No abstract available.
Fungemia*

BACKGROUND: Fast identification of Candida glabrata is important, because empirical antifungal therapy for fungemia with C. glabrata and non-C. glabrata varies. We proposed an algorithm for rapid presumptive diagnosis to identify fungemia with C. glabrata using earlier or only growth from anaerobic bottles and longer time to positivity (TTP) in blood cultures. METHODS: Positivity and TTP using the BacT/Alert 3D system (bioMerieux Inc, USA) with resin bottles (FA Plus and FN Plus) were analyzed in 215 candidemia patients from June 2014 to June 2016 in a university-affiliated hospital in Korea. RESULTS: A higher proportion of earlier or only growth from anaerobic bottles was observed in C. glabrata (38.8%, 7/18) than in C. albicans (7.6%, 8/105), C. parapsilosis (10.5%, 4/138), and C. tropicalis (9.2%, 5/54) (P=0.006). The mean (±standard deviation) TTP for C. glabrata was 41.7 h (±16.3 h) compared with 26.7 h (±15.9 h) for C. albicans, 33.4 h (±8.4 h) for C. parapsilosis, and 23.1 h (±17.3 h) for C. tropicalis (P < 0.0001). We could predict fungemia with C. glabrata with a sensitivity of 94.4%, specificity of 63.9%, positive predictive value of 19.3%, and negative predictive value of 99.2% using a two-step algorithm: earlier or only growth from anaerobic bottles and TTP >31.4 h. CONCLUSION: This two-step algorithm in the BacT/Alert 3D system could be the basis for an initial empirical antifungal therapy for fungemia with C. glabrata prior to final identification.
Candida glabrata* ; Candida* ; Candidemia ; Diagnosis ; Fungemia* ; Humans ; Korea ; Sensitivity and Specificity

A case of fungemia caused by Cyberlindera fabianii was reported in the September issue of Annals of Clinical Microbiology. The C. fabianii that causes rare invasive infection can easily be misidentified as Candida utilis by Vitek-2 YST ID (bioMerieux, USA) and as Candida pelliculosa by API kit (bioMerieux, USA) with high probability. Recently, we also experienced a case of fungemia caused by C. fabianii that was misidentified as C. pelliculosa using API 20C Aux (bioMerieux, USA). As molecular identification is becoming more widespread, cases of C. fabianii infection are expected to be more frequently identified.
Candida ; Fungemia

BACKGROUND: The incidence of fungal urinary tract infections has increased in the immunocompromized patients. We analyzed urine culture results of St. Mary's Hospital during 28 month period between October 1993 and January 1996 to evaluate the frequency of yeast isolates and to survey the distribution of departments from where yeasts isolated. METHODS: We performed a retrospective analysis of urine culture results. Yeasts were identified by the examination of germ tube production in human serum at 37degrees C and API2OC (BioMerieux, France) yeast strip. RESULT: A total of 1,387 urine cultures were reviewed, of which 164 (11.8%) were isolated as fungi. Candida albicans occurred in 36.5% of the total yeast isolates, C. tropicalis in 35.3%, C. glabrata in 10.9% and Trichosporon beigelii in 0.6%. The incidence of urinary fungal infection increased in 1995 (13.0%) than 1994 (9.1%) (P=0.047). Fifty two percents (85/164) of urinary fungi were isolated from patients in Neurosurgery (NS), where isolation of C. tropicalis was significantly more increased than other departments. In four patients, candiduria progressed to candidemia, which were caused by C. albicans (three patients) and C. glabrata (1 patient). CONCLUSIONS: The isolation rate of yeast species was different in NS and non-NS department. The frequency of isolation of C. albicans increased in non-NS department than NS department, while the frequency of isolation of C. tropicalis increased in NS department than non-NS department. The most common organism was C. albicans and department was Neurosurgery.
Candida albicans ; Candidemia ; Fungemia ; Fungi ; Humans ; Incidence ; Neurosurgery ; Retrospective Studies* ; Trichosporon ; Urinary Tract Infections ; Yeasts

