A forty-eight-year old male diagnosed with acute lymphocytic leukemia was further complicated by Candida krusei fungemia despite introduction of fluconazole prophylaxis during antileukemic therapy. The fungemia subsided after intravenous amphotericin B therapy followed by itraconazole therapy. Multiple ulcerative lesions and a carcinoid lesion were observed in the transverse colon, and it was thought that the C. krusei had invaded from the ulcerative lesions. Azole antifungal agents, especially fluconazole, have frequently been used for therapy and the prophylaxis of fungal infections. Though infections due to fluconazole-resistant Candida species such as C. krusei are a growing problem, in the hematology division of our hospital there is no evidence of an increasing incidence of C. krusei fungemia or an increasing rate of C. krusei in surveillance culture from admitted patients. However, future increases in infections due to fluconazole-resistant Candida species like C. krusei and C. glabrata are entirely possible, making it necessary to identify isolated fungi, perform susceptibility tests on antifungal agents against isolates, measure the serum concentrations of antifungal agents, and then to treat patients with the appropriate therapies.
A strain of yeast labeled Torulopsis candida, which was isolated from a clinical specimen in Canada and reported as a new opportunistic pathogen causing intravenous catheter-associated fungemia, was found to be a strain of Candida palmioleophila in a DNA-DNA reassociation experiment.
Twenty-four serotype AD strains of Cryptococcus neoformans were tested for ploidy and mating type. These included 13 natural isolates (1 from a patient, 1 from peach juice, 11 from pigeon droppings), 2 single clones from one of these natural isolates, 7 F1 progeny from a self-fertile strain and 2 F1 progeny of a cross between a strain from a patient (serotype A, α-mating type: MATα) and a tester strain (serotype D, a-mating type: MATa). Six strains (2 of natural isolates, 1 of single clone and 3 of F1 progeny) were MATα, 1 of F1 progeny was MATa, 4 (1 of natural isolate, 1 of single clone and 2 of F1 progeny) were aα-mating type (MATaα) and 13 (10 of natural isolates and 3 of F1 progeny) were untypable. Most strains, regardless of mating type, were diploid.
Thirty-six patients with tinea unguium were treated with 200mg of itraconazole daily for 7 days each month, We suggested that a patient who had a lesion in the thumbnail needed 5 months of treatment for mycologial cure, while in a patient without thumbnail lesion, 3 months of treatment was enough.