title: Loss of in vitro resistance in Candida glabrata following discontinuation of fluconazole prophylaxis in a hematopoietic stem cell transplantation patient.
abstract: 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.
authors.affiliation: 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
authors.forename: Steven D
authors.initials: SD
authors.lastname: Westbrook
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Wiederhold
authors.forename: Ana C
authors.initials: AC
authors.lastname: Vallor
authors.forename: Susann
authors.initials: S
authors.lastname: Kotara
authors.forename: Stella
authors.initials: S
authors.lastname: Bernardo
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Lee
authors.forename: William R
authors.initials: WR
authors.lastname: Kirkpatrick
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Toro
authors.forename: Cesaro
authors.initials: C
authors.lastname: Freytes
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.forename: Spencer W
authors.initials: SW
authors.lastname: Redding
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D054714:Echinocandins; D015725:Fluconazole