Emerging Multidrug-Resistant Candida duobushaemulonii Infections in Panama Hospitals: Importance of Laboratory Surveillance and Accurate Identification

Abstract

, a yeast closely related to , is thought to cause infections in rare cases and is often misidentified. In October 2016, the Panamanian Ministry of Health implemented laboratory surveillance for Suspected isolates were forwarded to the national reference laboratory for identification by matrix-assisted laser desorption ionization-time of flight mass spectrometry and antifungal susceptibility testing. Between November 2016 and May 2017, 17 of 36 (47%) isolates suspected to be were identified as These 17 isolates were obtained from 14 patients at six hospitals. Ten patients, including three children, had bloodstream infections, and MICs for fluconazole, voriconazole, and amphotericin B were elevated. No resistance to echinocandins was observed. causes more invasive infections than previously appreciated and poses a substantial problem, given its resistance to multiple antifungals. Expanded laboratory surveillance is an important step in the detection and control of such emerging pathogens.

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.…”

Identification of Candida auris by Use of the Updated Vitek 2 Yeast Identification System, Version 8.01: a Multilaboratory Evaluation Study

“…In the past, distinction between these closely related species has been difficult. Ramos et al reported a high rate of incorrect identification among these closely related species with the Vitek 2 software version prior to 8.01; among 36 isolates identified as C. haemulonii by Vitek 2, 47% were C. duobushaemulonii, 22% were C. haemulonii, and 14% were C. auris when identified by MALDI-TOF and genome sequencing (23). In the prior Vitek 2 software version, the majority of isolates suspected to be C. auris were identified as C. haemulonii (5).…”

“…Taken together, our results suggest that a C. duobushaemulonii identification result obtained by Vitek 2 warrants further testing to determine whether it is in fact C. duobushaemulonii or C. auris. Epidemiology of C. duobushaemulonii is not well studied, but cases of vulvovaginitis, wound and cutaneous infections, and invasive infections have been reported in the literature (23). A large survey in Latin America reported that C. haemulonii accounted for less than 0,01% of candidemia episodes at a time when C. duobushaemulonii was not yet described (24).…”

Identification of Cryptic Species of Four Candida Complexes in a Culture Collection

“…Candida auris is currently considered as one of the most important emerging microorganisms for public health, due to its virulence, its multiple resistance against different classes of antifungal drugs and high mortality rate [25]. There are reports of this yeast in neighboring countries such as Panama [56,57] and Colombia [58], and consequently there are high probabilities that this species will be dispersed to the rest of Central America in the near future. Phenotypic methods available in Honduras would not allow the identification of C. auris if it were to occur.…”

“…A study in Brazil identified 40 (0.3%) strains of the C. haemulonii complex from a collection of 14,632 isolates [59]. However, a considerable number of isolates suspected to be C. auris in Panama were further identified as C. duobushaemulonii and some of them were responsible for bloodstream infections and showed elevated minimal inhibitory concentrations for fluconazole, voriconazole, and amphotericin B [56]. Other Brazilian studies reported C. haemulonii complex isolates with low susceptibility to fluconazole or amphotericin B [60,61].…”