Candida auris is a multidrug-resistant and emergent pathogen that has caused healthcare-associated infection outbreaks. Recently, C. auris has spread worldwide; nevertheless, it was unexpectedly rare before 2009. Based on the molecular epidemiological analysis, C. auris may independently emerge at specific areas at first and recently may be transmitted to other continents. As C. auris cannot be detected using conventional methods, internally transcribed spacers, D1/D2 regions of the 26S rDNA sequencing, and/or matrix-assisted laser desorption ionization time-of-flight mass spectrometry method can be selected as comparatively accessible choices. Thus, detection of C. auris using the conventional method might be underestimated. In Japan, all C. auris strains were isolated from ear specimen and not from invasive mycoses. Japan strains were classified as an East Asian clade under a single clone. Although colonization, virulence, and infection pattern are almost the same as with other Candida species, its antifungal resistance is different. Fluconazole resistance is notably common, but resistance to all three classes of antifungals (azole, polyene, and echinocandin) rarely exists. Once C. auris is detected, screening, emphasis on hand hygiene adherence, use of single-patient room isolation, contact precaution, surveillance, and eradication from the environment and patients are appropriately required for infection control.
BackgroundGemella bergeri is one of the nine species of the genus Gemella and is relatively difficult to identify. We herein describe the first case of septic shock due to a Gemella bergeri coinfection with Eikenella corrodens.Case presentationA 44-year-old Asian man with a medical history of IgG4-related ophthalmic disease who was prescribed corticosteroids (prednisolone) presented to our hospital with dyspnea. On arrival, he was in shock, and a purpuric eruption was noted on both legs. Contrast enhanced computed tomography showed fluid retention at the right maxillary sinus, left lung ground glass opacity, and bilateral lung irregular opacities without cavitation. Owing to suspected septic shock, fluid resuscitation and a high dose of vasopressors were started. In addition, meropenem, clindamycin, and vancomycin were administered. Repeat computed tomography confirmed left internal jugular and vertebral vein thrombosis. Following this, the patient was diagnosed with Lemierre’s syndrome. Furthermore, he went into shock again on day 6 of hospitalization. Additional soft tissue infections were suspected; therefore, bilateral below the knee amputations were performed for source control. Cultures of the exudates from skin lesions and histopathological samples did not identify any pathogens, and histopathological findings showed arterial thrombosis; therefore it was concluded that the second time shock was associated with purpura fulminans. Following this, his general status improved. He was transferred to another hospital for rehabilitation. The blood culture isolates were identified as Gemella bergeri and Eikenella corrodens. Gemella bergeri was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and confirmed by 16S rRNA gene sequencing later. The primary focus of the infection was thought to be in the right maxillary sinus, because the resolution of the fluid retention was confirmed by repeat computed tomography.ConclusionsGemella bergeri can be the causative pathogen of septic shock. If this pathogen cannot be identified manually or through commercial phenotypic methods, 16S rRNA gene sequencing should be considered.
Background Candida auris has not been detected since firstt report in Japan, despite worldwide reports. We recently reported a second isolate of C. auris (TWCC 58191) from ear discharge in Japan. We re-analyzed unidentified yeast strains.MethodsOver 2,000 clinical yeast samples were available. Among these, 16 yeast strains isolated from the ear discharge were not identified using conventional method. C. auris was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and internal transcribed spacer and D1/D2 region sequencing. To determine the minimum inhibitory concentration (MIC), the Clinical and Laboratory Standards Institute broth microdilution method was used. Whole genome sequencing, assembly and error correction was performed (Japanese strains). Average nucleotide identity (ANI) among two Japanese strains and four other strains (India, Pakistan, South Africa) was determined. Our 6 strains and previously reported strains (n = 126) were mapped to JCM15448 and single nucleotide variants (SNVs) were detected. An SNV-based phylogenetic tree was constructed.ResultsFive were identified as C. auris. Our strains exhibited relatively low MICs (Table 1). Japanese strains had susceptibility to nearly all agents. Because all strains were obtained from chronic otitis media, the susceptibility may be explained by a lack of exposure to antifungal agents. JCM15448 was assembled based on 11 contigs. All ANIs were over 99%; therefore, all of these strains are C. auris. A total of 168,810 SNVs were detected in 133 strains. The SNV-based phylogenetic tree is shown Figure 1. Since independent clusters were observed from strains from each area, it is possible that C. auris emerged independently in different regions worldwide. The SNV-based phylogenetic tree was more effective for the identification of Japanese strains (Figure 2).Table 1.Characteristics of our C. auris StrainsFigure 1.Phylogenic tree based on SNVsFigure 2.Phylogenic tree of SNVs (only Japanese strains)ConclusionDespite a general lack of reports, C. auris exists in Japan. Clinicians must consider the potential for C. auris detection from otorrhea samples.A phylogenic analysis separates native strains from each area. During an outbreak, an SNV-based phylogenic tree is suitable for analysis owing to its good identification ability.Disclosures All authors: No reported disclosures.
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