[Refractory colitis by Clostridium difficile treated with fecal microbiota transplant]

Clostridium difficile infection is an increasingly recognized cause of diarrhea in inpatients, frequently associated to high mortality. Vancomycin is the treatment of choice for all Clostridium difficile- associated diarrheas, with different degrees of severity. However, some patients develop refractory forms to that treatment and there are no alternative antibiotic schemes recommended for these cases. Fecal microbiota transplantation has been shown to be successful in a series of cases of severe diarrhea associated with this organism. We present a case of refractory C. difficile infection successfully treated with fecal microbiota transplantation.

[Useful phenotypic characteristics for presumptive identification of Candida guilliermondii]

Candida guilliermondii developed a pink-purplish colony on CHROMagar Candida. In the micromorphology in milk-tween 80 1% agar at 28 degrees C after 48 h of incubation C. guilliermondii showed small (3-5 microm), spherical yeasts without pseudohyphaes. This Candida species presented a characteristic cluster of blastospores with pseudohyphaes radiating from the centre at 96 h. The trehalose-sucrose assimilation assay was applied to the C. guilliermondii isolates which proved negative for trehalose and positive for sucrose. These results allowed for the presumptive identification of C. guilliermondii. The results were concordant in 100% of the isolates with the identification of the C. guilliermondii species by the ID 32C and Vitek YBC methods. Such automated methods offered Candida famata as a second option, with a reliability percentage of 10%. Micromorphological studies increase yeast identification reliability, especially among species presenting similar biochemical profiles.