Candida norvegensis is an emerging fluconazole-resistant pathogen isolated in most cases from skin and mucous membranes of immunocompromized patients. Documented invasive candidiasis IC due to C. We report a liver transplant patient who developed IC due to C. In recent years, there has been an increase in the incidence of invasive candidiasis IC and a shift toward non- albicans Candida species, some of them resistant to fluconazole. Among Candida species C. Here, we report a patient who developed an IC due to C.
|Published (Last):||28 December 2015|
|PDF File Size:||4.45 Mb|
|ePub File Size:||6.37 Mb|
|Price:||Free* [*Free Regsitration Required]|
Candida norvegensis is an emerging fluconazole-resistant pathogen isolated in most cases from skin and mucous membranes of immunocompromized patients. Documented invasive candidiasis IC due to C. We report a liver transplant patient who developed IC due to C. In recent years, there has been an increase in the incidence of invasive candidiasis IC and a shift toward non- albicans Candida species, some of them resistant to fluconazole.
Among Candida species C. Here, we report a patient who developed an IC due to C. A year-old man, with history of HCV-related cirrhosis and hepatocarcinoma, was referred to our hospital for spontaneous bacterial peritonitis and partial portal vein thrombosis. After three months of hospitalization he underwent liver transplantation. The transplant procedure was uneventful, a duct-to-duct biliary anastomosis was done, antimicrobial prophylaxis was stopped within 24 hours after the surgical procedure, and no antifungal prophylaxis was administered.
The patient was discharged on a standard immunosuppressive regimen with tacrolimus 3 mg every 12 hours , mycofenolate mofetil mg every 12 hours and prednisone 5 mg every 12 hours. After two weeks from discharge he was readmitted for fever, malaise and moderate hepatic dysfunction. We consider the date of readmission as day 0. A magnetic resonance cholangiography showed a biliary leak with bilioma and ascites.
On the same day bilioma was drained percutaneously and a bile sample was sent to the laboratory for microbiological tests. Despite the antimicrobial therapy and the surgical procedure, the patient clinical conditions worsened and, on day 3, he was admitted to the intensive care unit ICU on septic shock. Chest x-ray showed bilateral pneumonia. Surgical drainage of the hepato-biliary ducts was performed. The microbiological tests collected on day 1 yielded C.
Identification and susceptibility assay of C. Data regarding antifungal susceptibilities in C. Due to these considerations, we assumed that our strain was non susceptible to azoles as other non albicans candida species. We are aware that C. In the following days, the clinical conditions of the patient improved with resolution of fever, achievement of hemodynamic stability and weaning from MV.
The blood cultures drawn on day 5 after hospital admission were negative, whereas the cultures of bile became negative for C. Trans-esophageal echocardiography ruled out infective endocarditis, and the fundus oculi examination was negative for embolisms. Linezolid was stopped on day six, whereas meropenem and anidulafungin were continued up to 2 and 4 weeks, respectively. The bile tract was repaired with the implant of three stents by endoscopic procedure.
After one month of hospital stay, the patient was discharged on good health conditions and he remained asymptomatic during one year of follow-up. The strength of our case is the isolation of a very uncommon fluconazole resistant Candida species in a liver transplant patient with proven invasive candidiasis. Candida norvegensis has been an unusual cause of infection in humans.
It was first isolated in Norway from the sputum of three patients with asthma nearly 60 years ago. We performed a literature research on PubMed using as key word Candida norvegensis and as limit English language.
Case reports and case series of IC due to C. Overall, eight manuscripts including 12 patients with invasive infection due to C. Among the four survivors, two were affected by an intra-abdominal abscess treated with antifungal therapy liposomal amphotericin B followed by caspofungin and liposomal amphotericin B alone associated to surgical drainage.
