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Fungal opportunistic infections, and in particular those caused by the variousCandida species, have gained considerable significance as a cause of morbidity and, often, mortality. The newly described speciesCandida dubliniensis phenotypically resemblesCandida albicans so closely that it is easily misidentified as such. The present study was designed to determine the frequency at which this new species is not recognized in the clinical laboratory, to determine the patient populations with whichC. dubliniensis is associated, to determine colonization versus infection frequency, and to assess fluconazole resistance. Over a 2-year period, 1,251 isolates that were initially identified asC. albicans by a hospital clinical laboratory were reevaluated forC. dubliniensis by inability to grow at 45°C, colony color on CHROMagar Candida medium, coaggregation assay withFusobacterium nucleatum , and sugar assimilation profiles (API 20C AUX yeast identification system). A total of 15 (1.2%) isolates from 12 patients were identified asC. dubliniensis . Ten of the patients were found to be immunocompromised (these included patients with human immunodeficiency virus infection or AIDS, cancer patients receiving chemotherapy, and patients awaiting transplantation). Thirteen isolates were highly susceptible to fluconazole (MIC, &lt;0.5 μg/ml). Three isolates from one patient, genotypically confirmed as the same strain, showed variable susceptibility to fluconazole. The first isolate was susceptible, whereas the other two isolates were dose-dependent susceptible (MIC, 16.0 μg/ml). These data confirm the close association ofC. dubliniensis with immunocompromised states and that increased fluconazole MICs may develop in vivo. This study emphasizes the importance of screening germ-tube-positive yeasts for the inability to grow at 45°C followed by confirmatory tests in order to properly identify this species.

journal of clinical microbiology

Retrospective Identification and Characterization of <i>Candida dubliniensis</i> Isolates among <i>Candida albicans</i> Clinical Laboratory Isolates from Human Immunodeficiency Virus (HIV)-Infected and Non-HIV-Infected Individuals

Retrospective Identification and Characterization of Candida dubliniensis Isolates among Candida albicans Clinical Laboratory Isolates from Human Immunodeficiency Virus (HIV)-Infected and Non-HIV-Infected Individuals