Multiple Patterns of Resistance to Fluconazole in
            <i>Candida glabrata</i>
            Isolates from a Patient with Oropharyngeal Candidiasis Receiving Head and Neck Radiation

Redding, Spencer W.; Kirkpatrick, William R.; Saville, Stephen P.; Coco, B.; White, William L.; Fothergill, Annette W.; Rinaldi, Michael G.; Eng, Tony Y.; Patterson, Thomas F.; Lopez-Ribot, José L.

doi:10.1128/jcm.41.2.619-622.2003

Cited by 80 publications

(82 citation statements)

References 21 publications

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“…has increased as a cause of BSI in U.S. intensive care units. Other studies have shown that in certain regions of the United States, C. glabrata both is a common cause of BSI and is also often resistant to fluconazole (26,30,35,42). The U.S. findings, however, may not be universal (15,24,27).…”

Section: Resultsmentioning

confidence: 63%

See 1 more Smart Citation

Geographic Variation in the Susceptibilities of Invasive Isolates of Candida glabrata to Seven Systemically Active Antifungal Agents: a Global Assessment from the ARTEMIS Antifungal Surveillance Program Conducted in 2001 and 2002

Pfaller

Messer²,

Boyken³

et al. 2004

J Clin Microbiol

167

109

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Section: Resultsmentioning

confidence: 63%

“…There is no question that C. glabrata has emerged as an important, and potentially resistant, opportunistic fungal pathogen (9,10,26,30,35,40). Trick et al (40) have demonstrated that C. glabrata alone among Candida spp.…”

Section: Resultsmentioning

confidence: 99%

Geographic Variation in the Susceptibilities of Invasive Isolates of Candida glabrata to Seven Systemically Active Antifungal Agents: a Global Assessment from the ARTEMIS Antifungal Surveillance Program Conducted in 2001 and 2002

Pfaller

Messer²,

Boyken³

et al. 2004

J Clin Microbiol

167

109

View full text Add to dashboard Cite

“…Often, these non-albicans species are associated with elevated MIC levels for the azoles, the most commonly prescribed class of antifungal drugs. It has been well documented that C. glabrata demonstrates both intrinsically low susceptibility to the azoles and the ability to develop frank resistance (8,12,13,14,15,16). Moreover, a recent increase in the trailing phenotype, with low-level resistance to the azoles, has been observed for the Candida tropicalis isolates (1, 3).…”

mentioning

confidence: 99%

Survey of Vaginal-Flora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection

et al. 2008

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A retrospective survey of 93,775 samples testing positive in Candida species-specific PCR tests performed on cervicovaginal swabs over a 4-year period demonstrated consistent yearly distributions of Candida albicans (89%), C. glabrata (7.9%), C. parapsilosis (1.7%), and C. tropicalis (1.4%). However, the species distributions among different age groups revealed increases in the percentages of non-albicans species with increases in age.Vulvovaginal candidiasis (VVC) is a common fungal infection that affects healthy women of all ages. At least 75% of women will develop one or more infections once during their lifetime, with 5 to 8% of those individuals developing recurrent infections (5, 7). Current literature examining the species distribution of Candida isolates involved in VVC is limited; however, several important observations have been made. For example, one study shows that Candida albicans accounts for 70 to 90% of all VVC cases, with a recent emergence of nonalbicans species (10). The rise in VVC infections, more specifically in those caused by non-albicans species, could be due to several factors, ranging from an increase in over-the-counter antifungal use to an increase in high-risk patient populations (i.e., diabetics and menopausal women). Candida glabrata is the primary non-albicans species emerging in VVC, accounting for up to 14% of infections in immune-competent women (9, 10).In addition to an increase in non-albicans species overall, it is becoming clear that certain patient populations may experience higher risks of infection from these non-albicans species, often leading to limited treatment options. Interestingly, in a few small studies, C. glabrata was found to be the primary species isolated from diabetic (61.3%) and elderly (51.2%) patients with VVC (2, 4, 6, 11). Often, these non-albicans species are associated with elevated MIC levels for the azoles, the most commonly prescribed class of antifungal drugs. It has been well documented that C. glabrata demonstrates both intrinsically low susceptibility to the azoles and the ability to develop frank resistance (8,12,13,14,15,16). Moreover, a recent increase in the trailing phenotype, with low-level resistance to the azoles, has been observed for the Candida tropicalis isolates (1, 3). This highlights the importance of identifying Candida species within clinical samples in order to provide physicians with information concerning the proper treatment for their patients.

