title: [Double fungemia. Report of four Tunisian cases].
abstract: Fungemia is classically caused by a single species and the detection of more than one species in blood samples is uncommon. We report four cases of mixed fungemia (MF) diagnosed in the parasitology-mycology laboratory of Farhat-Hached hospital in Sousse, Tunisia. The MF episodes occurred in two neonates and two adults suffering from acute myeloid leukemia. Two fungal species were detected concomitantly within the same blood culture in all cases. Species combination was detected by the subculture of the blood culture on Candida ID(®) chromogenic medium in three cases and on Sabouraud agar in one case. Predisposing factors were: indwelling catheters (4/4), broad-spectrum antibiotics (3/4), neutropenia (2/4), exclusive parenteral nutrition (2/4) and Candida colonization (1/4). Patients presented febrile sepsis with no response to broad-spectrum antibiotic therapy in all cases. Outcome under antifungal treatment was favorable in two cases and the two other patients died.
  
  
  CONCLUSIONS
  MF appears similar to the more common monomicrobial fungemia. The use of chromogenic media in routine can improve the detection of MF episodes allowing appropriate antifungal therapy.
authors.affiliation: Laboratoire de parasitologie-mycologie, hôpital Farhat-Hached, Sousse, Tunisia. saghrounifatma@yahoo.fr
authors.forename: F
authors.initials: F
authors.lastname: Saghrouni
authors.forename: J
authors.initials: J
authors.lastname: Ben Abdeljelil
authors.forename: S
authors.initials: S
authors.lastname: Nouri
authors.forename: S
authors.initials: S
authors.lastname: Gheith
authors.forename: A
authors.initials: A
authors.lastname: Fathallah
authors.forename: H
authors.initials: H
authors.lastname: Sboui
authors.forename: M
authors.initials: M
authors.lastname: Ben Said
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification*; D002176:Candida albicans / Q000302:isolation & purification; D041022:Candida tropicalis / Q000302:isolation & purification; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D002971:Cleft Lip / Q000150:complications; D002972:Cleft Palate / Q000150:complications; D060085:Coinfection; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D003470:Culture Media; D004820:Epidermolysis Bullosa / Q000150:complications; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D005847:Geotrichosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D005848:Geotrichum / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D010288:Parenteral Nutrition / Q000009:adverse effects; D014416:Tunisia; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D003470:Culture Media