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Sakai Y, Taniguchi T, Herai Y, Yahaba M, Watanabe A, Kamei K, Igari H. Fungemia With Wickerhamomyces anomalus: A Case Report and Literature Review. Cureus 2024; 16:e53550. [PMID: 38445156 PMCID: PMC10912825 DOI: 10.7759/cureus.53550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
We report the case of an 84-year-old man with a history of IgG4-related sclerosing cholangitis who was diagnosed with advanced esophageal cancer and underwent radiation and chemotherapy. An implantable central venous access port was placed for chemotherapy and total parenteral nutrition. The patient presented with a fever and received antimicrobial therapy for acute cholangitis but remained febrile, and subsequently, yeast was detected in the aerobic bottle of blood culture obtained from the central venous line. The yeast was identified as Wickerhamomyces anomalus. Liposomal amphotericin B was administered, and the central line access port was removed. After confirmation of negative blood cultures and 14 days post treatment, he underwent reinsertion of the central line access port. Due to persistent pain at the insertion site, fluconazole was added for an additional 14 days, and the patient was discharged and transferred to another hospital. Wickerhamomyces anomalus is a rare fungal infection with other synonyms including Pichia anomala, Hansenula anomala, and Candida pelliculosa. A literature review of 53 case reports of Wickerhamomyces anomalus, Pichia anomala, Hansenula anomala, and Candida pelliculosa was conducted, with a total of 211 cases reviewed. Fungemia was reported in 94% of cases, with central venous catheterization, parental feeding, low birth weight, and immunocompromised status identified as major risk factors. The majority of cases were pediatric, particularly neonatal, and there were reports of nosocomial infections causing outbreaks, with some cases involving the eye such as endophthalmitis or keratitis.
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Affiliation(s)
- Yui Sakai
- Infectious Diseases, Chiba University School of Medicine, Chiba, JPN
| | | | - Yoriko Herai
- Infectious Diseases, Chiba University Hospital, Chiba, JPN
- Respiratory Medicine, Misato Central General Hospital, Misato, JPN
| | - Misuzu Yahaba
- Infectious Diseases, Chiba University Hospital, Chiba, JPN
| | - Akira Watanabe
- Clinical Research, Chiba University Medical Mycology Research Centre, Chiba, JPN
| | - Katsuhiko Kamei
- Clinical Research, Chiba University Medical Mycology Research Centre, Chiba, JPN
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Aboutalebian S, Mirhendi H, Eshaghi H, Nikmanesh B, Charsizadeh A. The first case of Wickerhamomyces anomalus fungemia in Iran in an immuneodeficient child, a review on the literature. J Mycol Med 2023; 33:101351. [PMID: 36413850 DOI: 10.1016/j.mycmed.2022.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/24/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
The incidence of invasive candidiasis in pediatric patients is increasing and is associated with significant morbidity and mortality. C. pelliculosa has been rarely reported as a human pathogen, however, it has been associated with serious nosocomial infections and clonal outbreaks with poor clinical outcomes in immunocompromised children were reported. Here, we describe the first case of candidemia due to Candida pelliculosa in a 5-year-old immunocompromised male suffered from Griscelli syndrome with hemophagocytic syndrome hospitalized in the pediatric intensive care unit (PICU), Tehran, Iran. In addition, the history of reported cases or case-series due to C. pelliculosa is reviewed.
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Affiliation(s)
- Shima Aboutalebian
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Mirhendi
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Eshaghi
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran Iran
| | - Bahram Nikmanesh
- Department of Medical Laboratory Science, School of Allied Medical Science, Tehran University of Medical Science, Tehrn, Iran; Zoonoses Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Charsizadeh
- Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran Iran.
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3
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Invasive fungal infections in neonates: a review. Pediatr Res 2022; 91:404-412. [PMID: 34880444 DOI: 10.1038/s41390-021-01842-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Invasive fungal infections remain the leading causes of morbidity and mortality in neonates, especially preterm and very low birth weight infants. Most invasive fungal infections are due to Candida or Aspergillus species, and other fungi are increasingly reported and described. Appropriate identification and treatment are required to augment activity and reduce the toxicity of antifungal drugs. Successful use of antifungals in the vulnerable neonatal population is important for both prevention and treatment of infection. Strategies for prevention, including prophylactic antifungal therapy as well as reducing exposure to modifiable risk factors, like limiting antibiotic exposure, discontinuation of central catheters, and hand hygiene are key techniques to prevent and decrease rates of invasive fungal infections. In conclusion, this is a review of the most common causes, prevention strategies, prophylaxis, and treatment of invasive fungal infections in neonates.
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Jain N, Jansone I, Obidenova T, Sīmanis R, Meisters J, Straupmane D, Reinis A. Epidemiological Characterization of Clinical Fungal Isolates from Pauls Stradinš Clinical University Hospital, Latvia: A 4-Year Surveillance Report. Life (Basel) 2021; 11:1002. [PMID: 34685374 PMCID: PMC8537438 DOI: 10.3390/life11101002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Nosocomial fungal infections are an emerging global public health threat that requires urgent attention and proper management. With the limited availability of treatment options, it has become necessary to understand the emerging epidemiological trends, mechanisms, and risk factors. However, very limited surveillance reports are available in the Latvian and broader European context. We therefore conducted a retrospective analysis of laboratory data (2017-2020) from Pauls Stradinš Clinical University Hospital (PSCUH), Riga, Latvia, which is one of the largest public multispecialty hospitals in Latvia. A total of 2278 fungal isolates were analyzed during the study period, with Candida spp. comprising 95% of the isolates, followed by Aspergillus spp. and Geotrichum spp. Amongst the Candida spp., C. albicans and C. glabrata made up about 75% of the isolates. The Department of Lung Diseases and Thoracic Surgery had the highest caseload followed by Intensive Care Department. Majority of the fungal isolates were collected from the bronchoalveolar lavage (37%), followed by urine (19%) and sputum (18%) samples. A total of 34 cases of candidemia were noted during the study period with C. albicans being the most common candidemia pathogen. Proper surveillance of emerging epidemiological trends serve as the most reliable and powerful cornerstone towards tackling this emerging threat.
