A Fatal Case of Candida auris and Candida tropicalis Candidemia in Neutropenic Patient

Abstract

We report a fatal case of Candida auris that was involved in mixed candidemia with Candida tropicalis, isolated from the blood of a neutropenic patient. Identification of both isolates was confirmed by amplification and sequencing of internal transcribed spacer and D1/D2 domain of large subunit in rRNA gene. Antifungal susceptibility test by E-test method revealed that C. auris was resistant to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole and voriconazole. On the other hand, C. tropicalis was sensitive to all antifungal tested. The use of chromogenic agar as isolation media is vital in detecting mixed candidemia.

Keywords: Candida auris; Mixed candidemia; Multidrug resistant.

Fig. 1

Mix growth of two yeast-like colonies produced distinguish colour on CHROMagar Candida plate after 48-h incubation

Fig. 2

Pure culture of both isolates on CHROMagar Candida. After 48-h incubation at 30 °C, UZ1446 produces very weak blue-green colour (a), while UZ1447 produces pink colour (b). Nonetheless, after prolong incubation (120 h), the colour of UZ1447 colonies became violet (c), while UZ1446 remained the same

Fig. 3

Lactophenol cotton blue staining from the 48-h-old culture on SDA exhibited ovoid and larger blastoconidia of UZ1446, later was identified as C. tropicalis (a); ellipsoidal and smaller blastoconidia of UZ1447, later was identified as C. auris (b) at magnification of ×100

Fig. 4

Slide culture on corn meal agar of UZ1446 (C. tropicalis) demonstrating abundance, long and branched pseudohyphae with single or in cluster blastoconidia on the pseudohyphae and (a) the absence of pseudohyphae for UZ1447 (C. auris) and (b) at magnification of ×40