ABSTRACT
We determined the echinocandin susceptibility and FKS1 genotypes of 13 clinical isolates of Candida auris that were recovered from 4 patients at a tertiary care center in Salvador, Brazil. Three isolates were categorized as echinocandin-resistant, and they harbored a novel FKS1 mutation that led to an amino acid change W691L located downstream from hot spot 1. When introduced to echinocandin-susceptible C. auris strains by CRISPR/Cas9, Fks1 W691L induced elevated MIC values to all echinocandins (anidulafungin, 16 to 32×; caspofungin, >64×; micafungin, >64×).
Subject(s)
Antifungal Agents , Candida auris , Humans , Antifungal Agents/pharmacology , Fungal Proteins/genetics , Fungal Proteins/metabolism , Echinocandins/pharmacology , Caspofungin , Microbial Sensitivity Tests , Drug Resistance, Fungal/geneticsABSTRACT
We analyzed 19 cases of breakthrough candidemia from a referral pediatric cancer center in Brazil. All patients had neutropenia and were under antifungal prophylactic regimens, mostly micafungin (68%). Most of the patients were treated with amphotericin B formulations and 30-day mortality was 21%. Candida parapsilosis was the main etiologic agent (63%), and horizontal transmission was not evidenced by microsatellite analysis.
Subject(s)
Antifungal Agents/therapeutic use , Candidemia/complications , Neoplasms/complications , Brazil , Candida/classification , Catheter-Related Infections/drug therapy , Catheter-Related Infections/microbiology , Child , Humans , Retrospective StudiesABSTRACT
IMPORTANCE: To our knowledge, these are the first reports of bloodstream infections by Trichosporon inkin in patients with pemphigus. OBSERVATIONS: Trichosporon inkin, a novel organism causing bloodstream infection, was detected in 2 patients with pemphigus. An elderly man with pemphigus foliaceus died despite treatment with liposomal amphotericin B, 3 mg/kg/d, and a young girl with pemphigus vulgaris responded to treatment with voriconazole, 8 mg/kg/d, for 24 days. One of the T inkin isolates had a minimal inhibitory concentration of 2 mg/L against amphotericin B, suggesting resistance to the drug. CONCLUSIONS AND RELEVANCE: Delayed suspicion of invasive infection by T inkin may result in a poor outcome in patients with severe forms of pemphigus. This opportunistic infection is highly refractory to conventional potent antifungal treatment.
Subject(s)
Antifungal Agents/therapeutic use , Pemphigus/drug therapy , Trichosporon/isolation & purification , Trichosporonosis/diagnosis , Aged , Amphotericin B/therapeutic use , Child , Drug Resistance, Fungal , Fatal Outcome , Female , Humans , Male , Microbial Sensitivity Tests , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Pemphigus/pathology , Severity of Illness Index , Trichosporon/drug effects , Trichosporonosis/drug therapy , Trichosporonosis/pathology , Voriconazole/therapeutic useABSTRACT
Twenty-nine Candida parapsilosis, seventeen Candida orthopsilosis and two Candida metapsilosis bloodstream isolates were submitted for identification by VITEK-MS™ mass spectrometer. Four isolates, two C. orthopsilosis and two C. metapsilosis, were not identified. Inclusion of Superspectra of both species in this database is required to improve its discrimination power.
