Three virulence factors comprising proteinase, phospholipase, and biofilm among 68 Candida albica... more Three virulence factors comprising proteinase, phospholipase, and biofilm among 68 Candida albicans and 31 non-albicans Candida strains (11 C. tropicalis, 8 C. parapsilosis, 6 C. glabrata, 4 C. guillermondii, 2 C. krusei) isolated from blood cultures were analyzed. In total, 61 (89.7%) C. albicans strains were detected as proteinase positive whereas eight (25.8%) non-albicans Candida strains were proteinase positive (P < 0.05). Phospholipase production was detected in 41 (60.3%) C. albicans strains. All non-albicans Candida strains were phospholipase negative. Biofilm production was determined by both visual and spectrophotometric methods. Eight (11.8%) of C. albicans strains and 13 (41.93%) of 31 non-albicans Candida strains were biofilm positive with two of the methods (P < 0.05). According to our results, we may suggest that detection of hydrolytic enzyme and biofilm production abilities of the Candida isolates in clinical mycology laboratories may warn the clinician for a possible hematogenous infection.
Journal de Mycologie Médicale / Journal of Medical Mycology, 2005
Rhodotorula species including Rhodotorula minuta are emerging yeast pathogens defined particularl... more Rhodotorula species including Rhodotorula minuta are emerging yeast pathogens defined particularly in immunocompromised patients. In this study the patient was a woman with a history of diabetes mellitus (DM) and uterus cancer, which was treated with chemotherapy following hysterectomy. The patient had more than one operation on her hip joint due to several complaints including restriction in movement and severe pain. The cultures obtained during operations revealed several microorganisms including Candida albicans, Enterobacter cloacae, ESBL (+) Escherichia coli and lastly R. minuta. The last agent, R. minuta was treated successfully with fluconazole. This is the second case of hip joint infection caused by R. minuta, which was hardly isolated following a long period of cultivation.
Infectious Diseases in Obstetrics and Gynecology, 2004
Objectives: In this study, 210 women with vaginal discharge and other symptoms/signs of genital p... more Objectives: In this study, 210 women with vaginal discharge and other symptoms/signs of genital pathology suggestive of vulvovaginal candidiasis (VVC) were involved in order to distinguish true VVC and cytolytic vaginosis (CV) cases. Methods: Fungal cultures, 10% potassium hydroxide (KOH) and Gram stained preparations and pH measurements were performed on the vaginal discharge material of each patient. Results: Fifteen patients (7.1%) were diagnosed with cytolytic vaginosis according to their clinical and microbiological findings, including abundant lactobacilli, fragmented epithelial cells and/or free nuclei due to cytolysis, seen in their discharge materials on microscopic examination, but no fungal growth. Conclusions: The results of this study may contribute to the reports in the literature indicating the importance of such disorders, which are generally misdiagnosed as candidiasis.
Fungal infections like Paecilomyces keratitis have emerged in childhood recently. The diagnosis a... more Fungal infections like Paecilomyces keratitis have emerged in childhood recently. The diagnosis and treatment of Paecilomyces keratitis is difficult and the outcome is usually poor. Corneal culture should be performed on fungal media such as Sabouraud glucose neopeptone agar (SDA) as soon as possible for diagnosis. We report a rare case of Paecilomyces keratitis in an immunocompetent child, which was unresponsive to amphotericin B. The case was managed by a multidisciplinary approach involving the departments of ophthalmology, microbiology and pediatric infectious diseases. We want to draw attention once again that fungal keratitis caused by unusual agents are increasing. Physicians should consider fungal causes of keratitis, in patients with some predisposing factors like ocular surgery and prolonged use of topical corticosteroids.
Trichosporon spp. are emerging as opportunistic agents that cause systemic diseases in immunocomp... more Trichosporon spp. are emerging as opportunistic agents that cause systemic diseases in immunocompromised hosts. Trichosporonosis carries a poor prognosis in neutropenic patients. Trichosporon japonicum was isolated from the air and named by Sugita et al. Here we present the first case of T. japonicum isolated from a clinical specimen. Two cases of acute myeloid leukemia who had Trichosporon isolates are discussed because of their rarity and growing importance. T. asahii was isolated from the throat, feces and urine of the first patient. T. japonicum was isolated from the sputum of the second patient. Both cases produced high MICs to itraconazole, and low MICs to fluconazole and voriconazole. In virulance factor investigations there was (++) biofilm formation in T. japonicum but not in T. asahii. Conventional mycological studies were not adequate for the identification of the isolate at the species level. In our second case as in the first one, the isolate was identified as T. asahii...
Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunoco... more Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow-up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy. Pichia anomala gilt als opportunistischer Erreger nosokomialer Infektionen bei Neugeborenen und immunsupprimierten Kindern. Wir beschreiben nosokomiale Katheterinfektionen durch P. anomala bei drei Kindern mit Krebs, bei einer Fru ¨hgeburt und bei einem immunsupprimierten Sa ¨ugling. Alle fu ¨nf Patienten hatten vorab antibakterielle Therapie erhalten und wurden durch Amphotericin B erfolgreich behandelt. Alle Isolate waren empfindlich fu ¨r Amphotericin B und Fluconazol. In der Nachbeobachtungszeit wurde an vier fu ¨nf Patienten kein Rezidiv beobachtet.
Premature infants are at high risk of developing candidal infections originating from their own n... more Premature infants are at high risk of developing candidal infections originating from their own normal flora or from the hospital environment. This study involves the surveillance cultures and blood cultures of candidemic preterm infants with low birth weights who have been analyzed for colonization period and status, and for virulence factors such as acid proteinase and phospholipase. Arbitrarily primed-polymerase chain reaction (AP-PCR) was applied to the blood culture isolates of the babies with candidemia and their last colonizing strains in order to determine whether the source of fungemia was the rectum. Of 65 colonized infants, 6.2% developed candidemia with identical strains originating from their rectum according to their PCR patterns. Our findings indicate that the properties of the colonizing yeasts such as increase in number--although not statistically significant because of the small sample size--and/or exhibition of strong hydrolytic enzyme activities through a long du...
In this study, we investigated the presence of virulence factors in a total of 33 Candida parapsi... more In this study, we investigated the presence of virulence factors in a total of 33 Candida parapsilosis strains, including adherence, acid proteinase and phospholipase production capabilities. Of the 33 strains, 19 were isolated from blood cultures of hospitalised fungaemic patients (study group 2). We also investigated the importance of other factors present in the development of fungaemia. The mean adherence values of 19 blood isolates and 14 non-blood isolates were found to be 52.63 and 57.96, respectively; these values did not differ significantly (P > 0.05). Nine non-blood strains (64.29%) of study group 2 and five blood strains (26.31%) of study group 1 were found to be positive for acid proteinase production; this difference was statistically significant (P < 0.05). Phospholipase production was found in five strains (26.31%) of the 19 blood isolates. None of the 14 non-blood strains exhibited phospholipase activity; this difference between the two groups was statistically significant (P < 0.05). In this study, correlations between adherence-phospholipase, and adherence-acid proteinase properties of strains were detected as well. In the present study, it has been observed that phospholipase production can be an important virulence factor in bloodstream infections caused by C. parapsilosis.
Early detection of slime production may be useful for clinical decision because of its suggestive... more Early detection of slime production may be useful for clinical decision because of its suggestive property for potential pathogenic capacity of a Candida strain especially in patients with a prosthetic device. In this study we aimed to compare the visual tube method (VTM) with transmission electron microscopy (TEM) in order to confirm the reliability of the former method. In order to demonstrate the reproducibility of the tube method and to determine the correct timing for the test, Candida isolates directly obtained from blood culture (DBC) bottles and their two subsequent subcultures were used. The results of this study showed that VTM is a simple and reliable method which can be used in every clinical mycology laboratory, provided that the test is applied on DBC isolates; as the ability of slime production is decreased or lost even after the first subculturing. We suggest that this simple method can be used and may have some contributions to the ongoing studies on the controversial issue concerning removal of biomaterials in candidemic patients.
