Loss of in vitro resistance in Candida glabrata following discontinuation of fluconazole prophylaxis in a hematopoietic stem cell transplantation patient.
We report a case of fluconazole-resistant oropharyngeal colonization caused by a strain of Candida glabrata that rapidly regained susceptibility once prophylaxis with this agent was discontinued and echinocandin therapy was initiated. Isolates collected before and after discontinuation of fluconazole were confirmed to be isogenic by RAPD analysis. Transcription analysis demonstrated constitutive expression of genes encoding efflux pumps in the isolate recovered on fluconazole prophylaxis and transient expression in those isolates collected after fluconazole was discontinued.
Westbrook
Steven D
SD
Department of Dental Diagnostic Sciences, Division of General Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. westbrooks@uthscsa.edu
Wiederhold
Nathan P
NP
Vallor
Ana C
AC
Kotara
Susann
S
Bernardo
Stella
S
Lee
Samuel A
SA
Kirkpatrick
William R
WR
Toro
Juan J
JJ
Freytes
Cesaro
C
Patterson
Thomas F
TF
Redding
Spencer W
SW
D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D041221:Candida glabrata / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D002177:Candidiasis / Q000382:microbiology; D002353:Carrier State / Q000382:microbiology; D018890:Chemoprevention / Q000379:methods*; D016172:DNA Fingerprinting; D004271:DNA, Fungal / Q000235:genetics; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000627:therapeutic use; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use*; D005838:Genotype; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016533:Mycological Typing Techniques; D009960:Oropharynx / Q000382:microbiology; D019105:Random Amplified Polymorphic DNA Technique
D000935:Antifungal Agents; D004271:DNA, Fungal; D054714:Echinocandins; D015725:Fluconazole