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Caggiano G, Fioriti S, Morroni G, Apollonio F, Triggiano F, D'Achille G, Stefanizzi P, Dalfino L, Ronga L, Mosca A, Sparapano E, De Carlo C, Signorile F, Grasso S, Barchiesi F, Montagna MT. Genotypic and phenotypic characteristics of Candida parapsilosis bloodstream isolates: Health Care Associated Infections in a teaching Hospital in Italy. J Infect Public Health 2024; 17:967-974. [PMID: 38631066 DOI: 10.1016/j.jiph.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/09/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Candidemia is the most common healthcare associated invasive fungal infection. Over the last few decades, candidemia caused by Candida species other than Candida albicans, particularly the Candida parapsilosis complex, has emerged worldwide. The aims of this study were: to analyze the genotypic and phenotypic characteristics of C. parapsilosis strains isolated from blood cultures and the environment in a hospital in southern Italy, to study the possible source of infection and to correlate the isolated strains. METHODS From April to October 2022, cases of candidemia due to C. parapsilosis in patients admitted to a hospital in the Apulia region were investigated. However, 119 environmental samples from the intensive care unit were collected for identification of the likely environmental reservoir of infection. Routine antifungal (amphotericin B, anidulafungin, fluconazole) susceptibility was performed on all isolates. Whole genome sequencing was performed to study the genotypic correlation of the isolates. Biofilm biomass and metabolic activity were also quantified for all isolates. RESULTS A total of 43 C. parapsilosis isolates were cultured from the bloodstream of each patient in different departments, and seven surface samples were positive for C. parapsilosis. Most of the isolated yeasts (41/50; 85 %) were resistant to fluconazole and were genetically related to each other, suggesting an ongoing clonal outbreak of this pathogen. The fluconazole-susceptible isolates produced significantly more biofilm than did the resistant isolates. Metabolic activity was also higher for fluconazole-susceptible than resistant isolates. CONCLUSION Cross-transmission of the microorganisms is suggested by the phenotypic similarity and genetic correlation between clinical and environmental strains observed in our study.
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Affiliation(s)
- Giuseppina Caggiano
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, Bari 70124, Italy.
| | - Simona Fioriti
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Gianluca Morroni
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Francesca Apollonio
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, Bari 70124, Italy
| | - Francesco Triggiano
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, Bari 70124, Italy
| | - Gloria D'Achille
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, Bari 70124, Italy
| | - Lidia Dalfino
- Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari Aldo Moro
| | - Luigi Ronga
- Microbiology and Virology Unit, Azienda OU Policlinico of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Adriana Mosca
- Interdisciplinary Department of Medicine, Microbiology Section, University of Bari Aldo Moro, Piazza G. Cesare 11, Bari 70124, Italy
| | - Eleonora Sparapano
- Microbiology and Virology Unit, Azienda OU Policlinico of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Carmela De Carlo
- Microbiology and Virology Unit, Azienda OU Policlinico of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Fabio Signorile
- Clinic of Infectious diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Policlinic of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Salvatore Grasso
- Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari Aldo Moro
| | - Francesco Barchiesi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy; Clinic of Infectious Diseases, Azienda Sanitaria Territoriale 1, Pesaro-Urbino, Italy.
| | - Maria Teresa Montagna
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, Bari 70124, Italy
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Orive Bañuelos A, Santamaría Carro A, Feijóo Lera R, Sacristán Egüén C, Andollo Victoriano N, Etxebarria Ecenarro J. Candida Colonization on the Surface of Contact Lenses in Long-Term Wearers and Boston Type 1 Keratoprosthesis Patients Presenting as White Mulberry-Shaped Deposits. Eye Contact Lens 2023; 49:188-192. [PMID: 37088944 DOI: 10.1097/icl.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To report Candida colonies on the surface of the contact lens in long-term contact lens wearers and patients with Boston type 1 keratoprosthesis (KPro I). METHODS A retrospective study was performed based on analyzing cultures from bandage contact lenses with small whitish mulberry-shaped deposits on their surface. RESULTS Eight samples (from seven patients) were positive for Candida. Seven of the eight were positive for Candida parapsilosis. CONCLUSIONS The whitish deposits on contact lenses are often Candida colonies that colonize the surface but do not cause an active infection in the eye. C. parapsilosis is well-known for colonizing prosthetic devices. We underline the importance of including Candida species in the differential diagnosis of lens deposits, especially in susceptible patients such as keratoprosthesis carriers.