caryotype was normal (46, XX). The neonate required immediate surgical intervention due to respir... more caryotype was normal (46, XX). The neonate required immediate surgical intervention due to respiratory compromise that revealed an extended form of right congenital diaphragmatic eventration (CDE). Fifty-five ml of pleural fluid was drained from the right hemithorax. A thin diaphragm was covering the liver and the intestine that was herniated in the right hemithorax. Histological examination of diaphragmatic tissue revealed lack of muscle cells with loose connective tissue, rich vascularisation and lymphocytic infiltration. By the means of PCR we identified the genome of Parvovirus B19 in the pleural fluid. Both pleural fluid and blood cultures were negative. Positive maternal serologic test for previous Parvo B19 infection confirmed our hypothesis for intrauterine infection.
A 24-year-old male patient with acute myeloid leukemia (AML), who had been in remission for 18 mo... more A 24-year-old male patient with acute myeloid leukemia (AML), who had been in remission for 18 months following the completion of chemotherapy, presented with fatigue and nasal bleeding. He was found to have pancytopenia, and bone marrow aspiration showed relapsed AML. He was given high-dose sequential chemotherapy consisting of cytosine arabinoside, 500 mg/m 2 per day as a 24-h continuous infusion, idarubicin, 12 mg/m 2 per day on days 1-3, etoposide, 200 mg/m 2 per day as a 24-h continuous infusion on days 8-10, and granulocyte colony-stimulating factor (G-CSF), 5 mg/kg per day subcutaneously, starting from day 12 until absolute neutrophil recovery above 1000/mL. The patient became neutropenic, with a count below 100/mL, on the 5th day of chemotherapy. He was pyrexial on the next day, with a temperature of 39 8C, without any localizing symptoms or signs of infection. Blood cultures were taken, and chest X-ray was normal. Empirical antibiotic therapy with piperacillin-tazobactam was commenced, and vancomycin was added 48 h later, when no response was obtained. Examination revealed widespread oral mucositis on the fourth day of the febrile neutropenic episode. Blood cultures, which had been taken every other febrile day, revealed extended-spectrum b-lactamase-producing Escherichia coli on the seventh day of pyrexia, and meropenem and amikacin were substituted for piperacillin-tazobactam.
Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unkn... more Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unknown origin that had lasted for 7 months, in conjunction with transthoracic echocardiography, demonstrating a 20-mm vegetation, superior to the tricuspid valve, herniating into the right atrial cavity. The finding led to the diagnosis of fungal endocarditis. Fluconazole, 600 mg daily, was commenced for 8 days; followed by amphotericin B, 1 mg/kg daily. On the fourth day of the amphotericin B treatment, the patient underwent replacement of the infected tricuspid valve. Even though the initial postoperative period was relatively uncomplicated, the patient died after a gross aspiration on the 67th day of his hospital stay, despite aggressive cardiovascular support and antimicrobial therapy. This is the first report of a native tricuspid valve fungal endocarditis due to C. colliculosa or Torulaspora delbrueckii, which is not known to be a human pathogen.
In order to determine the local epidemiology of candidemia, Candida strains isolated between 1994... more In order to determine the local epidemiology of candidemia, Candida strains isolated between 1994 and 2000 were identified to species level; antifungal resistance patterns and DNA fingerprints were analyzed. Identification of Candida strains (n: 140) was performed with germ tube test and carbohydrate assimilation reactions. Minimal inhibitory concentrations were determined using a commercial test for 5-flucytosine and the broth macrodilution method according to NCCLS for fluconazole and amphotericin B. Molecular relatedness was determined by restriction endonuclease analysis of genomic DNA followed by probe hybridization. C. albicans (37.2%), C. parapsilosis (32.2%), and C. tropicalis (12.2%) comprised 114 (81.4%) of 140 isolates. Susceptibility tests did not reveal resistance to amphotericin B in any of the Candida isolates. Fluconazole resistance was detected in one isolate of C. krusei, and 5-flucytosine resistance in two C. tropicalis isolates and one C. albicans isolate. Significantly higher frequency of clusters with identical strains in C. parapsilosis and C. tropicalis was detected compared to C. albicans. Pediatric wards are particularly important in the nosocomial transmission of non-albicans candida species.
Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunoco... more Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow-up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy.
