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Journal of Clinical Microbiology, June 2000, p. 2423-2426, Vol. 38, No. 6
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Retrospective Identification and Characterization of Candida dubliniensis Isolates among Candida albicans Clinical Laboratory Isolates from Human Immunodeficiency Virus (HIV)-Infected and Non-HIV-Infected Individuals

M. A. Jabra-Rizk,1,2,* W. A. Falkler Jr.,2 W. G. Merz,3 A. A. M. A. Baqui,1 J. I. Kelley,1 and T. F. Meiller1

Department of Oral Medicine1 and Department of OCBS,2 Dental School, University of Maryland, and Department of Pathology, The Johns Hopkins University,3 Baltimore, Maryland 21201

Received 11 February 2000/Returned for modification 22 March 2000/Accepted 7 April 2000

Fungal opportunistic infections, and in particular those caused by the various Candida species, have gained considerable significance as a cause of morbidity and, often, mortality. The newly described species Candida dubliniensis phenotypically resembles Candida albicans so closely that it is easily misidentified as such. The present study was designed to determine the frequency at which this new species is not recognized in the clinical laboratory, to determine the patient populations with which C. dubliniensis is associated, to determine colonization versus infection frequency, and to assess fluconazole resistance. Over a 2-year period, 1,251 isolates that were initially identified as C. albicans by a hospital clinical laboratory were reevaluated for C. dubliniensis by inability to grow at 45°C, colony color on CHROMagar Candida medium, coaggregation assay with Fusobacterium nucleatum, and sugar assimilation profiles (API 20C AUX yeast identification system). A total of 15 (1.2%) isolates from 12 patients were identified as C. dubliniensis. Ten of the patients were found to be immunocompromised (these included patients with human immunodeficiency virus infection or AIDS, cancer patients receiving chemotherapy, and patients awaiting transplantation). Thirteen isolates were highly susceptible to fluconazole (MIC, <0.5 µg/ml). Three isolates from one patient, genotypically confirmed as the same strain, showed variable susceptibility to fluconazole. The first isolate was susceptible, whereas the other two isolates were dose-dependent susceptible (MIC, 16.0 µg/ml). These data confirm the close association of C. dubliniensis with immunocompromised states and that increased fluconazole MICs may develop in vivo. This study emphasizes the importance of screening germ-tube-positive yeasts for the inability to grow at 45°C followed by confirmatory tests in order to properly identify this species.

* Corresponding author. Mailing address: Department of Oral Medicine, Dental School, UMAB, 666 W. Baltimore St., Baltimore, MD 21201. Phone: (410) 708-7628. Fax: (410) 706-0519. E-mail: mrizk{at}umaryland.edu.

Journal of Clinical Microbiology, June 2000, p. 2423-2426, Vol. 38, No. 6
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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