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Clonal outbreak of Candida vulturna in a paediatric oncology ward in Maranhão, Brazil - 06/12/24

Doi : 10.1016/j.jinf.2024.106349 
Alessandra Teixeira de Macedo a, Daniel Wagner de Castro Lima Santos b, c, Bram Spruijtenburg d, e, f, Dayse Azevedo Coelho de Souza a, g, Leila Ferreira Moreira dos Santos Barbosa g, Sirlei Garcia Marques c, h, Julliana Ribeiro Alves dos Santos i, Eelco F.J. Meijer d, e, f, Theun de Groot d, f, Conceição de Maria Pedrozo e Silva de Azevedo a, g, Jacques F. Meis d, e, j,
a Universidade Federal do Maranhão (UFMA)-Programa de Pós Graduação em Ciências da Saúde, São Luís, MA, Brazil 
b Instituto D′Or de Pesquisa e Ensino (IDOR), São Luís, MA, Brazil 
c Hospital Universitário, Universidade Federal do Maranhão, São Luís, MA, Brazil 
d Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands 
e Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands 
f Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital/Dicoon, Nijmegen, the Netherlands 
g Hospital de Cancer Aldenora Bello (HCAB), São Luís, MA, Brazil 
h Laboratório Cedro, São Luís, MA, Brazil 
i Instituto de Ciências Biológicas, Universidade de Pernambuco, Recife, PE, Brazil 
j Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany 

Corresponding author at: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.Department of Medical Microbiology, Radboud University Medical CenterNijmegenthe Netherlands

Summary

Objective

To describe an outbreak due to Candida vulturna, a newly emerging Candida species belonging to the Candida haemulonii species complex in the Metschnikowiaceae family.

Methods

In this retrospective cohort study we genotyped 14 C. vulturna bloodstream isolates, occurring in a 4-month-period in paediatric cancer patients in a Brazilian hospital. To prove an outbreak, ITS sequence analysis and whole genome sequencing (WGS) was done. Antifungal susceptibility was performed with the reference CLSI method and the commercial Sensititre YeastOne (SYO) YO10 plates. A control C. vulturna isolate from another region in Brazil was included in all analyses.

Results

MALDI-TOF-MS identified isolates as C. pseudohaemulonii and C. duobushaemulonii albeit with low scores and therefore molecular methods were required for accurate identification. ITS sequence analyses clearly differentiated C. vulturna from other species in the C. haemulonii species complex. WGS proved the presence of a clonal outbreak with C. vulturna involving 14 paediatric patients. Antifungal susceptibility testing (AFST) with two methods showed the isolates had low MICs of commonly available antifungals.

Conclusion

This study describes an outbreak due to the rare yeast C. vulturna, related to C. auris, during a four-month period in patients admitted to a paediatric oncology ward in a Brazilian hospital. In contrast to previous studies the yeast was susceptible to all antifungals and patient outcome was good.

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Highlights

This study aimed to diagnose and evaluate an outbreak of Candida vulturna fungaemia.
MALDI-TOF was not able to correctly identify C. vulturna, a close relative of Candida auris.
The isolates involved in this outbreak of 14 patients had low amphotericin B and azoles MICs.
Internal transcribed spacer (ITS) region sequencing was necessary to identify C. vulturna.
Whole genome sequencing of a subset proved a clonal outbreak of C. vulturna.

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Keywords : Fungal outbreak, Genotyping, Rare yeast, Candida vulturna, Candida haemulonii species complex, Whole genome sequencing, Antifungal susceptibility


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Vol 89 - N° 6

Article 106349- décembre 2024 Retour au numéro
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