First case report of catheter-related fungemia by Candida nivariensis in the Iberian Peninsula

Background: 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. Aims: To describe the first isolation of C nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia. Case report: 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 (R) 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 mu g/ml for amphotericin B, 0.015 mu g/ml for anidulafungin, 0.125 mu g/ml for caspofungin, 0.015 mu g/ml for micafungin, 4 mu g/ml for fluconazole, 0.25 mu g/ml for itraconazole, 0.25 mu g/ml for posaconazole, and 0.03 mu g/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. Conclusions: C nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin. (C) 2012 Revista lberoamericana de Micologia. Published by Elsevier Espana, S.L. All rights reserved.