Fatal septicemia due to amphotericin B-resistant Candida lusitaniae

Guinet, R; Chanas, J; Goullier, A; Bonnefoy, G; Ambroise-Thomas, P

doi:10.1128/jcm.18.2.443-444.1983

Cited by 112 publications

(41 citation statements)

References 4 publications

(1 reference statement)

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“…All except two cases of sepsis were caused by Cundidu tropicalis or Cundidu lusitaniae, which may account for the high (four of seven) mortality rate. 27,28,34 In conclusion, serial oral cytologic examinations on patients with acute leukemia undergoing remission induction chemotherapy detect oral colonization with candidal organisms in approximately 90% of patients. Those with colonization with or without pseudohyphae are at risk for disseminated candidiasis.…”

Section: Discussionmentioning

confidence: 93%

The pathogenesis and clinical significance of cytologically detectable oralCandida in acute leukemia

Rodu

Carpenter

Jones

1988

Cancer

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Using serial examination and oral cytology, 50 adult patients undergoing induction therapy for acute leukemia were studied for oral colonization with candida species. Ninety percent of patients were found to be colonized with Candida, with most of these colonizations present by day 14. The 30 patients exhibiting colonization with pseudohyphae received ketoconazole 400 mg daily by mouth. Of 20 patients in this group treated for 5 or more days, Candida organisms were eradicated in nine. Sixteen patients from the above group with persistent colonization on ketoconazole were treated by independent clinical decision for sustained fever and neutropenia with Amphotericin B, but only one responded by elimination of colonization. Seven of the 15 patients who did not initially receive ketoconazole developed Candida dissemination in contrast to two of 30 who received ketoconazole initially (P = 0.003, Fisher's exact test). No patient who initially had or acquired a negative cytology developed oral or disseminated candidiasis. Clinical oral candidiasis occurred in three patients, all of whom were receiving amphotericin B. Approximately 90% of these patients have or develop oral colonization with Candida organisms as identified by oral cytology. Those with colonization, both with and without pseudohyphae present, are at risk for dissemination. Amphotericin B does not eliminate colonization remaining after treatment with 400 mg of ketoconazole daily. More effective diagnostic and therapeutic strategies are needed to identify and eliminate Candida organisms and to prevent disseminated candidiasis in this population of patients.

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Section: Discussionmentioning

confidence: 93%

The pathogenesis and clinical significance of cytologically detectable oralCandida in acute leukemia

Rodu

Carpenter

Jones

1988

Cancer

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“…Several molds (Pseudallescheria boydii, Scopulariopsis, Fusarium), as well as the yeasts Trichosporon beigelii, Candida lusitaniae, and Candida guilliermondii, possess primary resistance to amphotericin B. However, the clinical impact has been limited by the infrequency of invasive infection caused by these resistant organisms and the lack of evidence that such resistance has led to increased numbers of these infections (39,61,136,215). Secondary resistance to amphotericin B has been found in yeasts causing infections in patients with cancer (30,145,205).…”

Section: Epidemiology: Prevalence Risk Factorsmentioning

confidence: 99%

Clinical, Cellular, and Molecular Factors That Contribute to Antifungal Drug Resistance

1998

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SUMMARY In the past decade, the frequency of diagnosed fungal infections has risen sharply due to several factors, including the increase in the number of immunosuppressed patients resulting from the AIDS epidemic and treatments during and after organ and bone marrow transplants. Linked with the increase in fungal infections is a recent increase in the frequency with which these infections are recalcitrant to standard antifungal therapy. This review summarizes the factors that contribute to antifungal drug resistance on three levels: (i) clinical factors that result in the inability to successfully treat refractory disease; (ii) cellular factors associated with a resistant fungal strain; and (iii) molecular factors that are ultimately responsible for the resistance phenotype in the cell. Many of the clinical factors that contribute to resistance are associated with the immune status of the patient, with the pharmacology of the drugs, or with the degree or type of fungal infection present. At a cellular level, antifungal drug resistance can be the result of replacement of a susceptible strain with a more resistant strain or species or the alteration of an endogenous strain (by mutation or gene expression) to a resistant phenotype. The molecular mechanisms of resistance that have been identified to date in Candida albicans include overexpression of two types of efflux pumps, overexpression or mutation of the target enzyme, and alteration of other enzymes in the same biosynthetic pathway as the target enzyme. Since the study of antifungal drug resistance is relatively new, other factors that may also contribute to resistance are discussed.

