A Fatal Case of Candida auris and Candida tropicalis Candidemia in Neutropenic Patient

Abstract

We report a fatal case of Candida auris that was involved in mixed candidemia with Candida tropicalis, isolated from the blood of a neutropenic patient. Identification of both isolates was confirmed by amplification and sequencing of internal transcribed spacer and D1/D2 domain of large subunit in rRNA gene. Antifungal susceptibility test by E-test method revealed that C. auris was resistant to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole and voriconazole. On the other hand, C. tropicalis was sensitive to all antifungal tested. The use of chromogenic agar as isolation media is vital in detecting mixed candidemia.

Evaluation of Microsatellite Typing, ITS Sequencing, AFLP Fingerprinting, MALDI-TOF MS, and Fourier-Transform Infrared Spectroscopy Analysis of Candida auris

“…A set of 96 C. auris isolates was obtained from the Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands ( n = 37), the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA; n = 10), and individual researchers ( n = 49). The majority of isolates came from India ( n = 38) [ 2 , 9 , 10 ], followed by 58 isolates from other geographical areas, namely Austria (from a Turkish patient) ( n = 1) [ 40 ], Belgium (from a Kuwaiti patient) ( n = 2) [ 41 ], Japan ( n = 3) [ 42 ], Israel ( n = 9) [ 43 , 44 ], Korea ( n = 3) [ 8 ], Malaysia ( n = 3) [ 45 ], Oman ( n = 13) [ 46 , 47 ], Pakistan ( n = 2), Saudi Arabia ( n = 2) [ 48 ], Spain ( n = 13) [ 49 ], South Africa ( n = 4), Switzerland ( n = 1) [ 50 ], and Venezuela ( n = 2) [ 13 ] ( Supplementary Table S1 ). The isolates were identified by MALDI-TOF MS (Bruker Daltonik) using routine settings [ 27 , 51 ], and the Bruker MBT Compass Library, Revision E (7854 reference entries).…”

Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris

“…Later, in South Korea [ 14 ], 15 patients affected by chronic otitis media were identified to be infected by unusual and clonally related yeast isolates of C. auris confirmed by genomic sequencing [ 43 ]. Since the first isolation, C. auris infections have been reported from many countries, including India [ 15 , 24 , 38 , 44 ], Pakistan [ 41 ], South Korea [ 42 ], Malaysia [ 45 ], South Africa [ 46 ], Oman [ 47 , 48 ], Kenya [ 49 ], Kuwait [ 50 ], Israel [ 51 ], United Arab Emirates [ 52 ], Saudi Arabia [ 53 ], China [ 54 ], Colombia [ 55 – 57 ], Venezuela [ 58 ], the United States (US) (( https://www.cdc.gov/fungal/diseases/candidiasis/tracking-c-auris.html ); [ 59 – 61 ]), Russia [ 62 ], Canada [ 63 ], Panama [ 64 , 65 ], the United Kingdom (UK) [ 66 ], and continental Europe [ 28 , 67 – 70 ]. Figure 2 shows C. auris reported isolations in chronological order.…”

“…In accordance with previous studies, risk factors were not different from those associated with invasive infection due to other Candida spp. [ 22 ], including prior or continuous exposure to broad-spectrum antibiotics and antifungal agents, diabetes mellitus, abdominal and vascular surgery, presence of central venous catheters, urinary catheterization, post-operative drain placement, chronic kidney disease, chemotherapy, blood transfusions, hemodialysis, total parenteral nutrition, immunosuppressive state [ 75 ] and neutropenia [ 45 ], and length of ICU stay [ 15 , 18 , 76 ]. The incidence of C. auris is significantly higher in patients with primary or acquired altered immune response, secondary to therapeutic management of hematologic malignancies, bone marrow transplantation, and other condition requiring immunosuppressive agents [ 60 ].…”

Candida auris—the growing menace to global health

“…The first report of C. auris involved in mixed candidemia with C. tropicalis have been reported from Malaysia in 2018 from the blood of 63‐year‐old neutropenic patient …”

“…By 2018, cases of C. auris infections become widespread across the globe and had been reported from South Korea, India, Pakistan, Bangladesh, Israel, Kuwait, Oman, Malaysia, China, United Arab Emirates , Saudi Arabia, Iran, Singapore, Thailand, South Africa, Kenya, Spain, Germany, France, Austria, Norway, Belgium, United Kingdom, Switzerland, Netherlands, Russia, USA, Canada, Panama, Colombia, Venezuela and Australia . It is anticipated that C. auris has emerged in other countries also but has remained undetected due to its phenotypical resemblance with Candida haemulonii, Candida famata, Candida sake, Saccharomyces cerevisiae and Rhodotorula glutinis and is frequently misidentified by commercially available identification systems, such as Vitek‐2, API20 C‐AUX and Auxacolor .…”