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“…In C. glabrata, upregulation of the ABC transporter genes CgCDR1 and CgCDR2 is primarily responsible for acquired azole resistance that remains stable over time (7,12). Increased expression of CgCDR1 and CgCDR2 upon fluconazole exposure has been observed in resistant C. glabrata clinical isolates (2,11,13) and in vitro (3). Treatment failures due to C. glabrata resistance to azoles have previously been described and occur mainly in AIDS patients with oropharyngeal candidiasis (2, 4, 6, 11).…”

Section: Case Reportmentioning

confidence: 99%

“…However, in only a few of these cases was genotyping performed to determine whether resistance was acquired and selected for in vivo. To assess this, both the original azole-susceptible isolates and the subsequent azole-resistant isolates must be genotyped to determine whether all isolates from the same patient were of the same strain (2,11).…”

Section: Case Reportmentioning

confidence: 99%

Azole Resistance of Candida glabrata in a Case of Recurrent Fungemia

Posteraro¹,

Tumbarello

Sorda³

et al. 2006

J Clin Microbiol

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We describe a case of recurrent Candida glabrata fungemia that became unresponsive to fluconazole treatment. Posttreatment isolates from blood and vaginal cultures of the immunocompetent patient were azole resistant and exhibited upregulated expression of CgCDR1/CgCDR2 efflux pumps compared to the original isolates. Amphotericin B therapy eradicated the infection. CASE REPORTIn July 2002, a 35-year-old woman at 5 weeks' gestation following intrauterine insemination was referred to our University Medical Center. She presented with fever (39°C), tachycardia (116 beats/min), and hypotension (90/60 mm Hg). The white blood cell count was 23.5 ϫ 10 9 /liter with 78% neutrophils, and the C-reactive protein level was elevated (40 mg/liter; normal range, Ͻ3 mg/liter). Liver and renal function tests were normal. She experienced spontaneous abortion. Severe chorioamnionitis was clinically diagnosed, placental and fetal tissues were cultured, and serial blood cultures and vaginal swabs were obtained. The patient was treated with a combination of ciprofloxacin and imipenem. Five days later, no clinical improvement was seen. The cultured blood and placental samples grew the yeast Candida glabrata, which was also isolated from the patient's vaginal cultures. Because the C. glabrata isolates showed fluconazole susceptibility, the patient began to receive fluconazole at a dosage of 400 mg/day. Four weeks later, she experienced complete resolution of symptoms with eradication of the fungus from the bloodstream. Therefore, antifungal treatment was discontinued and she returned home. Clinically, the patient remained well, except for vaginal candidiasis and sporadic episodes of low-grade fever (Ͻ38°C) of 2 days' duration. For each vaginitis episode (a total of four), she was given oral therapy with fluconazole (1-week courses of 100 mg/day), as prescribed by a family practitioner. Six months later, the patient was readmitted to the hospital with a new severe fever attack with temperatures of up to 40°C. She complained of chills and fatigue. Physical examination revealed diffuse attenuation of heart sounds, moderate hepatosplenomegaly, and white plaques on the vaginal mucosa. The white blood cell count had risen to 21.5 ϫ 10 9 /liter with 73% neutrophils. No abnormalities in liver or renal function were detected, and the chest X-ray was normal. An echocardiogram revealed no valvular lesions. Treatment with ceftriaxone (2 g/day) and fluconazole (400 mg/day) was initiated. Consecutive cultures of blood samples were again positive for C. glabrata, which was also found in cultures of vaginal exudates. All isolates were found to be resistant to fluconazole. On the basis of these microbiological findings, the patient was treated with 1-mg/kg intravenous amphotericin B deoxycholate daily. Within 1 week of the initiation of antifungal treatment, the patient's clinical condition improved and her renal function remained normal. After 1 month of amphotericin B treatment, blood specimens were sterile and the patient was discharged from the hospi...

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Multiple Patterns of Resistance to Fluconazole in Candida glabrata Isolates from a Patient with Oropharyngeal Candidiasis Receiving Head and Neck Radiation

Cited by 80 publications

References 21 publications

Geographic Variation in the Susceptibilities of Invasive Isolates of Candida glabrata to Seven Systemically Active Antifungal Agents: a Global Assessment from the ARTEMIS Antifungal Surveillance Program Conducted in 2001 and 2002

Geographic Variation in the Susceptibilities of Invasive Isolates of Candida glabrata to Seven Systemically Active Antifungal Agents: a Global Assessment from the ARTEMIS Antifungal Surveillance Program Conducted in 2001 and 2002

Survey of Vaginal-Flora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection

Azole Resistance of Candida glabrata in a Case of Recurrent Fungemia

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