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Affiliation(s)
- Nityanand Jain
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Inese Jansone
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Tatjana Obidenova
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Raimonds Sīmanis
- Department of Infectology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Jānis Meisters
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Dagnija Straupmane
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Aigars Reinis
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
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Shubham S, Naseeruddin S, Rekha US, Priyadarshi M, Gupta P, Basu S. Wickerhamomyces anomalus: A Rare Fungal Sepsis in Neonates. Indian J Pediatr 2021; 88:838. [PMID: 34018136 DOI: 10.1007/s12098-021-03783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Shaik Naseeruddin
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - U Sasi Rekha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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Zhang Z, Cao Y, Li Y, Chen X, Ding C, Liu Y. Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit. BMC Infect Dis 2021; 21:620. [PMID: 34187390 PMCID: PMC8244135 DOI: 10.1186/s12879-021-06295-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background Candida pelliculosa is an ecological fungal species that can cause infections in immunocompromised individuals. Numerous studies globally have shown that C. pelliculosa infects neonates. An outbreak recently occurred in our neonatal intensive care unit; therefore, we aimed to evaluate the risk factors in this hospital-acquired fungal infection. Methods We performed a case-control study, analysing the potential risk factors for neonatal infections of C. pelliculosa so that infection prevention and control could be implemented in our units. Isolated strains were tested for drug resistance and biofilm formation, important factors for fungal transmission that give rise to hospital-acquired infections. Results The use of three or more broad-spectrum antimicrobials or long hospital stays were associated with higher likelihoods of infection with C. pelliculosa. The fungus was not identified on the hands of healthcare workers or in the environment. All fungal isolates were susceptible to anti-fungal medications, and after anti-fungal treatment, all infected patients recovered. Strict infection prevention and control procedures efficiently suppressed infection transmission. Intact adhesin-encoding genes, shown by genome analysis, indicated possible routes for fungal transmission. Conclusions The use of three or more broad-spectrum antimicrobials or a lengthy hospital stay is theoretically associated with the risk of infection with C. pelliculosa. Strains that we isolated are susceptible to anti-fungal medications, and these were eliminated by treating all patients with an antifungal. Transmission is likely via adhesion to the cell surface and biofilm formation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06295-1.
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Affiliation(s)
- Zhijie Zhang
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China
| | - Yu Cao
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China
| | - Yanjian Li
- College of Life and Health Sciences, Northeastern University, 195, Chuangxin Road, Hunnan District, Shenyang, China
| | - Xufang Chen
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China
| | - Chen Ding
- College of Life and Health Sciences, Northeastern University, 195, Chuangxin Road, Hunnan District, Shenyang, China
| | - Yong Liu
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China.
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Wickerhamomyces anomalous: A Rare Cause of Fungemia Causing Febrile Neutropenia in Acute Lymphoblastic Leukemia. Case Rep Infect Dis 2020; 2020:8847853. [PMID: 33457028 PMCID: PMC7785382 DOI: 10.1155/2020/8847853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
Candida bloodstream infection is the major cause of increased morbidity and mortality (20-49%) in hospitalized patients in both paediatric and adult age groups. Due to the increase in the number of immunocompromised patients, other important species such as Trichosporon asahii and Debaryomyces hansenii are emerging. One such organism, Wickerhamomyces anomalous, previously known as Pichia anomala (teleomorph stages of several Candida species), is increasingly being reported as a cause of fungemia in neonatal intensive care units and is now increasingly being reported in a lot of immunosuppressive conditions such as interstitial lung disease, endocarditis, enteritis, corticosteroids, and chemotherapy uptake. Though this yeast is ubiquitous in nature, systemic infections from isolated cases and sporadic outbreaks with high mortality have been reported in ICUs, which emphasize the importance to consider this fungus within the diagnostic possibilities. Here, we report a case of catheter-related bloodstream infection (CRBSI) caused by W. anomalus in a leukemic immunosuppressed patient who was successfully treated by early detection and treatment of this emerging fungus.
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Dutra VR, Silva LF, Oliveira ANM, Beirigo EF, Arthur VM, Bernardes da Silva R, Ferreira TB, Andrade-Silva L, Silva MV, Fonseca FM, Silva-Vergara ML, Ferreira-Paim K. Fatal Case of Fungemia by Wickerhamomyces anomalus in a Pediatric Patient Diagnosed in a Teaching Hospital from Brazil. J Fungi (Basel) 2020; 6:jof6030147. [PMID: 32854208 PMCID: PMC7558373 DOI: 10.3390/jof6030147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
In recent decades, emerging fungal infections have changed the clinical mycology scenario as a consequence of the advances in medical diagnostics and therapeutic procedures, long hospitalization times, and the growing number of individuals with debilitating chronic diseases and impaired immune systems. This report presents a 19 months old Brazilian female patient who developed a severe fungal sepsis by an uncommon yeast. She was admitted at the intensive care unit with severe pneumonia, bronchopulmonary dysplasia, and weight-for-age z score of less than −2. She remained more than 30 days in the intensive care unit where she had a femoral venous catheter placement, enteral nutrition, broad-spectrum antibiotic therapy, and prophylaxis with fluconazole. Moreover, pericardiocentesis was performed due to cardiac tamponade. She had a previous history of prematurity, cardiac surgery due to patent ductus arteriosus, and a long period of hospital stay. Despite the antifungal prophylaxis, two yeast isolates were recovered from blood and then identified by classical mycological methods and internal transcribed spacer (ITS) sequencing as Wickerhamomyces anomalus. Both isolates exhibited susceptibility to amphotericin B, ketoconazole, itraconazole, voriconazole, and fluconazole. Her clinical state worsened, presenting anasarca, epistaxis, and hemorrhagic suffusions in the mouth, sclera, oliguria, and bradycardia. Two days after the first positive culture, she presented a gradual reduction of the white blood cells count, with severe leukopenia and neutropenia. She died five days after.
