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      A case of Candida orthopsilosis associated septic arthritis in a patient with Systemic Lupus Erythematosus (SLE)

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          Abstract

          We report a case of persistent Candida orthopsilosis associated septic arthritis. Repeated isolation of C. orthopsilosis from tissue and joint fluid was confirmed by identification of the ITS region of the rRNA gene using a Candida-Specific Luminex based assay and gene sequencing of the D1/D2 regions. This was the first case of C. orthopsilosis associated septic arthritis reported in Jamaica and in the literature.

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          Candida orthopsilosis and Candida metapsilosis spp. nov. to replace Candida parapsilosis groups II and III.

          Arianna Tavanti, Amanda D. Davidson, Neil Gow … (2005)
          Two new species, Candida orthopsilosis and C. metapsilosis, are proposed to replace the existing designations of C. parapsilosis groups II and III, respectively. The species C. parapsilosis is retained for group I isolates. Attempts to construct a multilocus sequence typing scheme to differentiate individual strains of C. parapsilosis instead revealed fixed DNA sequence differences between pairs of subgroups in four genes: COX3, L1A1, SADH, and SYA1. PCR amplicons for sequencing were obtained for these four plus a further seven genes from 21 group I isolates. For nine group II isolates, PCR products were obtained from only 5 of the 11 genes, and for two group III isolates PCR products were obtained from a different set of 5 genes. Three of the PCR products from group II and III isolates differed in size from the group I products. Cluster analysis of sequence polymorphisms from COX3, SADH, and SYA1, which were common to the three groups, consistently separated the isolates into three distinct sets. All of these differences, together with DNA sequence similarities <90% in the ITS1 sequence, suggest the subgroups should be afforded species status. The near absence of DNA sequence variability among isolates of C. parapsilosis and relatively high levels of sequence variability among isolates of C. orthopsilosis suggest that the former species may have evolved very recently from the latter.
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            Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia.

            Mario Tumbarello, Brunella Posteraro, Enrico Trecarichi … (2007)
            Nosocomial Candida bloodstream infections rank among infections with highest mortality rates. A retrospective cohort analysis was conducted at Catholic University Hospital to estimate the risk factors for mortality of patients with candidemia. We reviewed records for patients with a Candida bloodstream infection over a 5-year period (January 2000 through December 2004). Two hundred ninety-four patients (42.1% male; mean age +/- standard deviation, 65 +/- 12 years) were studied. Patients most commonly were admitted with a surgical diagnosis (162 patients [55.1%]), had a central venous catheter (213 [72.4%]), cancer (118 [40.1%]), or diabetes (58 [19.7%]). One hundred fifty-four (52.3%) patients died within 30 days. Of 294 patients, 168 (57.1%) were infected by Candida albicans, 64 (21.7%) by Candida parapsilosis, 28 (9.5%) by Candida tropicalis, and 26 (8.8%) by Candida glabrata. When fungal isolates were tested for biofilm formation capacity, biofilm production was most commonly observed for isolates of C. tropicalis (20 of 28 patients [71.4%]), followed by C. glabrata (6 of 26 [23.1%]), C. albicans (38 of 168 [22.6%]), and C. parapsilosis (14 of 64 [21.8%]). Multivariable analysis identified inadequate antifungal therapy (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.09 to 5.10; P = 0.03), infection with overall biofilm-forming Candida species (OR, 2.33; 95% CI, 1.26 to 4.30; P = 0.007), and Acute Physiology and Chronic Health Evaluation III scores (OR, 1.03; 95% CI, 1.01 to 1.15; P < 0.001) as independent predictors of mortality. Notably, if mortality was analyzed according to the different biofilm-forming Candida species studied, only infections caused by C. albicans (P < 0.001) and C. parapsilosis (P = 0.003) correlated with increased mortality. Together with well-established factors, Candida biofilm production was therefore shown to be associated with greater mortality of patients with candidemia, probably by preventing complete organism eradication from the blood.
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              Biofilm production and evaluation of antifungal susceptibility amongst clinical Candida spp. isolates, including strains of the Candida parapsilosis complex.

              B A Arthington, Paulo Bizerra, L. Colombo … (2011)
              Candida cells can form biofilms that frequently are sources of infections and are less susceptible to antifungal drugs. Some authors have reported that Candida orthopsilosis and Candida metapsilosis isolates are not able to produce biofilms in vitro and there are no studies available on biofilm susceptibility for these species to antifungals. The aims of this study were to (i) quantify Candida spp. biofilms in vitro, and (ii) test the in vitro susceptibilities of Candida spp. biofilms to fluconazole (FLC) and amphotericin B (AMB). Isolates studied included four Candida albicans, six C. tropicalis, seven C. parapsilosis, eight C. orthopsilosis, and five C. metapsilosis. We compared two different methods to evaluate biofilm production, i.e., crystal violet (CV) staining and XTT-reduction assays (XTT). Scanning electron microscopy (SEM) was used to observe high, medium and low biofilm producing isolates screened by these two methods. To determine the minimum biofilm eradication concentration (MBEC) for FLC and AMB, XTT-reduction assay was used to measure cell metabolic activity. Biofilm quantification by CV and XTT showed that C. tropicalis isolates were the highest biofilm producer, followed by C. albicans, C. parapsilosis, C. orthopsilosis and C. metapsilosis. Examination of SEM images revealed that the extent of biofilms formed by high, medium, and low producers was highly correlated to the results generated by CV assay. Biofilm of all the isolates evaluated were resistant to FLC (MBEC(80) ≥ 256 ug/ml) but, in general, susceptible to AMB, except for six C. parapsilosis strains (MBEC(80) ≥ 8 ug/ml).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Mycol Case Rep
                Journal ID (iso-abbrev): Med Mycol Case Rep
                Title: Medical Mycology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2211-7539
                Publication date PMC-release: 12 November 2014
                Publication date Collection: March 2015
                Publication date (Electronic): 12 November 2014
                Volume: 7
                Pages: 1-3
                Affiliations
                [a ]Depatrtment of Microbiology, University of the West Indies, Mona, Kingston7, Jamaica
                [b ]University Hospital of the West Indies, Mona, Kingston 7, Jamaica
                Author notes
                [* ]Corresponding author.
                Article
                Publisher ID: S2211-7539(14)00050-5
                DOI: 10.1016/j.mmcr.2014.11.001
                PMC ID: 4909869
                PubMed ID: 27330938
                SO-VID: ed5d8a43-8d4a-4285-a7d7-1c4495af21cf
                Copyright © © 2014 Published by Elsevier B.V. on behalf of International Society for Human and Animal Mycology.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                Date received : 12 August 2014
                Date revision received : 29 October 2014
                Date accepted : 3 November 2014
                Categories
                Subject: Case Report

                Keywords: candida orthopsilosis,septic arthritis,persistent infection,fluconazole,biofilm formation
                Data availability:
                Keywords: candida orthopsilosis, septic arthritis, persistent infection, fluconazole, biofilm formation

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