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J Med Microbiol 55 (2006), 423-428; DOI: 10.1099/jmm.0.46045-0
© 2006 Society for General Microbiology
ISSN 0022-2615

Recurrent candidaemia in a neonate with Hirschsprung's disease: fluconazole resistance and genetic relatedness of eight Candida tropicalis isolates

Pei Pei Chong1, David Ching-Soo Chieng1, Lee Yean Low1, Asma Hafeez2, Mariana Nor Shamsudin3, Heng Fong Seow3 and Kee Peng Ng2

1 ,3 Department of Biomedical Sciences1 and Department of Clinical Laboratory Sciences3 , Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Selangor, Malaysia

2 Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia

Correspondence
Pei Pei Chong
cpp{at}medic.upm.edu.my

Received 15 February 2005
Accepted 30 November 2005

The incidence of candidaemia among immunocompromised patients in Malaysia is increasing at an alarming rate. Isolation of clinical strains that are resistant to fluconazole has also risen markedly. We report here the repeated isolation of Candida tropicalis from the blood of a neonatal patient with Hirschsprung's disease. In vitro fluconazole susceptibility tests of the eight isolates obtained at different time points showed that seven of the isolates were resistant and one isolate was scored as susceptible dose-dependent. Random amplification of polymorphic DNA fingerprinting of the isolates using three primers and subsequent phylogenetic analysis revealed that these isolates were highly similar strains having minor genetic divergence, with a mean pairwise similarity coefficient of 0·893±0·041. The source of the infectious agent was thought to be the central venous catheter, as culture of its tip produced fluconazole-resistant C. tropicalis. This study demonstrates the utility of applying molecular epidemiology techniques to complement traditional mycological culture and drug susceptibility tests for accurate and appropriate management of recurrent candidaemia and highlights the need for newer antifungals that can combat the emergence of fluconazole-resistant C. tropicalis strains.

Abbreviations: CVL, central venous line; ERIC, enterobacterial repetitive intergenic consensus primers; RAPD, random amplification of polymorphic DNA.

Scoring of polymorphic bands from RAPD-PCR analysis and a distance matrix resulting from the RAPD-PCR results are available as supplementary material in JMM Online.






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