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Affiliation(s)
- Vitor Rodrigues Dutra
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Leonardo Francisco Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | | | - Emília Freitas Beirigo
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Vanessa Mello Arthur
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Raíssa Bernardes da Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Thatiana Bragine Ferreira
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
| | - Leonardo Andrade-Silva
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
| | - Marcos Vinícius Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | | | - Mario León Silva-Vergara
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
| | - Kennio Ferreira-Paim
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
- Correspondence: ; Tel.: +55-34-3700-6480
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Investigation of a nosocomial outbreak of fungemia caused by Candida pelliculosa (Pichia anomala) in a Korean tertiary care center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:794-801. [DOI: 10.1016/j.jmii.2017.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/11/2017] [Accepted: 05/07/2017] [Indexed: 01/05/2023]
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Hamad I, Raoult D, Bittar F. Repertory of eukaryotes (eukaryome) in the human gastrointestinal tract: taxonomy and detection methods. Parasite Immunol 2016; 38:12-36. [PMID: 26434599 DOI: 10.1111/pim.12284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022]
Abstract
Eukaryotes are an important component of the human gut, and their relationship with the human host varies from parasitic to commensal. Understanding the diversity of human intestinal eukaryotes has important significance for human health. In the past few decades, most of the multitudes of techniques that are involved in the diagnosis of the eukaryotic population in the human intestinal tract were confined to pathological and parasitological aspects that mainly rely on traditionally based methods. However, development of culture-independent molecular techniques comprised of direct DNA extraction from faeces followed by sequencing, offer new opportunities to estimate the occurrence of eukaryotes in the human gut by providing data on the entire eukaryotic community, particularly not-yet-cultured or fastidious organisms. Further broad surveys of the eukaryotic communities in the gut based on high throughput tools such as next generation sequencing might lead to uncovering the real diversity of these ubiquitous organisms in the human intestinal tract and discovering the unrecognized roles of these eukaryotes in modulating the host immune system and inducing changes in host gut physiology and ecosystem.
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Affiliation(s)
- I Hamad
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
| | - D Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
| | - F Bittar
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
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Pasqualotto AC, Sukiennik TCT, Severo LC, de Amorim CS, Colombo AL. An Outbreak ofPichia anomalaFungemia in a Brazilian Pediatric Intensive Care Unit. Infect Control Hosp Epidemiol 2016; 26:553-8. [PMID: 16018431 DOI: 10.1086/502583] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To report an outbreak ofPichia anomalafungemia that occurred in a Brazilian pediatric intensive care unit (ICU) from October 2002 to January 2004.Design:Unmatched case-control study.Methods:We randomly selected four control-patients for each case-patient from a list of all patients admitted to the ICU for at least 48 hours during the outbreak. A second control group was composed of all consecutive patients with nosocomial candidemia in the ICU during the outbreak. An environmental study was performed, and genetic relatedness among the clinical isolates was characterized by randomly amplified polymorphic DNA assay.Results:During the study period, 1,046 children were admitted to the pediatric ICU, 17 of whom developedP. anomalafungemia (attack rate, 1.6%). The median age was 1.1 years, and the main underlying conditions were congenital malformations (35.3%) and neoplastic diseases (11.8%). The overall mortality rate was 41.2%. Two patients received no antifungal treatment; all of the others were treated with amphotericin B. On multivariate analysis, only the presence of a central venous catheter was significantly associated withP. anomalafungemia. The yeast was not found on healthcare workers' hands or in the environment. Molecular studies showed that the outbreak was caused by a single strain. The distribution of risk factors was similar between patients withP. anomalafungemia and control-patients with candidemia.Conclusions:This study highlights the importance ofP. anomalaas an emerging nosocomial fungal pathogen. Patients withP. anomalafungemia seem to have risk factors in common with those who have candidemia.
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Kamoshita M, Matsumoto Y, Nishimura K, Katono Y, Murata M, Ozawa Y, Shimmura S, Tsubota K. Wickerhamomyces anomalus fungal keratitis responds to topical treatment with antifungal micafungin. J Infect Chemother 2014; 21:141-3. [PMID: 25239058 DOI: 10.1016/j.jiac.2014.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/29/2014] [Accepted: 08/18/2014] [Indexed: 11/17/2022]
Abstract
We describe a 91-year-old woman who suffered from fungal keratitis after corneal transplantation. The causative organism was identified as Wickerhamomyces anomalus (formerly Pichia anomala or Hansenula anomala) on the basis of morphological characteristics and the sequence of the internal transcribed spacer region of the ribosomal RNA gene. The patient was successfully treated with topical micafungin (MCFG) only. We present the first report of a case of W. anomalus fungal keratitis that responded to topical treatment with the antifungal MCFG.
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Affiliation(s)
- Mamoru Kamoshita
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | | | | | - Yasuhiro Katono
- Department of Microbiology, Central Clinical Laboratory, Keio University Hospital, Japan
| | - Mitsuru Murata
- Department of Microbiology, Central Clinical Laboratory, Keio University Hospital, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Japan
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Lin HC, Lin HY, Su BH, Ho MW, Ho CM, Lee CY, Lin MH, Hsieh HY, Lin HC, Li TC, Hwang KP, Lu JJ. Reporting an outbreak of Candida pelliculosa fungemia in a neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 46:456-62. [DOI: 10.1016/j.jmii.2012.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/13/2012] [Accepted: 07/20/2012] [Indexed: 10/27/2022]
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Kang SJ, Jang MO, Jang HC, Jung SI, Shin JH, Park KH. A Case of Candida pelliculosaProsthetic Valve Endocarditis Treated with Anidulafungin and Valve Replacement. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ok Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Miceli MH, Díaz JA, Lee SA. Emerging opportunistic yeast infections. THE LANCET. INFECTIOUS DISEASES 2011; 11:142-51. [PMID: 21272794 DOI: 10.1016/s1473-3099(10)70218-8] [Citation(s) in RCA: 544] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Marisa H Miceli
- Department of Internal Medicine, Oakwood Hospital and Medical Center, Dearborn, MI, USA
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van Saene HK, Silvestri L, de la Cal MA, Gullo A. Outbreaks of Infection in the ICU: What’s up at the Beginning of the Twenty-First Century? INFECTION CONTROL IN THE INTENSIVE CARE UNIT 2011. [PMCID: PMC7120292 DOI: 10.1007/978-88-470-1601-9_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Hendrick K.F. van Saene
- , Institute of Aging and Chronic Diseases, University Liverpool, Daulby Street, Liverpool, L69 3GA United Kingdom
| | - Luciano Silvestri
- , Dept. Emergency, Hospital Gorizia, Via Vittorio Veneto 171, Gorizia, 34170 Italy
| | - Miguel A. de la Cal
- , Department of Intensive Care Medicine, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, 28045 Spain
| | - Antonino Gullo
- Policlinico di Catania, UCO di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, Via Santa Sofia 78, Catania, 95100 Italy
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19
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Wickerhamomyces anomalus in the sourdough microbial ecosystem. Antonie van Leeuwenhoek 2010; 99:63-73. [DOI: 10.1007/s10482-010-9517-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/30/2010] [Indexed: 11/30/2022]
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Walker GM. Pichia anomala: cell physiology and biotechnology relative to other yeasts. Antonie van Leeuwenhoek 2010; 99:25-34. [PMID: 20706871 DOI: 10.1007/s10482-010-9491-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/30/2010] [Indexed: 11/26/2022]
Abstract
Pichia anomala is a most interesting yeast species, from a number of environmental, industrial and medical aspects. This yeast has been isolated from very diverse natural habitats (e.g. in foods, insects, wastewaters etc.) and it also exhibits wide metabolic and physiological diversity. Some of the activities of P. anomala, particularly its antimicrobial action, make it a very attractive organism for biological control applications in the agri-food sectors of industry. Being a 'robust' organism, it additionally has potential to be exploited in bioremediation of environmental pollutants. This paper provides an overview of cell physiological characteristics (growth, metabolism, stress responses) and biotechnological potential (e.g. as a novel biocontrol agent) of P. anomala and compares such properties with other yeast species, notably Saccharomyces cerevisiae, which remains the most exploited industrial microorganism. We await further basic knowledge of P. anomala cell physiology and genetics prior to its fuller commercial exploitation, but the exciting biotechnological potential of this yeast is highlighted in this paper.
