Candida Dubliniensis

Candida dubliniensis is one of the newest species of candida to be ‘found’ and was originally isolated from AIDS patients, though it can sometimes affect those who are immunnocompetent. It is very similar to candida albicans but has some slight differences. It is most often found in the mouth though it can be found elsewhere sometimes. Up to 1995 it had been believed to be candida albicans but is now recognized as a separate species because of those slight differences that will be look at further in this article.

Comparing Candida dubliniensis with candida albicans
When a lab culture is done at a temperature of 42 degrees Celsius one of the first differences is noticeable. At that temperature, most strains of candida Albicans would have started to grow, but candida dubliniensis does not. Though phenotypically they are similar the two species also differ in what conditions cause the formation of chlamydospores. When looking at 2,589 isolates of what had believed to have been candida albicans, it was found by a European study that 2%, 52 of them were actually candida dubliniensis. In a US study, 1,251 yeasts thought to be candida albicans were re-examined and 1.2%, 15 were candida dubliniensis. Most strains were from the mouths of AIDS patients, though a small few were from other immunocompromised patients, or diabetic patients.

Candida dubliniensis and anti-fungal treatment
Candida dubliniensis seems to be susceptible to amphotericin B, itraconazole and ketoconazole but some isolates seem to have a resistance to fluconazole. It is believed that candida dubliniensis can very quickly become resistant to fluconazole particularly in patients who are in long term care in hospital. Its potential harm is not fully known because of its being mistaken for candida albicans in the past.

Candida dubliniensis case reports
Here are 4 cases of Candida dubliniensis, from patients in the United States.

  1. This patient was a 74 year old black male with a history of chronic lymphocytic leukaemia, chronic obstructive pulmonary disease, coronary artery disease and hypertension. He was admitted into hospital for anemia and fatigue and received multiple blood transfusions. After multiple organ failure he was moved to intensive care where had had several catheters inserted. Three days later a blood culture was taken and Candida dubliniensis was found. The patient died one day later.
  2. A black woman, 30 years old with a history of end-stage liver disease admitted for refactory ascites and gastrointestinal bleeding. Though the patient did have a history of drug abuse and alcoholism she was not HIV positive. As well as multiple transfusions the patient received many drugs and a triple lumen catheter. On days 11, 15 and 17 blood cultures were formed. Four revealed candida dubliniensis. She was administered fluconazole and though the blood culture taken 20 days later showed negative the patient died after being in hospital for 24 days.
  3. A 39 year old black man with end-stage liver disease, including acute renal failure and ascites, and diffuse lymphadenopathy of unknown etiology. A peripheral intravenous catheter and central venous catheter were placed and on day 2 a blood culture was done. When the results came in it was candida dubliniensis but the patient had worsened by then with respiratory distress. Treatment of fluconazole was given for 3 days but 5 days after the blood culture had been obtained he died.
  4. A 37 year old white woman with a history of chronic deep vain thrombosis, intravenous drug use, valvular heart disease and HIV positive. Admitted for fever and chills and treated with antibiotics. Blood cultures on day 7 revealed candida glabrata and candida dubliniensis. Treatment was oral fluconazole for two weeks and she was sent to a skilled nursing facility.

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