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Ahmad S, Asadzadeh M, Al-Sweih N, Khan Z. Spectrum and management of rare Candida/yeast infections in Kuwait in the Middle East. Ther Adv Infect Dis 2024; 11:20499361241263733. [PMID: 39070702 PMCID: PMC11273600 DOI: 10.1177/20499361241263733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024] Open
Abstract
Invasive fungal infections (IFIs) are associated with high mortality rates and mostly affect patients with compromised immunity. The incidence of IFIs is increasing worldwide with the expanding population of susceptible patients. Candida and other yeast infections represent a major component of IFIs. Rare Candida/yeast infections have also increased in recent years and pose considerable diagnostic and management challenges as they are not easily recognized by routine phenotypic characteristic-based diagnostic methods and/or by the automated yeast identification systems. Rare Candida/yeasts also exhibit reduced susceptibility to antifungal drugs making proper management of invasive infections challenging. Here, we review the diagnosis and management of 60 cases of rare Candida/yeast IFIs described so far in Kuwait, an Arabian Gulf country in the Middle East. Interestingly, majority (34 of 60, 56.7%) of these rare Candida/yeast invasive infections occurred among neonates or premature, very-low-birth-weight neonates, usually following prior bacteremia episodes. The clinical details, treatment given, and outcome were available for 28 of 34 neonates. The crude mortality rate among these neonates was 32.2% as 19 of 28 (67.8%) survived the infection and were discharged in healthy condition, likely due to accurate diagnosis and frequent use of combination therapy. Physicians treating patients with extended stay under intensive care, on mechanical ventilation, receiving broad spectrum antibiotics and with gastrointestinal surgery/complications should proactively investigate IFIs. Timely diagnosis and early antifungal treatment are essential to decrease mortality. Understanding the epidemiology and spectrum of rare Candida/yeast invasive infections in different geographical regions, their susceptibility profiles and management will help to devise novel diagnostic and treatment approaches and formulate guidelines for improved patient outcome.
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Affiliation(s)
- Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| | - Mohammad Asadzadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Noura Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Chamroensakchai T, Sanaklang N, Hurdeal VG, Banjongjit A, Hyde KD, Kanjanabuch T. Candida nivariensis, an emerging fungus causing peritonitis in a patient receiving peritoneal dialysis. Med Mycol Case Rep 2022; 39:5-7. [PMID: 36568645 PMCID: PMC9772606 DOI: 10.1016/j.mmcr.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Fungal peritonitis (FP) is usually associated with poor patient outcomes and is mostly caused by non-albicans Candida species. We present a Candida nivariensis-associated peritonitis in a 68-year-old woman with end-stage kidney disease on peritoneal dialysis (PD). Biochemical profiling of the cultured yeast of the effluent sample did not adequately identify the yeast. Hence, molecular phylogeny and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectroscopy were employed which correctly identified the causative species, C. nivariensis. PD catheter was removed and oral fluconazole was promptly started according to the 2022 International Society for PD (ISPD) Peritonitis Guidelines. However, the patient achieved only a partial clinical response and eventually died. The susceptibility test showed that the pathogen was susceptible to amphotericin B and voriconazole but resistant to other triazoles. This report underlines the importance of identifying the species, though rarely reported, and the drug susceptibility of the organism.
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Key Words
- CAPD, Continuous ambulatory peritoneal dialysis
- CLSI, Clinical and Laboratory Standards Institute
- Candida nivariensis
- ESKD, End-stage kidney disease
- Fungal peritonitis
- IP, Intraperitoneal
- ISPD, International Society for Peritoneal Dialysis
- ITS, Internal transcribed space
- KCMH, King Chulalongkorn Memorial Hospital
- MIC, Minimum inhibitory concentration
- PD, Peritoneal dialysis
- PDE, Peritoneal dialysis effluent
- Peritoneal dialysis
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Affiliation(s)
- Tamonwan Chamroensakchai
- Center of Excellence in Kidney Metabolic Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Vedprakash G. Hurdeal
- Center of Excellence in Fungal Research, Mae Fah Luang University, Chiang Rai, 57100, Thailand,School of Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Athiphat Banjongjit
- Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Bangkok, 10400, Thailand
| | - Kevin D. Hyde
- Center of Excellence in Fungal Research, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand,Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand,CAPD Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand,Corresponding author. Center of Excellence in Kidney Metabolic Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Muacevic A, Adler JR, Denmeade T, Luther V, Palavecino E, Beardsley J. Treatment of Candida nivariensis Blood Stream Infection With Oral Isavuconazole. Cureus 2022; 14:e32137. [PMID: 36601144 PMCID: PMC9805793 DOI: 10.7759/cureus.32137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/05/2022] Open
Abstract
Candida nivariensis is a rarely isolated yeast that is now considered a species within the Candida glabrata complex. Anti-fungal susceptibilities and treatments of Candida nivariensis are often assessed on a case-by-case basis. In this case, a 70-year-old male with a complex medical history presented to a large academic medical center in the United States for vascular surgery. After surgery, the patient's white blood cell count increased prompting an infectious workup. The patient was found to have a Candida nivariensis bloodstream infection of unknown origin. Given the patient's clinical stability and QTc prolongation, he was treated with a 14-day course of oral isavuconazole. The patient experienced resolution of symptoms and clearance of subsequent blood cultures. At the time of writing this case report (11 months later), he has had no relapse of his fungal infection. Based on a search of the medical literature, this appears to be the first published case of Candida nivariensis fungemia successfully treated with oral isavuconazole.