Indeed, candidemia is a predictor of poor outcome in liver transplant receivers; 15 therefore, we decided to stop fluconazole, that could be ineffective, and to start a fungicidal agent as anidulafungin. The review of the literature published from to shows that the high mortality of C. In previous reports, mortality among patients with IC due to C. Surgery and effective antifungal therapy seem to be together essential for a favorable outcome in patients with intrabdominal abscesses, as observed in our patient and in those reported in literature.
Funding: this study was partially supported by the funding of the Italian Ministry of Health RF National Center for Biotechnology Information , U. Journal List Infect Dis Rep v.
Infect Dis Rep. Published online Jun Author information Article notes Copyright and License information Disclaimer.
Camillo-Forlanini Hospital, Rome. Contributed by Contributions: the authors contributed equally. Conflict of interests: the authors declare no potential conflict of interests. Musso et al. This article has been cited by other articles in PMC. Abstract Candida norvegensis is an emerging fluconazole-resistant pathogen isolated in most cases from skin and mucous membranes of immunocompromized patients.
Key words: transplantation, infection, azole, resistant, fungal. Introduction In recent years, there has been an increase in the incidence of invasive candidiasis IC and a shift toward non- albicans Candida species, some of them resistant to fluconazole. Case Report A year-old man, with history of HCV-related cirrhosis and hepatocarcinoma, was referred to our hospital for spontaneous bacterial peritonitis and partial portal vein thrombosis.
Discussion The strength of our case is the isolation of a very uncommon fluconazole resistant Candida species in a liver transplant patient with proven invasive candidiasis. Table 1. Literature cases of invasive candidiasis due to C. Open in a separate window. Conclusions In previous reports, mortality among patients with IC due to C. References 1. Bloodstream infections: evolution and trends in the microbiology workload, incidence, and etiology, Medicine Baltimore.
Epidemiology and outcomes of candidemia in patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. Epidemiology, species distribution, antifungal susceptibility and outcome of nosocomial candidemia in a tertiary care hospital in Italy. PloS One. Candida norvegensis: a fluconazole-resistant species.
Antimicrob Agents Chemother. Nielsen H, Stenderup J. Invasive Candida norvegensis infection in immunocompromised patients. Scand J Infect Dis. Restriction enzyme analysis of ribosomal DNA shows that Candida inconspicua clinical isolates can be misidentified as Candida norvegensis with traditional diagnostic procedures. J Clin Microbiol. Candida norvegensis peritonitis and invasive disease in a patient on continuous ambulatory peritoneal dialysis.
Itraconazole for prophylaxis of systemic mycoses in neutropenic patients with haematological malignancies. J Antimicrob Chemother. Successful treatment with liposomal amphotericin B of an intraabdomianl abscess due to Candida norvegensis associated with a Gore-Tex mesh infection. Candida norvegensis fungaemia in a neutropenic patient with acute non-lymphoblastic leukaemia.
Fungemia and renal fungus ball formation with Candida norvegensis in a child with acute lymphoblastic leukemia. Turk J Pediatr. Invasive infections due to Candida norvegensis and Candida incospicua: report of 12 cases and review of the literature.
Med Mycol. Grossi PA. Clinical aspects of invasive candidiasis in solid organ transplant recipients. Epidemiology and clinical features of posttransplant bloodstream infection: an analysis of consecutive liver transplant recipients.
Candida norvegensis: a fluconazole-resistant species.
For practical reasons we have decided not to translate all pages in several languages anymore because it was too heavy to maintain but some of the labels of the basic and advanced query pages are still available. Click on the language titles to launch them. Chinese version. Run Zhang 1 and Dr. German version. Arabic version.
Candida norvegensis has been an unusual cause of infections in humans. In Norway this species was isolated from eight patients from to and was of probable pathogenic significance in four of them. All isolates were resistant to fluconazole. The same was true for two C. National Center for Biotechnology Information , U. Journal List Antimicrob Agents Chemother v. Antimicrob Agents Chemother.
The incidence of candidemia due to non- Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient.. A year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses.