López-Soria Leyre M, Bereciartua Elena, Santamaría Marta, Soria Luis Miguel, Hernández-Almaraz José Luis, Mularoni Alessandra, Nieto Javier, Montejo Miguel
Servicio de Microbiología, Hospital Universitario Cruces, Barakaldo, Bizkaia, España.
Rev Iberoam Micol. 2013 Jan 3;30(1):69-71. doi: 10.1016/j.riam.2012.09.001. Epub 2012 Sep 14.
In recent years the incidence of candidemia caused by non-albicans Candida species has been increasing. Two cryptic species have been described within the Candida glabrata complex, Candida nivariensis and Candida bracarensis, which may be troublesome in laboratory identification and have lower susceptibility to fluconazole.
To describe the first isolation of C. nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia.
An 81-year-old man was hospitalized for surgical treatment of an intestinal fistula that was associated to a severe malnutrition. Cultures of the patient's central venous catheter tip and blood yielded white colonies in BD CHROMagar Candida(®) medium, which could not be identified by conventional microbiological methods. Although intravenous fluconazole was administered, blood cultures continued being positive 5 days later. The MIC values of the isolate were as follows: 1 μg/ml for amphotericin B, 0.015 μg/ml for anidulafungin, 0.125 μg/ml for caspofungin, 0.015 μg/ml for micafungin, 4 μg/ml for fluconazole, 0.25 μg/ml for itraconazole, 0.25 μg/ml for posaconazole, and 0.03 μg/ml for voriconazole. Antifungal treatment was changed to intravenous caspofungin for 2 weeks. The intestinal fistula was surgically treated. There was no evidence of relapse during the following month, and the patient was discharged. The isolate was identified as C. nivariensis based on DNA sequencing of the ITS regions of rRNA.
C. nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin.
近年来，非白色念珠菌引起的念珠菌血症发病率一直在上升。光滑念珠菌复合体中已描述了两个隐匿种，即 nivariensis 念珠菌和布拉卡念珠菌，它们在实验室鉴定中可能会造成麻烦，并且对氟康唑的敏感性较低。
描述在伊比利亚半岛首次从一名患有导管相关真菌血症的患者中分离出 nivariensis 念珠菌。
一名81岁男性因与严重营养不良相关的肠瘘接受手术治疗而住院。患者中心静脉导管尖端和血液在 BD CHROMagar Candida（®）培养基中培养出白色菌落，用传统微生物学方法无法鉴定。尽管给予了静脉注射氟康唑，但 5 天后血培养仍为阳性。分离株的 MIC 值如下：两性霉素 B 为 1 μg/ml，阿尼芬净为 0.015 μg/ml，卡泊芬净为 0.125 μg/ml，米卡芬净为 0.015 μg/ml，氟康唑为 4 μg/ml，伊曲康唑为 0.25 μg/ml，泊沙康唑为 0.25 μg/ml，伏立康唑为 0.03 μg/ml。抗真菌治疗改为静脉注射卡泊芬净 2 周。对肠瘘进行了手术治疗。在接下来的一个月内没有复发迹象，患者出院。根据 rRNA 的 ITS 区域的 DNA 测序，分离株被鉴定为 nivariensis 念珠菌。
nivariensis 念珠菌应被视为一种新兴病原体，需要采用分子方法进行明确鉴定。我们的患者用卡泊芬净成功治愈。