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Affiliation(s)
- Ana Orive Bañuelos
- Department of Ophthalmology (A.O.B., A.S.C., R.F.L., C.S.E., J.E.E.), BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain; and Department of Cell Biology and Histology (N.A.V., J.E.E.), School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
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Sharma S, Samantaray S, Kumar D, Meena DS, Chaudhary R, Jain V, Bohra GK, Garg MK. Prosthetic valve endocarditis due to Candida parapsilosis - a rare case report. Access Microbiol 2023; 5:000462.v4. [PMID: 36911424 PMCID: PMC9996159 DOI: 10.1099/acmi.0.000462.v4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023] Open
Abstract
Fungal endocarditis is a rare and fatal condition, most frequently caused by species of the genera Candida and Aspergillus. Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging, with prosthetic valve endocarditis being extremely difficult to diagnose. The optimal management of the condition still remains debatable. We present a case of prosthetic valve endocarditis caused by Candida parapsilosis, managed empirically with liposomal amphotericin B, which was later shifted to combination therapy with high-dose echinocandin and fluconazole, but had a fatal outcome because the patient could not undergo timely surgical intervention. Treating C. parapsilosis endocarditis cases is difficult because of their biofilm production on native and prosthetic heart valves. A combined approach consisting of a high index of clinical suspicion, early diagnosis using serological markers followed by culture or PCR and prompt initiation of appropriate antifungals may aid in improving outcomes.
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Affiliation(s)
- Shivang Sharma
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Subhashree Samantaray
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Durga Shankar Meena
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Chaudhary
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal Krishana Bohra
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Khadilkar AC, Diaz Vera J, Enciso J, Hernandez Burgos P. Cardiac Imaging and Management of Prosthetic Valve Candida Parapsilosis Endocarditis. Cureus 2021; 13:e16082. [PMID: 34239801 PMCID: PMC8247458 DOI: 10.7759/cureus.16082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/03/2022] Open
Abstract
Fungal infective endocarditis is a rare and serious form of endocarditis associated with severe morbidity and mortality. The greatest propensity for infection can be found in patients with implanted prosthetic valves, implanted cardiac devices, and intravenous drug use. We present a case of a 45-year-old male with a prior bioprosthetic mitral valve who was diagnosed with Candida parapsilosis endocarditis. Computed tomography imaging of the abdomen was significant for splenic infarcts, and transesophageal echocardiography demonstrated a 1.23 cm x 0.55 cm lesion and 1.02 cm x 0.545 cm lesion on the bioprosthetic valve. The patient was subsequently treated with Amphotericin B and life-long Fluconazole. This case highlights the imaging findings and treatment of a rare disease process.
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Affiliation(s)
| | | | - Juan Enciso
- Internal Medicine, University of South Florida, Tampa, USA
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Hebert J, Barr E, Magee C. Pacemaker-related Candida parapsilosis fungaemia in an immunosuppressed renal transplant recipient. BMJ Case Rep 2021; 14:14/7/e242917. [PMID: 34230047 PMCID: PMC8264575 DOI: 10.1136/bcr-2021-242917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal transplant recipients are at risk for opportunistic infections due to their immunosuppressed state. We describe the case of a 59-year-old renal transplant recipient who presented with sepsis and bilateral pulmonary emboli due to Candida parapsilosis She was treated with intravenous caspofungin and had a transoesophageal echocardiogram, which revealed vegetations on her pacemaker leads. She then underwent surgery to replace her pacemaker; however, her blood cultures remained positive for C. parapsilosis postoperatively. Her antifungal was switched to liposomal amphotericin B and flucytosine for 6 weeks, which yielded sterile blood cultures, and she was then initiated on lifelong fluconazole. Her recovery was complicated by tacrolimus toxicity 1 month after discharge due to fluconazole-induced CYP3A inhibition.
