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Journal of Clinical Microbiology, August 2000, p. 3139-3140, Vol. 38, No. 8
0095-1137/00/$04.00+0
LETTERS TO THE EDITOR
One-Year Prevalence of Candida dublinienis in a
Dutch University Hospital
 |
LETTER |
With reference to a recently published article by Polacheck et al.
(9) reporting the isolation of Candida
dubliniensis from non-human immunodeficiency virus (HIV)-infected
patients in an Israeli hospital, we would like to add our data from a
single center in The Netherlands. Since we described the occurrence of candidemia due to C. dubliniensis in non-HIV-infected
patients (4), we prospectively studied the prevalence of
C. dubliniensis during the year 1999 in our 1,000-bed
tertiary-care university hospital. All germ-tube-positive yeasts
isolated from various clinical specimens submitted to the diagnostic
laboratory were further examined. Germ-tube-positive yeasts were
suspected to be C. dubliniensis when there was no growth at
45°C, no assimilation of xylose, and no elaboration of
-glucosidase and when microscopic morphology showed abundant
chlamydospore formation on rice-cream agar (8, 10, 12).
Molecular typing with RP02 (4, 5) was used to confirm the
phenotypic identification as C. dubliniensis. In 1999, a
total of 3,848 yeast isolates were cultured from various clinical
samples of which 2,605 (67.7%) were germ-tube positive. Of the
germ-tube-positive yeasts, 21 (0.8%) isolated from 11 patients were
C. dubliniensis as determined by phenotypic and molecular methods. Most isolates were recovered from oropharyngeal and fecal surveillance cultures from patients at the hematological ward (18 of 21 patients; 86%); one isolate each was cultured from a bronchial
secretion, a urine specimen, and a skin biopsy specimen. Of the 11 patients, 6 (55%) were HIV negative, and of 5 patients, no antibodies
against HIV were tested because there was no clinical suspicion for
HIV-related disease. In vitro susceptibility testing was performed on
one isolate per patient using the NCCLS broth microdilution method
(6). All isolates were susceptible to amphotericin B (MIC,
0.25 mg/liter), fluconazole (MIC, 0.25 mg/liter), 5-flucytosine (MIC,
<0.25 mg/liter), and itraconazole (MIC, 0.012 mg/liter). Only the
patient with the positive skin biopsy specimen, without concomitant
positive blood cultures, was treated with fluconazole (400 mg daily)
and recovered. Yeast infections are becoming a world-wide problem, with
C. albicans still the most frequently isolated species of
nosocomial infections (3, 7, 11, 12). In The Netherlands,
60% of all candidemic episodes were caused by C. albicans
(13). C. dubliniensis, which shares many
phenotypic characteristics with C. albicans, was first
described only 5 years ago for HIV-positive subjects in Ireland
(12). Since the methods for correct identification of
C. dubliniensis were established, the species has been
reported world-wide (1, 2, 9, 10). In a recent prospective
study (2) in the United States, 6 of 699 yeasts (0.9%)
isolated were C. dubliniensis, a prevalence which is similar
to ours. In contrast with our results, these isolates were mainly
recovered from the oral cavity of HIV-positive patients. In 1999, three
cases of C. dubliniensis candidemia in HIV-negative subjects
were reported in Europe (4), and recently, another four
cases, of which one was HIV positive, were reported in the United
States (1). Although C. dubliniensis was first described in HIV-positive patients, recent data suggest that it is also
common in HIV-negative patients as long as attempts are made to
differentiate the isolates from C. albicans. Microbiologists should be alerted to consider C. dubliniensis when an
atypical germ-tube-positive yeast is isolated because the most serious infections (six of seven) described until now have occurred in HIV-negative subjects with different forms of immunosuppression.
| |
FOOTNOTES |
*
Phone: 31-24-3614356 Fax: 31-24-3540216 E-mail:
j.meis{at}cwz.nl
| |
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|
| | | | |
Jacques F. G. M. Meis*
Department of Medical Microbiology
Canisius Wilhelmina Hospital
Nijmegen, The Netherlands
|
| | | | |
Frans M. Verduyn Lunel
Paul E. Verweij
Andreas Voss
Department of Medical Microbiology
University Medical Center Nijmegen
Nijmegen, The Netherlands
|
| |
AUTHOR'S REPLY |
We welcome the comments of Dr. Meis and colleagues and their additional
data on the frequency of isolation of Candida dubliniensis from HIV-negative individuals at the University Medical Center, Nijmegen, The Netherlands. We agree that although C. dubliniensis was originally thought to be mainly associated with
the oral cavity of HIV-infected and AIDS patients (3, 6, 8,
13-16), several recent studies have shown that it is more
prevalent in HIV-negative individuals than perhaps originally thought
(2, 5, 7-9, 15, 17). Our recent paper on the recovery of
C. dubliniensis from HIV-negative patients in Israel added
to this body of data and also provided the first report of the recovery
of C. dubliniensis from the Middle East (12).
Several studies have reported that C. dubliniensis is found
as a commensal organism in HIV-negative individuals and that it can
also cause overt oral and nonoral infection in this group (3, 5,
8, 9, 11, 15, 17). Our laboratory reported the first
authenticated blood culture isolate of C. dubliniensis in
1998 from an HIV-negative patient (11). Since then, seven
other cases of C. dubliniensis fungemia (six in HIV-negative
individuals) have been reported from Europe (7) and North
America (2) in patients with severe underlying medical conditions.
Because C. dubliniensis and its close relative Candida
albicans share many phenotypic characteristics in common, many
isolates of C. dubliniensis have been misidentified as
C. albicans (3, 8-10, 13-16). This situation
has been remedied to a large extent by the recent development of
methods for discriminating between the two species 1, 4, 10,
11, 13, 15; I. F. Salkin, W. R. Pruitt, A. A. Padhye, D. Sullivan, D. Coleman, and D. H. Pincus, Letter, J. Clin. Microbiol. 36:1467, 1998). Therefore, we agree with
Dr. Meis and colleagues that efforts must be made to correctly identify
germ-tube-positive yeast isolates, especially since the majority of
blood culture isolates of C. dubliniensis (seven of eight)
reported to date have been recovered from HIV-negative individuals.
| |
FOOTNOTES |
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36:2093-2095.
|
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|
Polacheck, I.,
J. Strahilevitz,
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I. F. Salkin, and D. C. Coleman.
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|
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Microbiology
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D. Coleman
Department of Oral Medicine and Pathology
School of Dental Science
University of Dublin
Trinity College
Dublin 2, Ireland
|
Journal of Clinical Microbiology, August 2000, p. 3139-3140, Vol. 38, No. 8
0095-1137/00/$04.00+0
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