Three virulence factors comprising proteinase, phospholipase, and biofilm among 68 Candida albica... more Three virulence factors comprising proteinase, phospholipase, and biofilm among 68 Candida albicans and 31 non-albicans Candida strains (11 C. tropicalis, 8 C. parapsilosis, 6 C. glabrata, 4 C. guillermondii, 2 C. krusei) isolated from blood cultures were analyzed. In total, 61 (89.7%) C. albicans strains were detected as proteinase positive whereas eight (25.8%) non-albicans Candida strains were proteinase positive (P < 0.05). Phospholipase production was detected in 41 (60.3%) C. albicans strains. All non-albicans Candida strains were phospholipase negative. Biofilm production was determined by both visual and spectrophotometric methods. Eight (11.8%) of C. albicans strains and 13 (41.93%) of 31 non-albicans Candida strains were biofilm positive with two of the methods (P < 0.05). According to our results, we may suggest that detection of hydrolytic enzyme and biofilm production abilities of the Candida isolates in clinical mycology laboratories may warn the clinician for a possible hematogenous infection.
Journal de Mycologie Médicale / Journal of Medical Mycology, 2005
Rhodotorula species including Rhodotorula minuta are emerging yeast pathogens defined particularl... more Rhodotorula species including Rhodotorula minuta are emerging yeast pathogens defined particularly in immunocompromised patients. In this study the patient was a woman with a history of diabetes mellitus (DM) and uterus cancer, which was treated with chemotherapy following hysterectomy. The patient had more than one operation on her hip joint due to several complaints including restriction in movement and severe pain. The cultures obtained during operations revealed several microorganisms including Candida albicans, Enterobacter cloacae, ESBL (+) Escherichia coli and lastly R. minuta. The last agent, R. minuta was treated successfully with fluconazole. This is the second case of hip joint infection caused by R. minuta, which was hardly isolated following a long period of cultivation.
Infectious Diseases in Obstetrics and Gynecology, 2004
Objectives: In this study, 210 women with vaginal discharge and other symptoms/signs of genital p... more Objectives: In this study, 210 women with vaginal discharge and other symptoms/signs of genital pathology suggestive of vulvovaginal candidiasis (VVC) were involved in order to distinguish true VVC and cytolytic vaginosis (CV) cases. Methods: Fungal cultures, 10% potassium hydroxide (KOH) and Gram stained preparations and pH measurements were performed on the vaginal discharge material of each patient. Results: Fifteen patients (7.1%) were diagnosed with cytolytic vaginosis according to their clinical and microbiological findings, including abundant lactobacilli, fragmented epithelial cells and/or free nuclei due to cytolysis, seen in their discharge materials on microscopic examination, but no fungal growth. Conclusions: The results of this study may contribute to the reports in the literature indicating the importance of such disorders, which are generally misdiagnosed as candidiasis.
Fungal infections like Paecilomyces keratitis have emerged in childhood recently. The diagnosis a... more Fungal infections like Paecilomyces keratitis have emerged in childhood recently. The diagnosis and treatment of Paecilomyces keratitis is difficult and the outcome is usually poor. Corneal culture should be performed on fungal media such as Sabouraud glucose neopeptone agar (SDA) as soon as possible for diagnosis. We report a rare case of Paecilomyces keratitis in an immunocompetent child, which was unresponsive to amphotericin B. The case was managed by a multidisciplinary approach involving the departments of ophthalmology, microbiology and pediatric infectious diseases. We want to draw attention once again that fungal keratitis caused by unusual agents are increasing. Physicians should consider fungal causes of keratitis, in patients with some predisposing factors like ocular surgery and prolonged use of topical corticosteroids.
Trichosporon spp. are emerging as opportunistic agents that cause systemic diseases in immunocomp... more Trichosporon spp. are emerging as opportunistic agents that cause systemic diseases in immunocompromised hosts. Trichosporonosis carries a poor prognosis in neutropenic patients. Trichosporon japonicum was isolated from the air and named by Sugita et al. Here we present the first case of T. japonicum isolated from a clinical specimen. Two cases of acute myeloid leukemia who had Trichosporon isolates are discussed because of their rarity and growing importance. T. asahii was isolated from the throat, feces and urine of the first patient. T. japonicum was isolated from the sputum of the second patient. Both cases produced high MICs to itraconazole, and low MICs to fluconazole and voriconazole. In virulance factor investigations there was (++) biofilm formation in T. japonicum but not in T. asahii. Conventional mycological studies were not adequate for the identification of the isolate at the species level. In our second case as in the first one, the isolate was identified as T. asahii...
Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunoco... more Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow-up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy. Pichia anomala gilt als opportunistischer Erreger nosokomialer Infektionen bei Neugeborenen und immunsupprimierten Kindern. Wir beschreiben nosokomiale Katheterinfektionen durch P. anomala bei drei Kindern mit Krebs, bei einer Fru ¨hgeburt und bei einem immunsupprimierten Sa ¨ugling. Alle fu ¨nf Patienten hatten vorab antibakterielle Therapie erhalten und wurden durch Amphotericin B erfolgreich behandelt. Alle Isolate waren empfindlich fu ¨r Amphotericin B und Fluconazol. In der Nachbeobachtungszeit wurde an vier fu ¨nf Patienten kein Rezidiv beobachtet.
Premature infants are at high risk of developing candidal infections originating from their own n... more Premature infants are at high risk of developing candidal infections originating from their own normal flora or from the hospital environment. This study involves the surveillance cultures and blood cultures of candidemic preterm infants with low birth weights who have been analyzed for colonization period and status, and for virulence factors such as acid proteinase and phospholipase. Arbitrarily primed-polymerase chain reaction (AP-PCR) was applied to the blood culture isolates of the babies with candidemia and their last colonizing strains in order to determine whether the source of fungemia was the rectum. Of 65 colonized infants, 6.2% developed candidemia with identical strains originating from their rectum according to their PCR patterns. Our findings indicate that the properties of the colonizing yeasts such as increase in number--although not statistically significant because of the small sample size--and/or exhibition of strong hydrolytic enzyme activities through a long du...
In this study, we investigated the presence of virulence factors in a total of 33 Candida parapsi... more In this study, we investigated the presence of virulence factors in a total of 33 Candida parapsilosis strains, including adherence, acid proteinase and phospholipase production capabilities. Of the 33 strains, 19 were isolated from blood cultures of hospitalised fungaemic patients (study group 2). We also investigated the importance of other factors present in the development of fungaemia. The mean adherence values of 19 blood isolates and 14 non-blood isolates were found to be 52.63 and 57.96, respectively; these values did not differ significantly (P > 0.05). Nine non-blood strains (64.29%) of study group 2 and five blood strains (26.31%) of study group 1 were found to be positive for acid proteinase production; this difference was statistically significant (P < 0.05). Phospholipase production was found in five strains (26.31%) of the 19 blood isolates. None of the 14 non-blood strains exhibited phospholipase activity; this difference between the two groups was statistically significant (P < 0.05). In this study, correlations between adherence-phospholipase, and adherence-acid proteinase properties of strains were detected as well. In the present study, it has been observed that phospholipase production can be an important virulence factor in bloodstream infections caused by C. parapsilosis.
Early detection of slime production may be useful for clinical decision because of its suggestive... more Early detection of slime production may be useful for clinical decision because of its suggestive property for potential pathogenic capacity of a Candida strain especially in patients with a prosthetic device. In this study we aimed to compare the visual tube method (VTM) with transmission electron microscopy (TEM) in order to confirm the reliability of the former method. In order to demonstrate the reproducibility of the tube method and to determine the correct timing for the test, Candida isolates directly obtained from blood culture (DBC) bottles and their two subsequent subcultures were used. The results of this study showed that VTM is a simple and reliable method which can be used in every clinical mycology laboratory, provided that the test is applied on DBC isolates; as the ability of slime production is decreased or lost even after the first subculturing. We suggest that this simple method can be used and may have some contributions to the ongoing studies on the controversial issue concerning removal of biomaterials in candidemic patients.
