Evaluación del medio cromógeno CHROMagar CandidaTM para la identificación de levaduras de interés médico

Raquel Ballesté; Zaida Arteta; Nora Fernández; Cristina Mier; Nélida Mousqués; Beatriz Xavier; María José Cabrera; Guillermo Acosta; Ana Combol; Elbio Gezuele

Authors

Raquel Ballesté Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Prof. Adj. Departamento de Laboratorio Clínico, Prof. Adj. Médico Parasitólogo. Especialista en Laboratorio de Patología Clínica
Zaida Arteta Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Asistente. Especialista en Medicina Interna
Nora Fernández Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Laboratorio Clínico, Asistente. Médico Parasitólogo
Cristina Mier Especialista en Laboratorio Clínico
Nélida Mousqués Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Ex Ayudante
Beatriz Xavier Médico Parasitólogo
María José Cabrera Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Ayudante
Guillermo Acosta Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Ayudante
Ana Combol Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Licenciada en Laboratorio Clínico
Elbio Gezuele Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Parasitología y Micología, Prof. Agregado. Médico Parasitólogo

Keywords:

YEASTS, CANDIDA

Abstract

The incidence of micosis especially systemic candidiasis has increased in the last years. The most frequent species is Candida albicans; that has been replaced (35%) by other "no albicans" species.
Cryptococcosis is the second most frequent systemic micosis.
The specific identification of these yeasts is a crucial step to determine an appropriate treatment. Chromogenic medium allows easily and rapidly selective identification of yeasts by differential localization of colony pigmentation; CHROMagar Candida is one of the most widespread in our country.
The objectives of the study were to determine the diagnostic value of CHROMagar Candida (sensitivity, specificity and predictive value) compared to conventional culture methods and their reliability.
We studied 127 strains of Candida spp., 23 Cryptococcus neoformans, 8 Rhodotorula spp. and 6 Trichosporon spp. EPIDAT program was used for statistical analysis.
Results showed good rates in identificating C. albicans. For "no albicans" species, this medium definitively lost diagnostic specificity, particularly in C. krusei false positive testing.
Chromogenic medium is reliable to identificate C. albicans, but complementary tests and morphologic studies are needed to selective identification of "non albicans" Candida and other strains considering their therapeutic implications.

