Candida guilliermondii fungemia in patients with hematologic malignancies

Abstract

The microbiological, clinical, and epidemiological features of most non-Candida albicans Candida species are well known, but much less is known about species such as Candida guilliermondii, an uncommon pathogen causing a variety of deep-seated infections in immunocompromised hosts. To characterize C. guilliermondii fungemia in patients with hematological malignancies and its susceptibility to antifungal drugs, all cases of C. guilliermondii fungemia diagnosed in our department between 1983 and 2005 were retrospectively analyzed and the literature was reviewed. C. guilliermondii caused 29/243 (11.7%) candidemia episodes diagnosed during the study period. Central venous catheters were the documented sources of candidemia in 19/29 episodes (65.5%), and invasive tissue infections were documented in 2 (6.9%). In the remaining eight, the catheter was not removed and the source of the fungemia remained obscure. Seven episodes ended in death, but only one could be attributed to invasive C. guilliermondii infection. Molecular typing data reveal no evidence of common infection sources. Isolates displayed high rates of in vitro susceptibility to amphotericin B (100%), voriconazole (95%), and fluconazole (90%) and lower rates of in vitro susceptibility to flucytosine (86%), itraconazole (76%), and caspofungin (33%). Our literature review confirms that C. guilliermondii is a significantly more frequent cause of candidemia among cancer patients compared with the general hospital population. It accounted for <1% of the total number of Candida bloodstream isolates reported in the articles we reviewed, with higher rates in Europe (1.4%) and Asia (1.8%) compared with North America (0.3%).

FIG. 1.

Prevalence of Candida species causing fungemia in patients with hematologic malignancies in three different periods at the Dipartimento di Biotecnologie Cellulari ed Ematologia of the University La Sapienza of Rome.

FIG. 2.

Representative DNA types (I to IV) of four C. guilliermondii isolates obtained by RAPD with primers RSD12 and OPE03. All amplifications were repeated twice, and the most intense bands in the patterns were reproducible. For comparative analyses, only high-intensity bands (lanes II and III for RSD12 and lanes I and II for OPE03) were considered. The combined results obtained with the two individual primers revealed four different DNA types (I to IV).