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Affiliation(s)
| | - Ellen Barr
- Nephrology Department, Beaumont Hospital, Dublin, Ireland
| | - Colm Magee
- Nephrology Department, Beaumont Hospital, Dublin, Ireland
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Teixeira da Silva F, Cardoso FS, Esteves A, Carvalho J, Maia R. Relapsing Candida parapsilosis Endocarditis With Septic Embolization: A Case Report. Cureus 2021; 13:e13159. [PMID: 33728162 PMCID: PMC7935201 DOI: 10.7759/cureus.13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Candida endocarditis is a rare infection that is becoming an emerging and growing health concern, especially among risk groups such as the elderly and the immunosuppressed. It is associated with high morbidity and mortality. Dilemmas about Candida endocarditis treatment are still around, particularly about the treatment options and their duration. We report a case of Candida parapsilosis prosthetic valve endocarditis with septic embolisms. An elderly male patient with a biological prosthetic valve presented with fever and constitutional symptoms. Abdominal computed tomography (CT) showed an area suggestive of splenic emboli. Transesophageal echocardiography showed a vegetation attaching to the prosthetic valve. Due to several comorbidities, he was not considered a candidate for surgical treatment. He was treated with antifungal drugs (liposomal amphotericin B and caspofungin) and was discharged with per os fluconazole. Later he presented with evidence of lumbar spondylodiscitis due to septic embolization and relapsing fungemia with multidrug-resistant isolates was documented. Unfortunately, the patient outcome was ill-fated and he died in hospital due to sepsis-related to the candidemia and also nosocomial urinary sepsis. Here, we illustrate the complexity of diagnosing and managing fungal endocarditis due to its complications and poor prognosis.
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Affiliation(s)
| | - Francisca S Cardoso
- Critical Care Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, PRT
| | - Alexandra Esteves
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, PRT
| | - José Carvalho
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, PRT
| | - Rosana Maia
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, PRT
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Guo P, He Y, Fan R, Wu Z, Chen Y, Huang Y, Liao K, Chen P. A case series of medically managed Candida parapsilosis complex prosthetic valve endocarditis. Ann Clin Microbiol Antimicrob 2021; 20:1. [PMID: 33402178 PMCID: PMC7786486 DOI: 10.1186/s12941-020-00409-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, Candida parapsilosis is recognized as a species complex and is composed of Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. Candida parapsilosis complex prosthetic valve endocarditis (PVE) is rare and the survival rate is still low despite of optimal therapeutic strategies. In our report, it is novel to report cases as Candida parapsilosis complex PVE at species and identify Candida parapsilosis using MALDI-TOF MS. Case presentation A series of 4 cases of Candida parapsilosis complex PVE from our institution was reported. Three were infected by Candida parapsilosis sensu stricto and one was infected by Candida metapsilosis. The condition of two cases got better and the other died. Conclusions More attention should be paid to Candida parapsilosis complex PVE and early diagnosis and prompt antibiotic therapy may play a role in the treatment for Candida parapsilosis complex PVE. It is recommended to identify Candida parapsilosis complex at species level and MALDI-TOF MS as an easy, fast and efficient identification method is worth promoting in clinical microbiology
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Affiliation(s)
- Penghao Guo
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yuting He
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Rui Fan
- Department of Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhongwen Wu
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yili Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yuli Huang
- Clinical Medicine Research Center, Shunde Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China.
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China.
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Abstract
Fungal endocarditis (FE) is a rare form of infectious endocarditis caused by fungi. Herein, we report a case of fungal pacemaker lead endocarditis. FE, especially in the setting of in-vivo cardiac devices, is on the rise. A high index of suspicion is required for its management that involves a combination of medical and surgical therapy.