caryotype was normal (46, XX). The neonate required immediate surgical intervention due to respir... more caryotype was normal (46, XX). The neonate required immediate surgical intervention due to respiratory compromise that revealed an extended form of right congenital diaphragmatic eventration (CDE). Fifty-five ml of pleural fluid was drained from the right hemithorax. A thin diaphragm was covering the liver and the intestine that was herniated in the right hemithorax. Histological examination of diaphragmatic tissue revealed lack of muscle cells with loose connective tissue, rich vascularisation and lymphocytic infiltration. By the means of PCR we identified the genome of Parvovirus B19 in the pleural fluid. Both pleural fluid and blood cultures were negative. Positive maternal serologic test for previous Parvo B19 infection confirmed our hypothesis for intrauterine infection.
A 24-year-old male patient with acute myeloid leukemia (AML), who had been in remission for 18 mo... more A 24-year-old male patient with acute myeloid leukemia (AML), who had been in remission for 18 months following the completion of chemotherapy, presented with fatigue and nasal bleeding. He was found to have pancytopenia, and bone marrow aspiration showed relapsed AML. He was given high-dose sequential chemotherapy consisting of cytosine arabinoside, 500 mg/m 2 per day as a 24-h continuous infusion, idarubicin, 12 mg/m 2 per day on days 1-3, etoposide, 200 mg/m 2 per day as a 24-h continuous infusion on days 8-10, and granulocyte colony-stimulating factor (G-CSF), 5 mg/kg per day subcutaneously, starting from day 12 until absolute neutrophil recovery above 1000/mL. The patient became neutropenic, with a count below 100/mL, on the 5th day of chemotherapy. He was pyrexial on the next day, with a temperature of 39 8C, without any localizing symptoms or signs of infection. Blood cultures were taken, and chest X-ray was normal. Empirical antibiotic therapy with piperacillin-tazobactam was commenced, and vancomycin was added 48 h later, when no response was obtained. Examination revealed widespread oral mucositis on the fourth day of the febrile neutropenic episode. Blood cultures, which had been taken every other febrile day, revealed extended-spectrum b-lactamase-producing Escherichia coli on the seventh day of pyrexia, and meropenem and amikacin were substituted for piperacillin-tazobactam.
Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unkn... more Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unknown origin that had lasted for 7 months, in conjunction with transthoracic echocardiography, demonstrating a 20-mm vegetation, superior to the tricuspid valve, herniating into the right atrial cavity. The finding led to the diagnosis of fungal endocarditis. Fluconazole, 600 mg daily, was commenced for 8 days; followed by amphotericin B, 1 mg/kg daily. On the fourth day of the amphotericin B treatment, the patient underwent replacement of the infected tricuspid valve. Even though the initial postoperative period was relatively uncomplicated, the patient died after a gross aspiration on the 67th day of his hospital stay, despite aggressive cardiovascular support and antimicrobial therapy. This is the first report of a native tricuspid valve fungal endocarditis due to C. colliculosa or Torulaspora delbrueckii, which is not known to be a human pathogen.
In order to determine the local epidemiology of candidemia, Candida strains isolated between 1994... more In order to determine the local epidemiology of candidemia, Candida strains isolated between 1994 and 2000 were identified to species level; antifungal resistance patterns and DNA fingerprints were analyzed. Identification of Candida strains (n: 140) was performed with germ tube test and carbohydrate assimilation reactions. Minimal inhibitory concentrations were determined using a commercial test for 5-flucytosine and the broth macrodilution method according to NCCLS for fluconazole and amphotericin B. Molecular relatedness was determined by restriction endonuclease analysis of genomic DNA followed by probe hybridization. C. albicans (37.2%), C. parapsilosis (32.2%), and C. tropicalis (12.2%) comprised 114 (81.4%) of 140 isolates. Susceptibility tests did not reveal resistance to amphotericin B in any of the Candida isolates. Fluconazole resistance was detected in one isolate of C. krusei, and 5-flucytosine resistance in two C. tropicalis isolates and one C. albicans isolate. Significantly higher frequency of clusters with identical strains in C. parapsilosis and C. tropicalis was detected compared to C. albicans. Pediatric wards are particularly important in the nosocomial transmission of non-albicans candida species.
Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunoco... more Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow-up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy.
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