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Affiliation(s)
- Graeme M Walker
- Yeast Research Group, School of Contemporary Sciences, University of Abertay Dundee, Bell Street, Dundee, DD1 1HG, Scotland, UK.
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Choi SW, Lee TJ, Kim MK, Lee M, Jung JH. A case of fungal arthritis caused by Hansenula anomala. Clin Orthop Surg 2010; 2:59-62. [PMID: 20191003 PMCID: PMC2824097 DOI: 10.4055/cios.2010.2.1.59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 10/08/2008] [Indexed: 11/06/2022] Open
Abstract
Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic therapy and surgery. Consequently, knee joint aspiration was performed again, which identified fungal arthritis caused by H. anomala. It was treated successfully with amphotericin B and fluconazole. When treating arthritis patients with diabetes, it is important to consider the possibility of septic arthritis by H. anomala and provide the appropriate treatment.
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Affiliation(s)
- Sung-Wook Choi
- Department of Orthopedic Surgery, Cheju National University Hospital, Jeju, Korea
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22
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Diekema DJ, Messer SA, Boyken LB, Hollis RJ, Kroeger J, Tendolkar S, Pfaller MA. In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods. J Clin Microbiol 2009; 47:3170-7. [PMID: 19710283 PMCID: PMC2756931 DOI: 10.1128/jcm.00942-09] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 06/22/2009] [Accepted: 08/12/2009] [Indexed: 01/09/2023] Open
Abstract
Five Candida species (C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei) account for over 95% of invasive candidiasis cases. Some less common Candida species have emerged as causes of nosocomial candidiasis, but there is little information about their in vitro susceptibilities to antifungals. We determined the in vitro activities of fluconazole, voriconazole, posaconazole, amphotericin B, anidulafungin, caspofungin, and micafungin against invasive, unique patient isolates of Candida collected from 100 centers worldwide between January 2001 and December 2007. Antifungal susceptibility testing was performed by the CLSI M27-A3 method. CLSI breakpoints for susceptibility were used for fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin, while a provisional susceptibility breakpoint of < or = 1 microg/ml was used for amphotericin and posaconazole. Of 14,007 Candida isolates tested, 658 (4.7%) were among the less common species. Against all 658 isolates combined, the activity of each agent, expressed as the MIC50/MIC90 ratio (and the percentage of susceptible isolates) was as follows: fluconazole, 1/4 (94.8%); voriconazole, 0.03/0.12 (98.6%); posaconazole, 0.12/0.5 (95.9%); amphotericin, 0.5/2 (88.3%); anidulafungin, 0.5/2 (97.4%); caspofungin, 0.12/0.5 (98.0%); and micafungin, 0.25/1 (99.2%). Among the isolates not susceptible to one or more of the echinocandins, most (68%) were C. guilliermondii. All isolates of the less common species within the C. parapsilosis complex (C. orthopsilosis and C. metapsilosis) were susceptible to voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Over 95% of clinical isolates of the rare Candida species were susceptible to the available antifungals. However, activity did vary by drug-species combination, with some species (e.g., C. rugosa and C. guilliermondii) demonstrating reduced susceptibilities to commonly used agents such as fluconazole and echinocandins.
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Affiliation(s)
- D J Diekema
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA
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23
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24
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da Matta VLR, de Souza Carvalho Melhem M, Colombo AL, Moretti ML, Rodero L, Duboc de Almeida GM, dos Anjos Martins M, Costa SF, Souza Dias MBG, Nucci M, Levin AS. Antifungal drug susceptibility profile of Pichia anomala isolates from patients presenting with nosocomial fungemia. Antimicrob Agents Chemother 2007; 51:1573-6. [PMID: 17261632 PMCID: PMC1855522 DOI: 10.1128/aac.01038-06] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 10/17/2006] [Accepted: 01/13/2007] [Indexed: 11/20/2022] Open
Abstract
In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.
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25
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Paula CR, Krebs VLJ, Auler ME, Ruiz LS, Matsumoto FE, Silva EH, Diniz EMA, Vaz FAC. Nosocomial infection in newborns by Pichia anomala in a Brazilian intensive care unit. Med Mycol 2006; 44:479-84. [PMID: 16882616 DOI: 10.1080/13693780600561809] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Disseminated candidiasis is the most common nosocomial fungal infection, and Candida albicans has been reported to account for 50% to more than 70% of cases of invasive candidiasis. However, recent reports have also suggested the emergence of infections caused by non-albicans species. In addition, less-common pathogenic yeasts (Malassezia, Trichosporon, Rhodotorula, Debaryomyces and Pichia) have recently been reported, with increased frequency, as causes of nosocomial infections with high mortality. This article describes two cases of fungemia caused by Pichia anomala in newborns that occurred in an intensive care unit (ICU), in November 2004 at the Instituto da Criança (Pediatric Institute) of the Hospital das Clínicas of the School of Medicine, São Paulo University, Brazil. The principal factors related to virulence (proteinase and phospholipase) and the susceptibility of the isolated strains to antifungal agents were also evaluated, and the biotype of each strain was determined through the use of an epidemiological marker (killer biotype).
