Case Report. Osteomyelitis caused by high resistant Candida guilliermondii

Abstract

We describe a case of a 57-year-old patient with osteomyelitis at a finger of his right hand caused by Candida guilliermondii. The strains isolated were highly resistant to fluconazole and itraconazole. Using the three methods, microdilution, agardilation and E-test, the highest minimum inhibitory concentrations (MICs) amounted to > 256 micrograms ml-1 for fluconazole and > 32 micrograms ml-1 for itraconazole. To our knowledge, this is the first time such high values have been described for C. guilliermondii. They correlated with the therapeutic non-response to a triazole therapy in our patient. The patient was cured by partial amputation of the affected finger.

Candida guilliermondii , an Opportunistic Fungal Pathogen with Decreased Susceptibility to Fluconazole: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program

“…Thus, it is worth noting that the single most common specimen to yield C. guilliermondii on culture was blood (Table 4). This finding lends support to the few clinical reports of invasive fungal infection due to this species, indicating that it may indeed cause significant infections (2,4,6,25).…”

“…Candida guilliermondii is an uncommon species of Candida that is most often associated with onychomycosis (3) and is rarely seen as a cause of invasive fungal infection (1,2,4,6,10,12,17,25,27). Dick et al (2) previously reported a case of disseminated candidiasis due to C. guilliermondii in which the patient died despite amphotericin B therapy.…”

“…The organism was shown by in vitro testing to be resistant to amphotericin B. Resistance to fluconazole was reported in a case of osteomyelitis of the finger caused by C. guilliermondii (25). The infection did not respond to prolonged treatment with fluconazole (400 mg/day) and ultimately required amputation of the affected digit.…”

Identification and Antifungal Susceptibility Profile of Candida guilliermondii and Candida fermentati from a Multicenter Study in China

“…The incidence of candidemia due to Candida guilliermondii is low, ranging from 1% to 3%, depending on the geographic region (3,4). However, the few available reports on C. guilliermondii infections indicate that these organisms are associated with poor clinical outcomes, which warrants further investigation (5)(6)(7)(8)(9).…”

Reavaliação da suscetibilidade de Candida à anfotericina B: estudo comparativo com isolados de três hospitais do estado do Rio Grande do Sul

“…Este resultado vem expressar a heterogeneidade do grupo não albicans; entre elas, Candida glabrata, naturalmente menos sensível ao fluconazol e anfotericina B, e Candida krusei, a qual é considerada multirresistente, pois, além de resistente ao fluconazol, somente 8% dos isolados evidenciam a anfotericina B CIM < 1 g/ml 24 30 . A resistência observada em Candida guilliermondii (CIM=1,2) 30 constituiu-se num achado inusitado, pois, a resistência desta espécie a anfotericina B costuma ser pouco expressiva; num estudo com 102 isolados, Tietz e cols 30 detectaram pelo E test apenas 2 isolados resistentes.…”