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“…C. lusitaniae se comporta como una levadura patógena oportunista, por lo tanto, comparte con otras especies del género los factores de riesgo para la colonización, tales como: neutropenia profunda y prolongada, implantación de material protésico, uso de catéteres endovenosos, prematuridad, corticoterapia, quimioterapia y el uso prolongado de antimicrobianos de amplio espectro, y en general cualquier tipo de inmunosupresión (2,8,9,19,26,32,33).…”

Section: Introduccionunclassified

“…Si bien se trata de un microrganismo con baja incidencia de infección en personas inmunocompetentes, actualmente es reconocida como un patógeno nosocomial emergente en pacientes graves e inmunocomprometidos, incluyendo septicemia, meningitis, pielonefritis, osteomielitis e infecciones del tracto respiratorio, urinario y gastrointestinal, en general de mal pronóstico (8,9,32,33).…”

Section: Introduccionunclassified

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Candida lusitaniae EN UN PACIENTE PEDIATRICO INMUNOCOMPROMETIDO: EXITO TERAPEUTICO DEL VORICONAZOL

Runco

Salim

2005

Bol. Micol.

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Palabras clave: Candida lusitaniae, paciente pediátrico, Voriconazol RESUMENCandida lusitaniae es reconocida como un patógeno emergente, ocasionalmente responsable de graves infecciones nosocomiales en pacientes con compromiso inmune. Esta levadura plantea dos desafíos importantes; la posibilidad de una identificación errónea de la especie y su resistencia primaria o adquirida a la Anfotericina B. El presente trabajo informa el aislamiento en cultivos puros de C.lusitaniae desde el líquido cefalorraquídeo de un paciente pediátrico inmunocomprometido, de 5 meses de edad, hospitalizado por hidrocefalia posthemorrágia neonatal valvulada. El paciente fue tratado inicialmente con Anfotericina B, substituida posteriormente por Voriconazol. Se destaca el éxito terapéutico de éste último en la dosis usada en este caso. Luego de un prolongado período de hospitalización el paciente fue dado de alta. Consideramos que para entender la importancia clínica de esta levadura, es necesario investigaciones más completas tanto de su epidemiología como de los mecanismos de resistencia a los antifúngicos y de su frecuencia, tanto in vivo como in vitro, condiciones útiles para entender algunas de las razones de la emergencia de C. lusitaniae en clínica. ABSTRACTCandida lusitaniae is known to be an emerging pathogenous which is occasionally responsible for serious nosocomial infections in immunocompromised patients. This yeast involves two significant challenges: the possibility of a wrong identification of the species and its primary or acquired resistance to Anfotericina B. The present paper reports the isolation of C.lusitaniae in pure cultures taken from a 5-month aged immunocompromised pediatric patient who had been diagnosed with a neonatal post hemorrhagic valvular hydrocephalus. The patient was firstly treated with Anfotericena B and later on with Voriconazole. The therapeutic success of the latter medication as used in this case is pointed out. After being a long time in the hospital, the patient was sent home. In order to understand the clinical significance of this yeast, we think it is necessary to carry out further research work both in its epidemiology and in its antifungal drug resistance mechanisms together with its frequency in situ and in vitro,being the above requirements useful to recognize the reasons for. C lusitaniae emergence in the clinic.

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Fatal septicemia due to amphotericin B-resistant Candida lusitaniae

Cited by 112 publications

References 4 publications

The pathogenesis and clinical significance of cytologically detectable oralCandida in acute leukemia

The pathogenesis and clinical significance of cytologically detectable oralCandida in acute leukemia

Clinical, Cellular, and Molecular Factors That Contribute to Antifungal Drug Resistance

Candida lusitaniae EN UN PACIENTE PEDIATRICO INMUNOCOMPROMETIDO: EXITO TERAPEUTICO DEL VORICONAZOL

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