Clinical Specimens. over a 1.5-year period. The same yeast also was. isolated from the skin of the foot, but no evidence

Transcription

1 JOURNAL OF CLINICAL MICROBIOLOGY, Nov. 1983, p /83/ $2./ Copyright 1983, American Society for Microbiology Vol. 18, No. 5 Candida ciferrii and Candida chiropterorum Isolated from Clinical Specimens RITA M. FURMANI* AND DONALD G. AHEARN2 Division of Mycotic Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 3333,1 and Laboratory for Microbial and Biochemical Sciences, Georgia State University, Atlanta, Georgia 3332 Received 17 June 1983/Accepted 15 August 1983 Ten clinical yeast isolates submitted to the Centers for Disease Control from diverse geographic areas were identified as Candida ciferrii and Candida chiropterorum. The association of C. ciferrii with clinical specimens, particularly its repeated isolation from a case of onychomycosis, suggests that this species may be an etiological agent of superficial yeast infections. In recent years, the incidence of yeast infections in humans has increased dramatically, accompanied by a lesser increase in the number of species implicated as etiological agents. These increases are related to two factors: (i) predisposition of immunocompromised hosts to colonization and infection by yeasts and (ii) improved diagnostic procedures. In , among the clinical isolates of yeasts submitted to the Division of Mycotic Diseases, Center for Infectious Diseases, Centers for Disease Control (CDC), Atlanta, Ga., there were 1 isolates of special interest. One of the 1 isolates was Candida chiropterorum Grose et Marinkelle 1968 (2), and the remaining 9 were Candida ciferrii Kregervan Rij 1965, the anamorph of Stephanoascus ciferrii Smith, van der Walt et Johannsen (5). A definite association of these two species with humans has not been established previously; therefore, we considered it worthwhile to report our findings. Case reports. (i) Case 1. On 19 May 1982, a 25- year-old man was examined at a Kansas ambulatory care center. The patient complained of headaches, pressure in the ears, and esophageal pains. A white, powdery material was observed in the patient's ear canals. Culture of this material on two occasions during the patient's hospitalization for appendicitis yielded profuse growth of a budding fungus. On the basis of this finding, the attending physician made a diagnosis of otomycosis. The ear canals were irrigated for 1 day with a 1% hydrocortisone-2.% acetic acid solution. One week later, the powdery material was no longer present. The yeast was sent to the Centers for Disease Control, where it was identified as C. ciferrii. (ii) Case 2. The distorted and discolored toenail of an elderly woman from Honolulu, Hawaii, was cultured for fungi on five occasions over a 1.5-year period. The same yeast also was isolated from the skin of the foot, but no evidence of skin infection was provided to us. All five cultures of the toenail yielded white, powdery yeastlike colonies on dermatophyte test agar (6). The yeast was identified as C. ciferrii. (iii) Cases 3, 4, and 5. Yeast isolates from the ear of a young man and from the gangrenous foot of a 68-year-old female (neither patient with evidence of infections) were identified as C.., IC FIG. 1. Lateral blastoconidia of C. ciferrii formed on denticles (light microscopy, x2,12). Downloaded from on January 13, 219 by guest 1252

2 VOL. 18, 1983 NOTES 1253,~~~~~~~ FIG. 2. Ascus of S. ciferrii containing two helmet- to hat-shaped ascospores (phase-contrast microscopy, x2,12). ciferrii. In case 5, a yeast identified as C. ciferrii was isolated from a case of tinea pedis. No other etiological agent was cultured. (iv) Case 6. A yeast identified as C. chiropterorum was isolated from the peritoneal dialysis fluid of a patient in Honolulu, Hawaii. The patient exhibited no overt evidence of yeast infection. Evaluation. The isolates were subcultured on Sabouraud dextrose agar and tryptic soy agar 4IML with 5.% sheep blood to screen for purity. The cultures were then identified according to standard procedures (1, 4). The sugars tested for fermentation were galactose, glucose, lactose, maltose, and sucrose. The compounds tested for assimilation were cellobiose, erythritol, galactose, glucose, inositol, lactose, maltose, melibiose, raffinose, rhamnose, sucrose, trehalose, xylose, and potassium nitrate. The isolates of C. ciferrii and C. chiropter- TABLE 1. Sources of all known isolates of C. chiropterorum and C. ciferrii Species Culture Mating number' type Source 1. C. chiropterorum ATCC 22291b? Liver of bat, Colombia 2. C. chiropterorum WO 633? Peritoneal dialysis fluid, Hawaii 3. C. ciferrii CBS 4856 a Neck of a cow, The Netherlands 4. C. ciferrii CBS 5165 a Wood pole from cow shed, The Netherlands 5. C. ciferrii CBS 5166 a Presumed human origin, Federal Republic of Germany 6. C. ciferrii CBS 5295b a Throat of pig, England 7. C. ciferrii CBS 5646 a Bovine placenta, England 8. C. ciferrii CBS 6699b a Uncultivated soil, South Africa 9. C. ciferrii WO 56 a Gangrenous human foot, Georgia 1 C. ciferrii WO 356 a Human ear, Oregon 11. C. ciferrii WO 638 a Human ear, Kansas 12. C. ciferrii WO 367 a Human toenail, Hawaii 13. C. ciferrii WO 736 a Human toe web, Florida a ATCC, American Type Culture Collection; CBS, Centraalbureau voor Schimmelcultures; WO, Centers for Disease Control. bisotype. s

