Favel Anne, Michel-Nguyen Annie, Peyron Florence, Martin Claude, Thomachot Laurent, Datry Annick, Bouchara Jean-Philippe, Challier Svetlana, Noël Thierry, Chastin Christiane, Regli Patrick
Laboratoire de Botanique, Cryptogamie et Biologie cellulaire, Faculté de Pharmacie, 13385 Marseille, France.
Diagn Microbiol Infect Dis. 2003 Sep;47(1):331-9. doi: 10.1016/s0732-8893(03)00094-4.
Candida lusitaniae is an emerging opportunistic pathogen which exhibits an unusual antifungal susceptibility pattern. We describe a case of fatal renal infection due to C. lusitaniae in a very low birth weight neonate who was treated with short courses of fluconazole given alternately with amphotericin B. A colony morphology switching was detected on the standard primary culture medium by changes in colony size. Switching was shown to affect deeply the susceptibility to amphotericin B. Afterwards, the switched phenotype developed a cross resistance to fluconazole and itraconazole. Several issues raised by this case are discussed in the light of an extensive review of the literature. Our observations point out the importance of both the detection of colony morphology switching and the close monitoring of antifungal susceptibility in the management of infections due to C. lusitaniae. A judicious therapeutic strategy should prevent the acquisition of multidrug resistance during antifungal therapy.
葡萄牙念珠菌是一种新出现的机会性病原菌，其表现出不寻常的抗真菌药敏模式。我们描述了一例极低出生体重新生儿因葡萄牙念珠菌导致的致命性肾脏感染病例，该患儿接受了短疗程氟康唑与两性霉素B交替治疗。在标准原代培养基上通过菌落大小变化检测到菌落形态转换。结果表明，这种转换对两性霉素B的敏感性有深远影响。随后，转换后的表型对氟康唑和伊曲康唑产生了交叉耐药性。结合广泛的文献综述，讨论了该病例引发的几个问题。我们的观察指出了在葡萄牙念珠菌感染管理中检测菌落形态转换和密切监测抗真菌药敏的重要性。明智的治疗策略应防止在抗真菌治疗期间获得多重耐药性。
