318 Candida blankii: New agent in cystic fibrosis airways?

Abstract

A 14-year-old teenage boy with increase in pulmonary exacerbations and worsening in pulmonary function and nutritional status is presented. He was diagnosed with meconium ileus when he was born (F508del/2183AA→G). He had intermittent P. aeruginosa sputum isolation and chronic MRSA infection since 2010. In 2012 chronic S. maltophilia infection began while MRSA disappeared. At the end of 2012 yeast isolation appeared although it could not be identified by Vitek2 system. As the patient began to show clinical and nutritional deterioration, a BAL was performed in order to find microbiological agents. During that procedure, a yeast was isolated again and it was finally identified by using molecular methods as Candida blankii. Another strain isolated later was also identified as C. blankii. MICs of amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, anidulafungin and caspofungin were determined using EUCAST E.Def 7.2 method. Although no breakpoints are established for this species, both isolates presented low MIC values against all the drugs tested (≤0.13 mg/L). Antifungal treatment with itraconazole 200 mg/d began in August 2014. Serum concentration was monitored after 2nd week treatment, and according to the result the dose was decreased to 100 up to now. As of December 2014 the patient is improving. He gained weight (5 kg) and is feeling better, and although his FEV 1 is stable, he has no pulmonary exacerbations. We report the first case of Candida blankii infection in humans. This finding reinforces the need to identify the fungal isolates to species level in order to know the current epidemiology of yeast isolates and their antifungal susceptibility profile.