1966-2020), OVID (1950-1965), EMBASE (1974-2020), and the Parasitology Database (1972-2020) using the terms Candida or lusitaniae or yeast infections or fungi or mycotic AND meningitis or brain or neuro or ventriculitis or central nervous system infection to identify cases of C. All follow-up CSF cultures obtained via the VP shunt were negative. We limited our search to human data in the English language. 08 μg /ml, respectively.

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Although MRR1 appeared to be under positive selection within the C. Cells expressing Mrr1 variants that led to drug resistance, by elevated expression of the MDR1-encoded efflux protein, were present at low levels in each sample and thus were undetected in standard assays. However, the patients survived in 20/28 (71. )

Young LY, et al. A simple, low-cost PCR assay was developed for rapid molecular identification of C. Management of the limited number of antimicrobials currently available requires the identification of infections that contain drug-resistant isolates and the discovery of factors that promote the evolution of drug resistance. This will help to protect your privacy. (4%) cases; four had catheters removal (two central venous and one veno­peritoneal shunt) and only three required combination therapy. Phylogenetic analysis using either SNPs or INDELs found similar relationships between isolates (Fig. )Medically significant Candida spp. The colony forming units (CFU) were counted after 48 h of incubation at 30°C.

8%), however, the difference was not statistically significant (P = 0.


The reaction and PCR cycling conditions were same as described previously except that primers CLUSITF and CLUSITR were used [ 17 ]. She was found to have Enterococcus faecalis endocarditis of her native, bicuspid, aortic valve. This patient was previously given liposomal amphotericin B without any clinical response.

Using the same methodology, the results of the bipolar symmetrical pulse PEF treatment were compared.


These cookies allow us to see information on user website activities including, but not limited to page views, source and time spent on a website. The exposure time has been controlled in the 20 μs–1 ms range and the respective growth inhibition dynamics of the colonies have been evaluated by calculation of the colony forming units (CFU) after the 48 h of incubation. Susceptibility testing was performed on the initial isolate only and revealed sensitivity to amphotericin B, caspofungin and fluconazole (Table 1). Caprylic acid helps to defeat candida overgrowth, this makes monolaurin interesting because not only has it demonstrated anti-Candida properties in research, it may also offer support for any co-existing bacterial and viral infections, as well as synergy with other anti-fungal medications (23; 24; 25). Like other Candida meningitis cases occurring in neurosurgical patients, our patient had preceding bacterial meningitis and had received broad-spectrum antibiotics; both are described risk factors. It was recognized as a human pathogen in three patients with septicemia and in two of them, the isolates were reported as variants of C. Analysis of genomes from hundreds of Clavispora (Candida) lusitaniae isolates, through individual and pooled isolate sequencing, from a single individual with cystic fibrosis revealed at least 25 nonsynonymous mutations in MRR1, which encodes a transcription factor capable of inducing fluconazole (FLZ) resistance in Candida species. Additional comments: In an effort to understand the mechanisms contributing to amphotericin B resistance in C.

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It has been demonstrated by time-kill curve analysis that susceptible C. FLC resistance could be linked with overexpression of a major facilitator gene (MFS7) in C. However, the application of azole derivative agents such as itraconazole may result in various side effects such as cardiac failure, mitochondrial dysfunction, or cardiomyopathy [14]. Candida, CAPD, Peritonitis, Renal failure. A study from Anderson Cancer Center (Houston, Texas) during 2020–2020 revealed a high rate of occurrence of C. Following elective pregnancy termination, microscopic examination and molecular analysis demonstrated Candida lusitaniae chorioamnionitis and pneumonia in all 3 fetuses associated with granulomatous inflammation. The patient's symptoms improved and four days later was discharged with dialysate WBC count of only 4 cells/mm 3. With the exception of the strain FMR 9474, against which PSC was more effective than VRC, no differences in reducing tissue burden were found between the treatments.

NET_SessionId: (5%) neonates died. J Clin Microbiol 48(1): The patient was initially treated with liposomal amphotericin B (AmBisome) 5 mg/kg per day as well as intrathecal amphotericin B at 0. See below for more information. Cookies mentioned in the last point are Google analytics cookies that are IP anonymized which means that we cannot trace single users. One of the potential methods to improve the inhibition rate or the cell permeability to inhibitors is the application of electroporation. No reported disclosures.