title: Outbreak of Candida rugosa candidemia: an emerging pathogen that may be refractory to amphotericin B therapy.
abstract: Candida rugosa has been rarely reported as a human pathogen. We retrospectively evaluated a cluster of Candida rugosa candidemia cases occurring in six hospitalized patients from a tertiary care teaching hospital in São Paulo, Brazil. Genetic relatedness among the six C. rugosa outbreak isolates was characterized by RAPD assay using 3 different 10-mer primers and by pulsed field gel electrophoresis. The source of the outbreak was not identified. All patients had been subjected to invasive medical procedures, including central venous catheterization, surgery or dialysis. Two patients were undergoing amphotericin B therapy prior to the onset of candidemia. The crude mortality rate was very high, despite antifungal therapy. C. rugosa may represent an emerging pathogen associated with invasive medical procedures, able to infect immunocompetent hosts causing serious systemic infection refractory to amphotericin B therapy.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. colomboal@terra.com.br
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
authors.forename: Analy S Azevedo
authors.initials: AS
authors.lastname: Melo
authors.forename: Robert F
authors.initials: RF
authors.lastname: Crespo Rosas
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomão
authors.forename: Marcelo
authors.initials: M
authors.lastname: Briones
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hollis
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Messer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pfaller
mesh_terms: D017677:Age Distribution; D000368:Aged; D000666:Amphotericin B / Q000494:pharmacology* / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000145:classification* / Q000187:drug effects*; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004196:Disease Outbreaks; D025141:Drug Resistance, Fungal; D005260:Female; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000666:Amphotericin B