Colony morphology switching of Candida lusitaniae and acquisition of multidrug resistance during treatment of a renal infection in a newborn: case report and review of the literature.
Candida lusitaniae is an emerging opportunistic pathogen which exhibits an unusual antifungal susceptibility pattern. We describe a case of fatal renal infection due to C. lusitaniae in a very low birth weight neonate who was treated with short courses of fluconazole given alternately with amphotericin B. A colony morphology switching was detected on the standard primary culture medium by changes in colony size. Switching was shown to affect deeply the susceptibility to amphotericin B. Afterwards, the switched phenotype developed a cross resistance to fluconazole and itraconazole. Several issues raised by this case are discussed in the light of an extensive review of the literature. Our observations point out the importance of both the detection of colony morphology switching and the close monitoring of antifungal susceptibility in the management of infections due to C. lusitaniae. A judicious therapeutic strategy should prevent the acquisition of multidrug resistance during antifungal therapy.
Favel
Anne
A
Laboratoire de Botanique, Cryptogamie et Biologie cellulaire, Faculté de Pharmacie, 13385 Marseille, France. anne.favel@pharmacie.univ-mrs.fr
Michel-Nguyen
Annie
A
Peyron
Florence
F
Martin
Claude
C
Thomachot
Laurent
L
Datry
Annick
A
Bouchara
Jean-Philippe
JP
Challier
Svetlana
S
Noël
Thierry
T
Chastin
Christiane
C
Regli
Patrick
P
D000935:Antifungal Agents / Q000494:pharmacology; D001483:Base Sequence; D002175:Candida / Q000145:classification / Q000187:drug effects*; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D015169:Colony Count, Microbial; D025141:Drug Resistance, Fungal; D018432:Drug Resistance, Multiple; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007674:Kidney Diseases / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D016533:Mycological Typing Techniques; D016133:Polymerase Chain Reaction; D012331:RNA, Fungal / Q000032:analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity
D000935:Antifungal Agents; D012331:RNA, Fungal