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MESH Headings
- Antifungal Agents/pharmacology
- Brazil/epidemiology
- Catheterization/adverse effects
- Cross Infection/epidemiology
- Cross Infection/microbiology
- DNA, Fungal/genetics
- Drug Therapy, Combination
- Fatal Outcome
- Female
- Fungemia/epidemiology
- Fungemia/microbiology
- Gestational Age
- Hospitals, University
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Intensive Care Units, Pediatric
- Killer Factors, Yeast
- Microbial Sensitivity Tests
- Molecular Epidemiology
- Mycoses/epidemiology
- Mycoses/microbiology
- Mycotoxins/pharmacology
- Peptide Hydrolases/metabolism
- Phospholipases/metabolism
- Pichia/classification
- Pichia/drug effects
- Pichia/isolation & purification
- Pichia/physiology
- Polymerase Chain Reaction
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Affiliation(s)
- Claudete R Paula
- Departamento de Microbiologia, Instituto de Ciências Biomédicas II, Universidade de São Paulo, São Paulo, Brasil.
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26
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Barchiesi F, Tortorano AM, Di Francesco LF, Rigoni A, Giacometti A, Spreghini E, Scalise G, Viviani MA. Genotypic variation and antifungal susceptibilities of Candida pelliculosa clinical isolates. J Med Microbiol 2005; 54:279-285. [PMID: 15713612 DOI: 10.1099/jmm.0.45850-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
At the Istituto Ricovero Cura Carattere Scientifico, Ospedale Maggiore di Milano, Italy, Candida pelliculosa accounted for 3.3 and 4.4 % of all Candida species other than Candida albicans collected during 1996 and 1998, respectively. Genetic variability was investigated by electrophoretic karyotyping and inter-repeat PCR, and the susceptibility to five antifungal agents of 46 strains isolated from 37 patients during these 2 years was determined. Combination of the two typing methods yielded 14 different DNA types. Although the majority of DNA types were randomly distributed among different units, one DNA type was significantly more common in patients hospitalized in a given unit compared with those from other wards (P = 0.034), whereas another DNA type was more frequently isolated in patients hospitalized during 1996 than in those hospitalized during 1998 (P = 0.002). Fluconazole, itraconazole and posaconazole MIC90 values were 16, 1 and 4 μg ml−1, respectively. All isolates but three were susceptible in vitro to flucytosine. All isolates were susceptible in vitro to amphotericin B. These data suggest that there are possible relationships among strains of C. pelliculosa, wards and time of isolation. Amphotericin B seems to be the optimal drug therapy in infections due to this yeast species.
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Affiliation(s)
- F Barchiesi
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - A M Tortorano
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - L Falconi Di Francesco
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - A Rigoni
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - A Giacometti
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - E Spreghini
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - G Scalise
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
| | - M A Viviani
- Istituto di Malattie Infettive e Medicina Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto Io, Via Conca, 60020, Torrette di Ancona, Ancona, Italy 2Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano IRCCS, Ospedale Maggiore di Milano, Italy
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27
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Bakir M, Cerikcioğlu N, Tirtir A, Berrak S, Ozek E, Canpolat C. Pichia anomala fungaemia in immunocompromised children. Fallbericht. Pichia anomala-Fungamie bei immunkompromittierten Kindern. Mycoses 2004; 47:231-5. [PMID: 15189190 DOI: 10.1111/j.1439-0507.2004.00962.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow-up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy.
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Affiliation(s)
- M Bakir
- Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
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28
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Walsh TJ, Groll A, Hiemenz J, Fleming R, Roilides E, Anaissie E. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004; 10 Suppl 1:48-66. [PMID: 14748802 DOI: 10.1111/j.1470-9465.2004.00839.x] [Citation(s) in RCA: 374] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The emergence of less common but medically important fungal pathogens contributes to the rate of morbidity and mortality, especially in the increasingly expanding population of immunocompromised patients. These pathogens include septate filamentous fungi (e.g., Fusarium spp., Scedosporium spp., Trichoderma spp.), nonseptate Zygomycetes, the endemic dimorphic pathogen Penicillium marneffei, and non-Cryptococcus, non-Candida pathogenic yeast (e.g., Trichosporon spp.). The medical community is thus called upon to acquire an understanding of the microbiology, epidemiology and pathogenesis of these previously uncommon pathogens in order to become familiar with the options for prevention and treatment.
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Affiliation(s)
- T J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, The National Cancer Institute, Bethesda, MD 20892-1928, USA.
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29
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Abstract
Less common and emerging fungal pathogens are often resistant to conventional antifungal therapy and may cause severe morbidity and mortality in immunocompromised hosts. Some Scedosporium species may be completely resistant to antifungal therapy. Hyaline septated filamentous fungi, such as Fusarium species, Acremonium species, Paecilomyces species, and Trichoderma species, are increasingly reported as causing invasive mycoses refractory to amphotericin B therapy. Dematiaceous septated filamentous fungi, such as Bipolaris species may cause pneumonia, sinusitis, and CNS infections that are unresponsive to current medical interventions. Trichosporon spp are resistant to the fungicidal effects of amphotericin B. An increasing number of different members of the class Zygomycetes are reported as causing lethal infections, despite aggressive medical and surgical interventions. Infections due to these and other less common and emergent fungal pathogens will likely continue to develop in the settings of selective anti-fungal pressure, permissive environmental conditions, and an expanding population of immunocompromised hosts.