3 ~~~~~ 1254 NOTES J. CLIN. MICROBIOL. c) = CZ' tvo v O i + C.) ±I + +±±+> X1 +._., C+ I C. Ct E -c EE 4:3 3 + ± :_ O a) c to, E 3E St M 3 Q i ++ II: +I _ I I ++ +I D,C-I-++±++++± I O C -Z to E 6 o U Ox. +, o ;> c c V)IzI + I> > + E _ Q.) -o C1 t H ll+ J + + -~~~~~~Z-.f >~ S-e c, *4 -. = -_ C. < tqx<<._ <s C. X -U.S.UZ O) *s D er < -z *o o

4 VOL. 18, 1983 orum were similar in their gross and microscopic morphologies. The colonies at 1 week were pale cream and finely sculptured with a powdery surface. Abundant pseudo-to-true mycelium was produced on Sabouraud and cornmeal agars (Fig. 1). Blastoconidia were borne laterally on small denticles. The hyphal branches often terminated in bulbous apical cells. In pairing our five clinical isolates of C. ciferrii from different patients with the a and a isotypes of S. ciferrii on V-8 juice agar, numerous asci, mostly with two thickened helmet- to hat-shaped ascospores, were produced in 5 to 1 days (Fig. 2). Three of them, 1, 11, and 12 (see Table 1), proved to be of the a mating type, and two, 5 and 13, were of the a mating type. Mating studies carried out with the other known isolates of the species demonstrated that four of these (no. 3 to 6) were of the a mating type, and two (no. 7 and 8) were of the a mating type (Table 1). Ascosporulation was not induced in the two isolates of C. chiropterorum when they were mated with each other or with the mating types of S. ciferrii. The salient physiological and morphological properties of C. chiropterorum and C. ciferrii are compared with those of phenotypically similar yeasts in Table 2. All of these species assimilate inositol as a sole source of carbon and presumably are ascomycetous because they do not give a color reaction with diazonium blue B (3). In contrast to C. chiropterorum, C. ciferrii assimilates melibiose. The guanine plus cytosine content of the DNA of both species is about 48%, but DNA hybridization studies are not yet available (S. A. Meyer, personal communication). With the exception of Candida inositophila, which we obtained from a clinical specimen on a single occasion, the remaining species have not been associated with humans. Grose NOTES 1255 and Marinkelle (2) reported that C. chiropterorum produced distinctive blastoconidia directly from the hyphae as well as chlamydospores and large refractory bodies. These latter structures may be nonfertile asci. We found the size and shape of the blastoconidia to overlap among all of our isolates. Furthermore, the type strains of both species and all other isolates classified with these species in Table 1 produced chlamydospore-like cells and blastoconidia on denticles. This mode of blastosporulation has not been observed for the other species listed in Table 2. We have insufficient evidence to establish C. chiropterorum and C. ciferrii as pathogenic yeasts. However, clinical laboratories should be alerted to their diagnostic properties, since they have now been shown to occur in human clinical materials. We thank Libero Ajello for help in reviewing the manuscript. LITERATURE CITED 1. Ahearn, D. G., and R. SchlHtzer Yeast infections, p In A. Balows (ed.), Diagnostic procedures in bacterial, mycotic and parasitic infections, 6th ed. American Public Health Association, Washington, D.C. 2. Grose, E. S., and C. J. Marinkelle A new species of Candida from Colombian bats. Mycopathol. Mycol. AppI. 36: Hagler, A. N., and D. G. Ahearn Rapid diazonium blue B test to detect basidiomycetous yeasts. Int. J. Syst. Bacteriol. 31: Silva-Hutner, M., and B. H. Cooper. 198 Yeasts of medical importance, p In E. H. Lennette, A. Balows, W. J. Hausler, Jr., and J. P. Truant (ed.), Manual of clinical microbiology, 3rd ed. American Society for Microbiology, Washington, D.C. 5. Smith, M. T., J. P. van der Walt, and E. Johannsen The genus Stephanoascus gen. nov. (Ascoideaceae). Antonie van Leeuwenhoek J. Microbiol. Serol. 42: Taplin, D., N. Zaias, G. Rebell, and H. Blank Isolation and recognition of dermatophytes on a new medium (DTM). Arch. Dermatol. 99:23-29.

5 ERRATA Candida ciferrii and Candida chiropterorum Isolated from Clinical Specimens RITA M. FURMAN AND DONALD G. AHEARN Division of Mycotic Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 3333, and Laboratory for Microbial and Biochemical Sciences, Georgia State University, Atlanta, Georgia 333 Vol. 18, no. 5, p : Figures 1 and 2 are reversed. They should appear as shown below. t *.A:1 -Ir t k FIG. 1. Lateral blastoconidia of C. ciferrii formed on denticles (light microscopy, x2,12). 1fer G,lt e.::.., qqw b > f.: et AM' s `5 FIG. 2. Ascus of C. ciferrii containing two helmet- to hat-shaped ascospores (phase-contrast microscopy, x2,12). 33