Neonatal Candidemia Caused by Candida haemulonii: Case Report and Review of Literature
- 333 Downloads
Candidemia is a frequent condition in Neonatal Intensive Care Units (NICU) and usually complicates the newborns clinical course. Several factors are responsible for candidiasis, such as prematurity and use of broad-spectrum antibiotics, and in these cases, there are the involvement of various Candida species, as C. albicans, and C. parapsilosis. However, other species as C. haemulonii has been rarely described in candidemia cases, being considered an emergent pathogen. Thus, we report a case of neonatal candidemia by C. haemulonii and a review of literature of fungemia by this yeast. The patient was a neonate with gestational age of 26 weeks and birth weight of 660 g hospitalized in a NICU from a Brazilian hospital. The identification of the etiological agent was performed by phenotypic methods, scanning electron microscopy, sequencing of the ITS region of rDNA, and mass spectrometry. Antifungal susceptibility testing was carried out according to the Clinical Laboratories and Standards Institute guidelines. The newborn was diagnosed with candidemia by C. haemulonii resistant to amphotericin B with minimal inhibitory concentration (MIC) of 8 µg/mL, sensitive to fluconazole (MIC: 8 µg/mL) and voriconazole (MIC: 0.12 µg/mL). The treatment with fluconazole (12 mg/kg/day) was established with good outcome. Candidemia by C. haemulonii is still being limited to a few sporadic cases in adults with endemic and restricted occurrences in neonates. Usually, the therapy with amphotericin B is ineffective against this species. Our results showed the importance of the mycological diagnosis associated to antifungigrama for the successful clinical management followed by important epidemiological data.
KeywordsCandidemia Neonates Neonatal Intensive Care Unit Emerging pathogen Antifungal sensibility Candida haemulonii
We thank the Coordination of Improvement of Higher Education Personnel (CAPES) for funding. We acknowledge the Special Mycology Laboratory—EPM/UNIFESP, Brazil, for DNA sequencing and CETENE for scanning electronic microscopy analysis.
- 2.Panackal AA. Optimizing containment and control of Candida parapsilosis fungemia among neonates in the outbreak setting using a mathematical modeling approach. J Mycol. 2013;2013:11.Google Scholar
- 6.Pedroso CPA, Krebs VLJ. Complications of systemic candidiasis in NICU. Revista de Ciências médicas biológicas. 2008;7(3):280–8.Google Scholar
- 8.Lavarde VF, Saez DH, Arnold M, Faguer B. Peritonite mycosique a Torulopsis haemulonii. Bull Soc Fr Mycol Med. 1984;13:173–6.Google Scholar
- 10.Cendejas-Bueno E, Kolecka A, Alastruey-Izquierdo A, Theelen B, Groenewald M, Kostrzewa M, Cuenca-Estrella M, Gómez-López A, Boekhout T. Reclassification of the Candida haemulonii Complex as Candida haemulonii (C. haemulonii Group I), C. duobushaemulonii sp. nov. (C. haemulonii Group II), and C. haemulonii var. vulnera var. nov.: three multiresistant human pathogenic yeasts. J Clin Microbiol. 2012;50:3641–51.PubMedCentralPubMedCrossRefGoogle Scholar
- 12.Barnett JA, Paine RW, Yarrow D. Yeasts: characteristics and identification. Cambridge: Cambridge University Press; 2000.Google Scholar
- 13.White TJBT, Lee S, Taylor J. Amplification and direct sequence of fungal ribosomal RNA genes for phylogenetics. In: Innis MAGD, Sninsky J, White TJ, editors. PCR protocols, a guide to methods and applications. New York: Academic Press; 1990. p. 315–22.Google Scholar
- 14.Lima-Neto RG, Santos C, Lima N, Sampaio P, Pais C, Neves RP. Application of MALDI-TOF MS for requalification of Candida clinical isolates culture collection. Braz J Microbiol. 2014;45(2):515–522.Google Scholar
- 15.Clinical and Laboratory Standards Institute (CLSI). Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard, 3rd ed. CLSI document M27-A3, Wayne, PA, 2008.Google Scholar
- 16.Marjolet M. Torulopsis ernobii, Torulopsis haemulonii: levures opportunistes chez I’immunode ´prime´? Bull Soc Fr Mycol Med. 1986;15:143–6.Google Scholar
- 22.CLSI. Reference method for broth dilution antifungal susceptibility testing of yeasts: fourth informational supplement. CLSI document M27-S4. Wayne, PA, 2012.Google Scholar