Recurrent candidaemia in a neonate with Hirschsprung's disease: fluconazole resistance and genetic relatedness of eight Candida tropicalis isolates.
The incidence of candidaemia among immunocompromised patients in Malaysia is increasing at an alarming rate. Isolation of clinical strains that are resistant to fluconazole has also risen markedly. We report here the repeated isolation of Candida tropicalis from the blood of a neonatal patient with Hirschsprung's disease. In vitro fluconazole susceptibility tests of the eight isolates obtained at different time points showed that seven of the isolates were resistant and one isolate was scored as susceptible dose-dependent. Random amplification of polymorphic DNA fingerprinting of the isolates using three primers and subsequent phylogenetic analysis revealed that these isolates were highly similar strains having minor genetic divergence, with a mean pairwise similarity coefficient of 0.893+/-0.041. The source of the infectious agent was thought to be the central venous catheter, as culture of its tip produced fluconazole-resistant C. tropicalis. This study demonstrates the utility of applying molecular epidemiology techniques to complement traditional mycological culture and drug susceptibility tests for accurate and appropriate management of recurrent candidaemia and highlights the need for newer antifungals that can combat the emergence of fluconazole-resistant C. tropicalis strains.
Pei Pei
PP
Chong
David Ching-Soo
DC
Chieng
Lee Yean
LY
Low
Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
Asma
A
Hafeez
Mariana Nor
MN
Shamsudin
Heng Fong
HF
Seow
Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
Kee Peng
KP
Ng
D000935:Antifungal Agents / Q000494:pharmacology; D041022:Candida tropicalis / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications* / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000494:pharmacology*; D016469:Fungemia / Q000382:microbiology; D014644:Genetic Variation; D006627:Hirschsprung Disease / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000382:microbiology*; D008297:Male
D000935:Antifungal Agents; D015725:Fluconazole