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Affiliation(s)
| | - Jian Guan
- Internal Medicine, Florida Hospital, Orlando, USA
| | - Jason D'Souza
- Cardiology, University of Missouri / St. Luke's Health System, Kansas City, USA
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Madakshira MG, Bal A, ShivaPrakash, Rathi M, Vijayvergiya R. Candida parapsilosis endocarditis in an intravenous drug abuser: an autopsy report. Cardiovasc Pathol 2018; 36:30-34. [PMID: 30005395 DOI: 10.1016/j.carpath.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022] Open
Abstract
Candida parapsilosis is a rare cause of endocarditis, which is seen to affect the native valves in patients who are known intravenous drug abusers or following contamination during surgery for prosthetic valves. We discuss a unique constellation of autopsy findings in a 35-year-old chronic opium abuser who presented with left-sided weakness followed by low-grade fever. He was diagnosed to have C. parapsilosis native valve endocarditis with septic emboli involving the myocardial vessels, left middle cerebral artery, spleen, and common iliac artery. In addition, autopsy highlighted a right basal ganglia infarct, focal segmental glomerulonephritis, and talc granulomatosis in the lungs and liver.
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Affiliation(s)
- Manoj Gopal Madakshira
- Department of Histopathology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India.
| | - ShivaPrakash
- Department of Medical Microbiology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
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Nasirian H. Contamination of cockroaches (Insecta: Blattaria) to medically fungi: A systematic review and meta-analysis. J Mycol Med 2017; 27:427-448. [DOI: 10.1016/j.mycmed.2017.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/08/2017] [Accepted: 04/14/2017] [Indexed: 01/08/2023]
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Guevara-Noriega KA, Velescu A, Zaffalon-Espinal DT, Mateos-Torres E, Roig-Santamaría L, Clará-Velasco A. [Aorto-bifermoral grafs infection due to Candida parapsilosis. An unusual pathogen]. CIR CIR 2016; 85:234-239. [PMID: 27039287 DOI: 10.1016/j.circir.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aorto-enteric fistula is a rare and potentially lethal entity. Its presentation may be as an enteric-paraprosthetic fistula, due to injury in the gut caused by direct contact with the vascular prosthesis. OBJECTIVE We report a case of enteric-paraprosthetic fistulae with the unusual finding of Candida parapsilosis as the only isolated pathogen. CLINICAL CASE A 65-year-old male, smoker, with aortobifemoral revascularisation with dacron due to aortoiliac occlusive disease, and re-intervention for thrombosis of left arm at 6 months. Hospitalisation at 22 months was required due to a toxic syndrome, which was diagnosed as enteric-paraprosthetic fistulae after complementary studies. The graft was removed and an extra-anatomic revascularisation was performed. Microbiology specimens taken from the duodenal segment in contact with the prosthesis showed the prosthetic segment and peri-prosthetic fluid were positive to C. parapsilosis. DISCUSSION The finding of C. parapsilosis in all cultures taken during surgery, along with negative blood cultures and no other known sources of infection, is of interest. It is an unusual pathogen with low virulence and limited as regards other Candida species. Our patient had no clinical data common to cases of infection with C. parapsilosis, and the mechanism of graft infection is unknown. CONCLUSION Graft infection by C. parapsilosis may be anecdotal. However, its consequences can also be severe. Microbiological tests can be useful to adjust antimicrobial therapy in the post-operative period, but their usefulness for determining the aetiology is doubtful, as it may be just an incidental finding.
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Affiliation(s)
| | - Alina Velescu
- Servicio de Angiología y Cirugía Vascular, Parc de Salut Mar Barcelona, Barcelona, España
| | | | - Eduardo Mateos-Torres
- Servicio de Angiología y Cirugía Vascular, Parc de Salut Mar Barcelona, Barcelona, España
| | - Luis Roig-Santamaría
- Servicio de Angiología y Cirugía Vascular, Parc de Salut Mar Barcelona, Barcelona, España
| | - Albert Clará-Velasco
- Servicio de Angiología y Cirugía Vascular, Parc de Salut Mar Barcelona, Barcelona, España
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