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Affiliation(s)
- Rhonda V Fleming
- Division of Infectious Diseases, Boston University Medical Center, Boston, MA, USA
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30
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Kalenic S, Jandrlic M, Vegar V, Zuech N, Sekulic A, Mlinaric-Missoni E. Hansenula anomala outbreak at a surgical intensive care unit: a search for risk factors. Eur J Epidemiol 2002; 17:491-6. [PMID: 11855583 DOI: 10.1023/a:1013739802940] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During a 5-month period, Hansenula anomala (H. anomala), an opportunistic fungus, caused an outbreak of infections in eight adult patients treated at a surgical intensive care unit (ICU). The source of the infections and route of transmission could not be identified. A case-control study included 32 patients treated simultaneously at the surgical ICU. Univariate analysis pointed to the following significant risk factors: blood alkalosis, reduced urea, duration of hospitalization, bacteremia and colonization with Pseudomonas aeruginosa, and an APACHE II score >17 (during bacteremia or fungemia). The stepwise logistic regression multivariate analysis showed only the duration of blood alkalosis to be significant in case patients.
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Affiliation(s)
- S Kalenic
- Institute of Clinical and Molecular Microbiology, Zagreb Clinical Hospital Center, Croatia.
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31
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Kane SL, Dasta JF, Cook CH. Amphotericin B lipid complex for Hansenula anomala pneumonia. Ann Pharmacother 2002; 36:59-62. [PMID: 11816259 DOI: 10.1345/aph.1a192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To document the first successful treatment of a patient with Hansenula anomala pneumonia. CASE SUMMARY A healthy 32-year-old white man who underwent splenectomy and aortic repair following a motor vehicle accident developed a life-threatening infection 2 days after admission into the intensive care unit (ICU). A rare fungus, H. anomala, was isolated from his lungs, blood, and urine. Lipid complex amphotericin B (ABLC) was initiated following worsening signs of infection complicated by renal failure. The patient received ABLC for 17 days, eventually making a full recovery, allowing ICU discharge 1 month after admission. DISCUSSION This case represents the first successful treatment of H. anomala pneumonia reported in the literature. H. anomala infections typically occur in immunocompromised, neonatal, or pediatric populations in extrapulmonary sites. All 6 cases of H. anomala pneumonia reported in the literature were fatal, and all preceded the availability of ABLC. This case of H. anomala pneumonia is unique because our adult patient survived possibly due to the availability of aggressive treatment. CONCLUSIONS ABLC may be the agent of choice for treatment of H. anomala infections, particularly in patients with acute renal failure.
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Affiliation(s)
- Sandra L Kane
- College of Pharmacy, Ohio State University, 500 W. 12th Ave., Columbus, OH 43210, USA.
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Aragão PA, Oshiro IC, Manrique EI, Gomes CC, Matsuo LL, Leone C, Moretti-Branchini ML, Levin AS. Pichia anomala outbreak in a nursery: exogenous source? Pediatr Infect Dis J 2001; 20:843-8. [PMID: 11734761 DOI: 10.1097/00006454-200109000-00004] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pichia anomala is a rare cause of fungemia. From February to April, 1998, eight cases of fungemia occurred in the intensive care and high risk units of the Nursery. There were four infants with P. anomala infection, one of whom also had Candida parapsilosis infection, two cases with C. parapsilosis infection and two with Candida albicans infection. OBJECTIVE To determine factors associated with fungemia in the intensive care and high risk units of the Nursery, especially P. anomala. METHODS A cohort study with 59 newborns. RESULTS Factors associated with fungemia were: central venous catheter (CVC) (P = 0.0006); total parenteral nutrition (TPN) (P = 0.0005); lipid emulsion (P = 0.002); previous antimicrobial use (P = 0.002); and other invasive procedures (P = 0.002). Factors associated with P. anomala fungemia were: CVC (P = 0.004); TPN (P = 0.018); previous antibiotic use (P = 0.037); and other invasive procedures (P = 0.037). Evaluation of the units demonstrated that there were several technical problems involving administration of TPN that was manipulated in the Nursery without precautions. Changes in TPN formulation and education as to adequate technique were implemented. During follow-up (1998 to 1999) only two fungemias occurred that were caused by C. albicans. Cultures of hands of personnel were negative for P. anomala. Electrophoretic karyotyping of P. anomala showed three profiles. CONCLUSIONS Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.
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Affiliation(s)
- P A Aragão
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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33
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Chakrabarti A, Singh K, Narang A, Singhi S, Batra R, Rao KL, Ray P, Gopalan S, Das S, Gupta V, Gupta AK, Bose SM, McNeil MM. Outbreak of Pichia anomala infection in the pediatric service of a tertiary-care center in Northern India. J Clin Microbiol 2001; 39:1702-6. [PMID: 11325977 PMCID: PMC88012 DOI: 10.1128/jcm.39.5.1702-1706.2001] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outbreak of nosocomial fungemia due to the unusual yeast, Pichia anomala occurred in the pediatric wards of our hospital over a period of 23 months (April 1996 to February 1998). A total of 379 neonates and children (4.2% admissions) were infected. The probable index case was admitted to the pediatric emergency ward, with subsequent transmission to the premature nursery, pediatric intensive care units, and other children wards. Carriage on the hands of health care personnel was likely to be responsible for dissemination of the fungus. The outbreak could only be controlled after a health education campaign to improve hand-washing practices was instituted and after nystatin-fluconazole prophylaxis to all premature neonates and high-risk infants was introduced. In a case-control study, we identified a lower gestational age, a very low birth weight (<1,500 g), and a longer duration of hospital stay as significant risk factors associated with P. anomala fungemia in premature neonates. We conducted a culture prevalence survey of 50 consecutive premature neonates and found that 28% were colonized with P. anomala at a skin or mucosal site on the date of delivery and that 20% of these neonates subsequently developed P. anomala fungemia. We performed multilocus enzyme electrophoresis on 40 P. anomala outbreak isolates (including patient and health care workers' hand isolates), and the results suggested that these isolates were identical. Our study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Ahmed A, Sesti F, Ilan N, Shih TM, Sturley SL, Goldstein SA. A molecular target for viral killer toxin: TOK1 potassium channels. Cell 1999; 99:283-91. [PMID: 10555144 DOI: 10.1016/s0092-8674(00)81659-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Killer strains of S. cerevisiae harbor double-stranded RNA viruses and secrete protein toxins that kill virus-free cells. The K1 killer toxin acts on sensitive yeast cells to perturb potassium homeostasis and cause cell death. Here, the toxin is shown to activate the plasma membrane potassium channel of S. cerevisiae, TOK1. Genetic deletion of TOK1 confers toxin resistance; overexpression increases susceptibility. Cells expressing TOK1 exhibit toxin-induced potassium flux; those without the gene do not. K1 toxin acts in the absence of other viral or yeast products: toxin synthesized from a cDNA increases open probability of single TOK1 channels (via reversible destabilization of closed states) whether channels are studied in yeast cells or X. laevis oocytes.
