A Case of Invasive Candidiasis Caused by Candida norvegensis in a Liver Transplant Patient
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Candida norvegensis is an emerging fluconazole-resistant species that can cause invasive candidiasis in immunocompromised patients, including organ transplant recipients. A 58-year-old man who had previously undergone a liver transplant was admitted due to recurrent liver and biliary abscesses. He was administered multiple broad-spectrum antibiotics for three weeks. Yeast-like fungi were then isolated from percutaneous drainage (PCD) and percutaneous transhepatic biliary drainage (PTBD) samples. Using VITEK 2 (bioMérieux, USA), the isolate was identified as C. norvegensis (99% probability). The identification was confirmed using a MALDI Biotyper (Bruker Daltonics, Germany; Pichia norvegensis, score value 2.283) and sequence analysis of the internal transcribed spacer region of rDNA and translation elongation factor 1-alpha gene (100% identity). The patient was discharged without antifungal treatment because there was no clear evidence of infection; however, he was readmitted nine days later for sepsis. Enterobacter cloacae and C. norvegensis were detected in PCD and PTBD specimens. The patient was started on anidulafungin as an antifungal and underwent a second liver transplant. He remained in good condition without signs of candidiasis for one year after the surgery. This is the first case of invasive candidiasis caused by C. norvegensis in Korea.
Abstract
Candida norvegensis is an emerging fluconazole-resistant species that can cause invasive candidiasis in immunocompromised patients, including organ transplant recipients. A 58-year-old man who had previously undergone a liver transplant was admitted due to recurrent liver and biliary abscesses. He was administered multiple broad-spectrum antibiotics for three weeks. Yeast-like fungi were then isolated from percutaneous drainage (PCD) and percutaneous transhepatic biliary drainage (PTBD) samples. Using VITEK 2 (bioMérieux, USA), the isolate was identified as C. norvegensis (99% probability). The identification was confirmed using a MALDI Biotyper (Bruker Daltonics, Germany; Pichia norvegensis, score value 2.283) and sequence analysis of the internal transcribed spacer region of rDNA and translation elongation factor 1-alpha gene (100% identity). The patient was discharged without antifungal treatment because there was no clear evidence of infection; however, he was readmitted nine days later for sepsis. Enterobacter cloacae and C. norvegensis were detected in PCD and PTBD specimens. The patient was started on anidulafungin as an antifungal and underwent a second liver transplant. He remained in good condition without signs of candidiasis for one year after the surgery. This is the first case of invasive candidiasis caused by C. norvegensis in Korea.
참고문헌 (17)
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