title: Candida dubliniensis: an appraisal of its clinical significance as a bloodstream pathogen.
abstract: A nine-year prospective study (2002-2010) on the prevalence of Candida dubliniensis among Candida bloodstream isolates is presented. The germ tube positive isolates were provisionally identified as C. dubliniensis by presence of fringed and rough colonies on sunflower seed agar. Subsequently, their identity was confirmed by Vitek2 Yeast identification system and/or by amplification and sequencing of the ITS region of rDNA. In all, 368 isolates were identified as C. dubliniensis; 67.1% came from respiratory specimens, 11.7% from oral swabs, 9.2% from urine, 3.8% from blood, 2.7% from vaginal swabs and 5.4% from other sources. All C. dubliniensis isolates tested by Etest were susceptible to voriconazole and amphotericin B. Resistance to fluconazole (≥8 µg/ml) was observed in 2.5% of C. dubliniensis isolates, 7 of which occurred between 2008-2010. Of note was the diagnosis of C. dubliniensis candidemia in 14 patients, 11 of them occurring between 2008-2010. None of the bloodstream isolate was resistant to fluconazole, while a solitary isolate showed increased MIC to 5-flucytosine (>32 µg/ml) and belonged to genotype 4. A review of literature since 1999 revealed 28 additional cases of C. dubliniensis candidemia, and 167 isolates identified from blood cultures since 1982. In conclusion, this study highlights a greater role of C. dubliniensis in bloodstream infections than hitherto recognized.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait. zkhan@hsc.edu.kw
authors.forename: Ziauddin
authors.initials: Z
authors.lastname: Khan
authors.forename: Suhail
authors.initials: S
authors.lastname: Ahmad
authors.forename: Leena
authors.initials: L
authors.lastname: Joseph
authors.forename: Rachel
authors.initials: R
authors.lastname: Chandy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002175:Candida / Q000378:metabolism*; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology; D002648:Child; D004275:DNA, Ribosomal / Q000378:metabolism; D025141:Drug Resistance, Fungal / Q000187:drug effects; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D005437:Flucytosine / Q000494:pharmacology; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008957:Models, Genetic; D016533:Mycological Typing Techniques; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D004275:DNA, Ribosomal; D015725:Fluconazole; D005437:Flucytosine