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Affiliation(s)
- A Ahmed
- Department of Pediatrics, Boyer Center for Molecular Medicine, Yale University School of Medicine, New Haven, Connecticut 06536, USA
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Cermeño-Vivas JR, Torres-Rodríguez JM, Corominas JM, Madrenys N. Pathogenicity of Hansenula anomala in model of immunocompromised mice. Mycopathologia 1999; 144:67-71. [PMID: 10481286 DOI: 10.1023/a:1007034905295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Systemic infections caused by opportunistic fungi have shown an increased frequency in the past 10 years, particularly in immunocompromised patients. Hansenula anomala is an ascosporogenous yeast of the Ascomycetes class found in the skin, throat, and digestive tract transient normal flora. This study was conducted to compare the pathogenicity of H. anomala and Candida albicans in a model of immunocompromised mice. Thirty-eight Swiss mice were divided into two groups as follows: 30 animals received an intraperitoneal (i.p.) injection of cyclophosphamide (200 mg/kg) four days before the induction of infection with H. anomala (1 x 10(6) yeasts/mL), and 8 animals received 100 mg/kg of cyclophosphamide at 3-day intervals during 3 weeks before inoculation of 1 x 10(7) yeasts/mL. All animals were treated with amoxicillin/clavulanic acid (40 mg/kg) four days before induction of infection. A group of mice inoculated with C. albicans (ATCC 64548) served as control. Tissue samples from the lung, spleen, liver, and kidney for histological and mycologic studies were obtained at necropsy. In each animal, the number of viable yeasts per gram of kidney was determined. The organs most frequently infected by H. anomala were the kidneys and the liver (20%), and the lung (10%). However, in conditions of sustained immunosuppression, H. anomala was found in 65.5% of the organs examined. It is concluded that in an experimental model of immunocompromised mice, the pathogenicity of H. anomala was low.
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Affiliation(s)
- J R Cermeño-Vivas
- Department of Parasitology and Microbiology, Universidad de Oriente, Ciudad Bolívar, Venezuela
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Abstract
The killer phenomenon in yeasts has been revealed to be a multicentric model for molecular biologists, virologists, phytopathologists, epidemiologists, industrial and medical microbiologists, mycologists, and pharmacologists. The surprisingly widespread occurrence of the killer phenomenon among taxonomically unrelated microorganisms, including prokaryotic and eukaryotic pathogens, has engendered a new interest in its biological significance as well as its theoretical and practical applications. The search for therapeutic opportunities by using yeast killer systems has conceptually opened new avenues for the prevention and control of life-threatening fungal diseases through the idiotypic network that is apparently exploited by the immune system in the course of natural infections. In this review, the biology, ecology, epidemiology, therapeutics, serology, and idiotypy of yeast killer systems are discussed.
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Affiliation(s)
- W Magliani
- Istituto di Microbiologia, Facoltà di Medicina e Chirurgia, Università degli Studi di Parma, Italy
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García-Martos P, Mira J, Galán F, Hernández JM. Sexual forms of yeasts in clinical samples. Mycopathologia 1996; 136:67-70. [PMID: 9208473 DOI: 10.1007/bf00437497] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sexual or teleomorphic state of yeasts has only been described in a few clinically involved species, mainly those of the Saccharomycetaceae family. With the aim of gathering information on their incidence in human pathology, a study has been made of a total of 2,135 strains isolated from clinical samples and cultivated in McClary agar. From these, 8 strains in teleomorphic state were identified: Kluyveromyces marxianus [1], Pichia anomala [2], Pichia farinosa [1], Pichia membranaefaciens [1] and Saccharomyces cerevisiae [3]. The two strains of P. anomala were responsible for fungemia; K, marxianus and the two strains of S. cerevisiae produced vaginitis; the other strains were oral cavity colonizers.
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Affiliation(s)
- P García-Martos
- Hospital Universitario Puerta del Mar, Universidad de Cádiz, Spain
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Pettoello-Mantovani M, Nocerino A, Polonelli L, Morace G, Conti S, Di Martino L, De Ritis G, Iafusco M, Guandalini S. Hansenula anomala killer toxin induces secretion and severe acute injury in the rat intestine. Gastroenterology 1995; 109:1900-6. [PMID: 7498655 DOI: 10.1016/0016-5085(95)90757-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS The yeast Hansenula anomala has been associated with gastrointestinal symptomatology and damage to the intestinal wall in humans. In vitro and in vivo, H. anomala secretes a toxin, killer toxin, which is lethal to other microorganisms. In view of the very high rate of killer phenotype expression recorded for H. anomala strains in nature, this study aimed to investigate the hypothesis that H. anomala killer toxin plays a role in the pathogenesis of H. anomala-induced enteritis. METHODS Effects of active and heat-inactivated H. anomala killer toxin on intestinal fluid homeostasis and electrolyte balance were investigated in rat small intestine using a standard intestinal perfusion technique. Sections of the perfused jejunum tracts were examined histologically. RESULTS H. anomala killer toxin induced a significant secretion of water and electrolytes. No significant change was observed when either heat-inactivated H. anomala killer toxin or control growth medium were tested. Histological analysis showed ischemic degeneration of villi and sloughing of surface epithelium in 50% of active H. anomala killer toxin-perfused jejuna. CONCLUSIONS This paper presents original observations compatible with the hypothesis that H. anomala killer toxin plays a role in the pathogenesis of H. anomala-induced enteritis.