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Sousa BR, Freitas JF, Valeriano CA, Neto LN, Neves RP, Gambarra FF, Gomes TM, da Silva Acioly JC, Lima-Neto RG. Refractory esophagitis caused by Candida nivariensis: second description of this yeast in Brazil and a literature review. Future Microbiol 2022; 17:903-915. [PMID: 35748170 DOI: 10.2217/fmb-2021-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Candida nivariensis caused refractory esophagitis in a 36-year-old Brazilian man coinfected with HIV and Leishmania. A literature review on this rare fungal pathogen is also presented. The diagnosis was made, and pathogen identification was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry and sequencing of the LSU/26S region. An antifungigram was performed using broth microdilution. A literature search of PubMed was performed. The causative agent, C. nivariensis, was resistant to fluconazole and voriconazole. The patient's condition worsened considerably, and he passed away. This is the second report of this Candida species in Brazil and the first case reported worldwide of refractory esophagitis in a patient coinfected with HIV and Leishmania. The case illustrates the importance of precise identification and antifungal susceptibility testing when isolating this emerging pathogen.
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Affiliation(s)
- Bruna R Sousa
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Jucieli F Freitas
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Carlos At Valeriano
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Luiz Na Neto
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Rejane P Neves
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Fernanda F Gambarra
- Department of Health, Infectious Diseases Hospital Dr Clementino Fraga, State of Paraíba, Rua Estér Borges Bastos, s/n, Jaguaribe, João Pessoa, 58015-270, Brazil
| | - Tiago M Gomes
- Department of Health, Infectious Diseases Hospital Dr Clementino Fraga, State of Paraíba, Rua Estér Borges Bastos, s/n, Jaguaribe, João Pessoa, 58015-270, Brazil
| | - Jack C da Silva Acioly
- Department of Health, Infectious Diseases Hospital Dr Clementino Fraga, State of Paraíba, Rua Estér Borges Bastos, s/n, Jaguaribe, João Pessoa, 58015-270, Brazil
| | - Reginaldo G Lima-Neto
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil.,Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
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Hernando-Ortiz A, Eraso E, Quindós G, Mateo E. Candidiasis by Candida glabrata, Candida nivariensis and Candida bracarensis in Galleria mellonella: Virulence and Therapeutic Responses to Echinocandins. J Fungi (Basel) 2021; 7:jof7120998. [PMID: 34946981 PMCID: PMC8708380 DOI: 10.3390/jof7120998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Candida albicans is the major etiological agent of invasive candidiasis but the increasing prevalence of emerging species of Candida, such as Candida glabrata and phylogenetically closely related species, Candida nivariensis and Candida bracarensis, requires special attention. Differences in virulence among these species and their therapeutic responses using in vivo non-mammalian models are scarcely analysed. The aim of this study was analyse the survival of G. mellonella and host-pathogen interactions during infection by C. glabrata, C. nivariensis and C. bracarensis. Moreover, therapeutic responses to echinocandins were also assessed in the G. mellonella model of candidiasis. These three species produced lethal infection in G. mellonella; C. glabrata was the most virulent species and C. bracarensis the less. Haemocytes of G. mellonella phagocytised C. bracarensis cells more effectively than those of the other two species. Treatment with caspofungin and micafungin was most effective to protect larvae during C. glabrata and C. nivariensis infections while anidulafungin was during C. bracarensis infection. The model of candidiasis in G. mellonella is simple and appropriate to assess the virulence and therapeutic response of these emerging Candida species. Moreover, it successfully allows for detecting differences in the immune system of the host depending on the virulence of pathogens.
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