Abstract
In this prospective and monocentric study, we investigated the performance of a commercialized real-time polymerase chain reaction (RT-PCR) test system for the specific detection of DNA from Candida albicans, C. dubliniensis, C. glabrata, C. krusei, C. lusitaniae, C. parapsilosis, and C. tropicalis in human milk samples of patients suspicious of mammary candidiasis. For this purpose, 43 breast-feeding women with characteristic symptoms of mammary candidiasis and 40 asymptomatic controls were enrolled. By culture, Candida spp. were detected in 8.8 % (4/46) and 9.3 % (4/43) of patient and control samples, respectively. Candida albicans (2/46), C. parapsilosis (1/46), and C. guilliermondii (1/46) were present in patient samples, and C. lusitaniae (3/43) and C. guilliermondii (1/43) were present in the controls. After RT-PCR was applied, Candida spp. were found to be present in 67.4 % (31/46) and 79.1 % (34/43) of patient and control samples investigated, respectively. PCR detection of C. albicans and C. parapsilosis revealed only a low sensitivity and specificity of 67.4 % and 41.9 %, respectively. Our data do not support the use of Candida RT-PCR for sensitive and specific diagnosis of mammary candidiasis.
Similar content being viewed by others
References
Heinig MJ, Francis J, Pappagianis D (1999) Mammary candidosis in lactating women. J Hum Lact 15(4):281–288
Francis-Morrill J, Heinig MJ, Pappagianis D, Dewey KG (2004) Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact 20(3):288–295
Vollmer T, Störmer M, Kleesiek K, Dreier J (2008) Evaluation of novel broad-range real-time PCR assay for rapid detection of human pathogenic fungi in various clinical specimens. J Clin Microbiol 46(6):1919–1926
Amir LH, Garland SM, Dennerstein L, Farish SJ (1996) Candida albicans: is it associated with nipple pain in lactating women? Gynecol Obstet Invest 41(1):30–34
Moorhead AM, Amir LH, O’Brien PW, Wong S (2011) A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeed Rev 19(3):25–29
Livingstone VH, Willis CE, Berkowitz J (1996) Staphylococcus aureus and sore nipples. Can Fam Physician 42:654–659
Andersson Y, Lindquist S, Lagerqvist C, Hernell O (2000) Lactoferrin is responsible for the fungistatic effect of human milk. Early Hum Dev 59(2):95–105
Lass-Flörl C, Mutschlechner W, Aigner M, Grif K, Marth C, Girschikofsky M, Grander W, Greil R, Russ G, Cerkl P, Eller M, Kropshofer G, Eschertzhuber S, Kathrein H, Schmid S, Beer R, Lorenz I, Theurl I, Nachbaur D (2013) Utility of PCR in diagnosis of invasive fungal infections: real-life data from a multicenter study. J Clin Microbiol 51(3):863–868
Sugawara Y, Nakase K, Nakamura A, Ohishi K, Sugimoto Y, Fujieda A, Monma F, Suzuki K, Masuya M, Matsushima Y, Wada H, Nobori T, Katayama N (2013) Clinical utility of a panfungal polymerase chain reaction assay for invasive fungal diseases in patients with haematologic disorders. Eur J Haematol 90(4):331–339
Panjaitan M, Amir LH, Costa AM, Rudland E, Tabrizi S (2008) Polymerase chain reaction in detection of Candida albicans for confirmation of clinical diagnosis of nipple thrush. Breastfeed Med 3(3):185–187
Amir LH, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Cooklin AR, Fisher JR, Payne MS (2011) The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol. BMC Pregnancy Childbirth 11:54
Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, Payne MS (2013) Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open 3(3). pii: e002351
Schabereiter-Gurtner C, Selitsch B, Rotter ML, Hirschl AM, Willinger B (2007) Development of novel real-time PCR assays for detection and differentiation of eleven medically important Aspergillus and Candida species in clinical specimens. J Clin Microbiol 45(3):906–914
Delgado S, Arroyo R, Martín R, Rodríguez JM (2008) PCR-DGGE assessment of the bacterial diversity of breast milk in women with lactational infectious mastitis. BMC Infect Dis 8:51
Morrill JF, Pappagianis D, Heinig MJ, Lönnerdal B, Dewey KG (2003) Detecting Candida albicans in human milk. J Clin Microbiol 41(1):475–478
Hale TW, Bateman TL, Finkelman MA, Berens PD (2009) The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis. Breastfeed Med 4(2):57–61
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
Austrian Science Fund ZFW012530.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in this study.
Rights and permissions
About this article
Cite this article
Mutschlechner, W., Karall, D., Hartmann, C. et al. Mammary candidiasis: molecular-based detection of Candida species in human milk samples. Eur J Clin Microbiol Infect Dis 35, 1309–1313 (2016). https://doi.org/10.1007/s10096-016-2666-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-016-2666-0