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Abstract
The most common yeast species that act as agents of human disease are Candida albicans, Candida tropicalis, Candida glabrata, Candida parapsilosis, and Cryptococcus neoformans. The incidence of infections by other yeasts has increased during the past decade. The most evident emerging pathogens are Malassezia furfur, Trichosporon beigelii, Rhodotorula species, Hansenula anomala, Candida lusitaniae, and Candida krusei. Organisms once considered environmental contaminants or only industrially important, such as Candida utilis and Candida lipolytica, have now been implicated as agents of fungemia, onychomycosis, and systemic disease. The unusual yeasts primarily infect immunocompromised patients, newborns, and the elderly. The role of central venous catheter removal and antifungal therapy in patient management is controversial. The antibiograms of the unusual yeasts range from resistant to the most recent azoles and amphotericin B to highly susceptible to all antifungal agents. Current routine methods for yeast identification may be insufficient to identify the unusual yeasts within 2 days after isolation. The recognition of unusual yeasts as agents of sometimes life-threatening infection and their unpredictable antifungal susceptibilities increase the burden on the clinical mycology laboratory to pursue complete species identification and MIC determinations. Given the current and evolving medical practices for management of seriously ill patients, further evaluations of the clinically important data about these yeasts are needed.
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Affiliation(s)
- K C Hazen
- Department of Pathology, University of Virginia Health Sciences Center, Charlottesville 22908, USA
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Yamada S, Maruoka T, Nagai K, Tsumura N, Yamada T, Sakata Y, Tominaga K, Motohiro T, Kato H, Makimura K. Catheter-related infections by Hansenula anomala in children. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1995; 27:85-7. [PMID: 7784824 DOI: 10.3109/00365549509018982] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
During August and September, 1992, we experienced 4 cases of Hansenula anomala (H. anomala, synonym Pichia anomala) fungemia in immunocompromised patients. Two patients had been suffering from a malignant disease, 3 of them had received broad-spectrum antibiotics and a central venous catheter (CVC) had been inserted in all of them. H. anomala was isolated as the sole pathogen from all 4 patients. Three of them responded favorably to fluconazole after withdrawal of the catheter, but one failed. H. anomala should be considered as a possible cause of catheter-related infections.
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Affiliation(s)
- S Yamada
- Department of Pediatrics, Kurume University School of Medicine, Japan
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Damjanovic V, van Saene HK, Weindling AM, Cook RW, Hart CA. The multiple value of surveillance cultures: an alternative view. J Hosp Infect 1994; 28:71-5. [PMID: 7806872 DOI: 10.1016/0195-6701(94)90155-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Damjanovic V, Connolly CM, van Saene HK, Cooke RW, Corkill JE, van Belkum A, van Velzen D. Selective decontamination with nystatin for control of a Candida outbreak in a neonatal intensive care unit. J Hosp Infect 1993; 24:245-59. [PMID: 8104984 DOI: 10.1016/0195-6701(93)90057-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Selective decontamination of the digestive tract (SDD) with oral nystatin was evaluated as a measure to control an outbreak of Candida infection in a neonatal intensive care unit (NICU). Seventy-six out of 106 neonates who carried Candida spp. received the main study manoeuvre (the application of oral nystatin in the throat and stomach) during the 12-month open trial. One third of the neonates weighed < 1500 g whilst about half were being ventilated. The mean stay was 33.2 d (SD +/- 46.9). Two cases with candidaemia within a fortnight were associated with a yeast carriage rate in the NICU of about 50%; more than 80% of the isolates were Candida parapsilosis. During the implementation period there were four new neonates with fungaemia caused by C. parapsilosis. Once the carriage rate dropped below 5% (P < 0.001), no new cases of systemic infection with the outbreak strain were recognized in the following 8 months. It took 3.5 months to control the outbreak. The observation that all other clinical diagnostic samples were free from Candida suggests that translocation from throat or gut into the systemic circulation occurred. SDD with oral nystatin was effective in reducing the yeast carriage index (mean index 1.93, before SDD; 0.45, after SDD; P < 0.001). A significant reduction of carriage, both in rates and indices, is thought to have contributed to the control of this candida outbreak.
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Abstract
We describe a case of fungaemia due to Candida pelliculosa (teleomorph: Hansenula anomala) in an otherwise non-immunocompromised patient with acute necrotizing pancreatitis of unknown origin. This species of Candida should be added to the list of pathogenic fungi which are increasingly important not only in patients with underlying immunosuppressive disease but also in patients with, for instance, severe surgical illness.
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Affiliation(s)
- B Neumeister
- Abteilung Bakteriologie, Universität Ulm, Germany
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Salesa R, Burgos A, Fernandez-Mazarrasa C, Quindós G, Pontón J. Transient fungaemia due to Candida pelliculosa in a patient with AIDS. Mycoses 1991; 34:327-9. [PMID: 1803237 DOI: 10.1111/j.1439-0507.1991.tb00670.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Candida pelliculosa Redaelli (syn. Hansenula anomala) was isolated from blood cultures of a patient with acquired immunodeficiency syndrome. The transient candidaemia was apparently associated with intravenous drug addiction. The isolate was identified by standard methods such as API 20 C Aux and 16 discs carbon auxanogram. The isolate was sensitive to amphotericin B, 5-fluorocytosine and ketoconazole. This organism adds to the growing list of Candida species associated with acquired immunodeficiency syndrome.
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Affiliation(s)
- R Salesa
- Servicio de Microbiología, Hospital Marques de Valdecilla, Santander
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Polonelli L, Conti S, Gerloni M, Campani L, Mantovani MP, Morace G. Production of yeast killer toxin in experimentally infected animals. Mycopathologia 1990; 110:169-75. [PMID: 2201918 DOI: 10.1007/bf00437542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The ability of a killer yeast (Pichia anomala, UCSC 25F) to produce toxin in vivo was demonstrated, for the first time, in tissues of normal and immunosuppressed experimentally infected mice by means of a fluorescent antibody technique and a killer toxin specific monoclonal antibody. The possible significance of the findings is discussed.
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Affiliation(s)
- L Polonelli
- Istituto di Microbiologia, Università degli Studi di Parma, Italy
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46
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Nielsen H, Stenderup J, Bruun B. Fungemia with Saccharomycetaceae. Report of four cases and review of the literature. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1990; 22:581-4. [PMID: 2259868 DOI: 10.3109/00365549009027100] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Invasive fungal disease with Saccharomycetaceae is very rarely reported and these fungi are usually considered nonpathogenic. We report here 4 cases of positive blood cultures with fungal species belonging to this family. Severe neutropenia, permanent central venous catheter, ongoing antibacterial chemotherapy, and major abdominal surgery were identified as risk factors for fungemia in patients. In the immunocompromised host isolation of such species from sterile fluids cannot be ignored but should be considered an opportunistic infection and treated as such.
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Affiliation(s)
- H Nielsen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
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