No abstract available.
Adult* ; Fungemia* ; Humans ; Malassezia*

No abstract available.
Burkitt Lymphoma ; Fungemia ; Humans ; Trichosporon

Candida spondylodiscitis with epidural abscess is rarely reported and known to be the late complication of candidemia. A 48-years-old man presented with 4 weeks of progressively aggravating low back pain. He had a history of fungemia caused by Candida albicans 4 months earlier, for which he had been treated successfully with systemic fluconazole. The MRI of lumbar spine demonstrated the spondylodiscitis with multiple epidural abscesses at the L2/3 level. Along with the surgical interventions including abscess drainage, the intravenous amphotericin B administration was begun. Culture of drained pus yielded the growth of Candida albicans. After therapy with parenteral amphotericin B for 2 weeks followed by oral fluconazole for 8 weeks, the back pain resolved. However the low back pain and inflammation relapsed during oral fluconazole therapy. Thereafter oral voriconazole had been administered for 24 weeks and the patient showed complete recovery and no recurrence.
Abscess ; Amphotericin B ; Back Pain ; Candida ; Candida albicans ; Candidemia ; Discitis ; Drainage ; Epidural Abscess ; Fluconazole ; Fungemia ; Humans ; Inflammation ; Low Back Pain ; Pyrimidines ; Recurrence ; Spine ; Suppuration ; Triazoles

Candida spondylodiscitis with epidural abscess is rarely reported and known to be the late complication of candidemia. A 48-years-old man presented with 4 weeks of progressively aggravating low back pain. He had a history of fungemia caused by Candida albicans 4 months earlier, for which he had been treated successfully with systemic fluconazole. The MRI of lumbar spine demonstrated the spondylodiscitis with multiple epidural abscesses at the L2/3 level. Along with the surgical interventions including abscess drainage, the intravenous amphotericin B administration was begun. Culture of drained pus yielded the growth of Candida albicans. After therapy with parenteral amphotericin B for 2 weeks followed by oral fluconazole for 8 weeks, the back pain resolved. However the low back pain and inflammation relapsed during oral fluconazole therapy. Thereafter oral voriconazole had been administered for 24 weeks and the patient showed complete recovery and no recurrence.
Abscess ; Amphotericin B ; Back Pain ; Candida ; Candida albicans ; Candidemia ; Discitis ; Drainage ; Epidural Abscess ; Fluconazole ; Fungemia ; Humans ; Inflammation ; Low Back Pain ; Pyrimidines ; Recurrence ; Spine ; Suppuration ; Triazoles

Non-albicans Candida species which are resistant to azole are emerging as important pathogens in patients with hematological malignancies who received antifungal prophylaxis. C. inconspicua is one of rare Candida spp. and resistant to fluconazole and deep infection due to C. inconspicua has not been reported in Korea so far. We reported here two cases of candidemia due to C. inconspicua in neutropenic patients with acute leukemia. C. inconspicua were presumed to be originated from gastrointestinal tract in both cases. The antifungal susceptibility test of C. inconspicua in case 1 showed resistance to fluconazole and itraconazole. Both cases were successfully treated by amphotericin B deoxycholate. Clinicians should keep in mind that non-albicans Candida species would be emerging pathogen in immunocompromised hosts and early recognition and appropriate use of antifungal agents is necessary.
Amphotericin B ; Antifungal Agents ; Candida* ; Candidemia ; Danazol ; Deoxycholic Acid ; Fluconazole ; Fungemia ; Gastrointestinal Tract ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Itraconazole ; Korea ; Leukemia* ; Neutropenia

Non-albicans Candida species which are resistant to azole are emerging as important pathogens in patients with hematological malignancies who received antifungal prophylaxis. C. inconspicua is one of rare Candida spp. and resistant to fluconazole and deep infection due to C. inconspicua has not been reported in Korea so far. We reported here two cases of candidemia due to C. inconspicua in neutropenic patients with acute leukemia. C. inconspicua were presumed to be originated from gastrointestinal tract in both cases. The antifungal susceptibility test of C. inconspicua in case 1 showed resistance to fluconazole and itraconazole. Both cases were successfully treated by amphotericin B deoxycholate. Clinicians should keep in mind that non-albicans Candida species would be emerging pathogen in immunocompromised hosts and early recognition and appropriate use of antifungal agents is necessary.
Amphotericin B ; Antifungal Agents ; Candida* ; Candidemia ; Danazol ; Deoxycholic Acid ; Fluconazole ; Fungemia ; Gastrointestinal Tract ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Itraconazole ; Korea ; Leukemia* ; Neutropenia