References

1) Anaissie E, Bodey GP. Nosocomial fungal infections. Old problems and new challenges. Infect Dis Clin North Am 1989; 3(4): 867-82.
2) Anaissie EJ, Bodey GP, Rinaldi MG. Emerging fungal pathogens. Eur J Clin Microbiol Infect Dis 1989; 8(4): 323-30.
3) Diekema DJ, Messer SA, Brueggemann AB, Coffman SL, Doern GV, Herwaldt LA, et al. Epidemiology of candidemia: 3-year results from the emerging Infections and epidemiology of Iowa organisms study. J Clin Microbiol 2002; 40(4): 1298-302.
4) Trik W, Harvis W. Epidemiology of nosocomial fungal infections in the 1990s. Rev Iberoam Micol 1998; 15: 2-6.
5) Beck-Sague C, Jarwis WR. Secuelar trends in the epidemiology of nosocomial infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System. J Infect Dis 1993; 167(5): 1247-51.
6) Espinel-Ingroff A, Shadomy S. In vitro and in vivo evaluation of antifungal agents. Eur J Clin Microbiol Infect Dis 1989; 8(4): 352-61.
7) Perea S, Patterson T. Antifungal resistance in pathogenic fungi. Clin Infect Dis 2002; 35(9): 1073-80.
8) Mitchell TG, Perfect JR. Cryptococcosis in the era of AIDS-100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev 1995; 8(4): 515-48.
9) Perfect JR, Casadevall A. Cryptococcosis. Infect Dis Clin North Am 2002; 16(4): 837-74.
10) Pappalardo MC, Melhem MS. Cryptococcosis: a review of the Brazilian experience for the disease. Rev Inst Med Trop Sao Paulo 2003; 45(6): 299-305.
11) Hazen KC. New and emerging yeast pathogens. Clin Microbiol Rev 1995; 8(4): 462-78.
12) Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, et al. Guidelines for treatment of candidiasis. Clin Infect Dis 2004; 38(2): 161-89.
13) Freydiere A, Guinet R. Rapid method for identification of the most frequent clinical yeast. Rev Iberoam Micol 1997; 14: 85-9.
14) Goldschmidt MC, Fung DY, Grant R, White J, Brown T. New aniline blue dye medium for rapid identification and isolation of Candida albicans. J Clin Microbiol 1991; 29(6): 1095-9.
15) Hoppe JE, Frey P. Evaluation of six commercial tests and the germ-tube test for presumptive identification of Candida albicans. Eur J Clin Microbiol Infect Dis 1999; 18(3): 188-91.
16) Bauters TG, Moerman M, Vermeersch H, Nelis HJ. Colonization of voice prostheses by albicans and non-albicans Candida species. Laryngoscope 2002; 112(4): 708-12.
17) Waller J, Koenig H, Debruyne M, Contant G. Evaluation d’un nouveau milieu d’isolement des levures et de diagnostique rapide de Candida albicans. Rev Fr Lab 1993; 252: 89-92.
18) Freydiere AM, Buchaille L, Gille Y. Comparison of three commercial media for direct identification and discrimination of Candida species in clinical specimens. Eur J Clin Microbiol Infect Dis 1997; 16(6): 464-7.
19) Cooke VM, Miles RJ, Price RG, Midgley G, Khamri W, Richardson AC. New chromogenic agar medium for the identification of Candida spp. Appl Environ Microbiol 2002; 68(7): 3622-7.
20) Bernal S, Martin Mazuelos E, Garcia M, Aller AI, Martinez MA, Gutierrez MJ. Evaluation of CHROMagar Candida medium for the isolation and presumptive identification of species of Candida of clinical importance. Diagn Microbiol Infect Dis 1996; 24(4): 201-4.
21) Silva JO, Franceschini SA, Lavrador MA, Candido RC. Performance of selective and differential media in the primary isolation of yeasts from different biological samples. Mycopathologia 2004; 157(1): 29-36.
22) Jabra-Rizk MA, Brenner TM, Romagnoli M, Baqui AA, Merz WG, Falkler WA Jr, et al. Evaluation of a reformulated CHROMagar Candida. J Clin Microbiol 2001; 39(5): 2015-6.
23) Powell HL, Sand CA, Rennie RP. Evaluation of CHROM-agar Candida for presumptive identification of clinically important Candida species. Diagn Microbiol Infect Dis 1998; 32(3): 201-4.
24) Odds FC, Bernaerts R. CHROMagar Candida, a new differential isolation medium for presumptive identification of clinically important Candida species. J Clin Microbiol 1994; 32(8): 1923-9.
25) Scarparo C, Piccoli P, Ricordi P, Scagnelli M. Comparative evaluation of two commercial chromogenic media for detection and presumptive identification of urinary tract pathogens. Eur J Clin Microbiol Infect Dis 2002; 21(4): 283-9.
26) Momani OM. Cost-effectiveness and efficacy of CHROMagar Candida medium in clinical specimens. East Mediterr Health J 2000; 6(5-6): 968-78.
27) Yera H, Poulain D, Lefebvre A, Camus D, Sendid B. Polymicrobial candidaemia revealed by peripheral blood smear and chromogenic medium. J Clin Pathol 2004; 57(2): 196-8.
28) Horvath LL, Hospenthal DR, Murray CK, Dooley DP. Direct isolation of Candida spp. from blood cultures on the chromogenic medium CHROMagar Candida. J Clin Microbiol 2003; 41(6): 2629-32.
29) García-Martos P, García-Agudo R, Hernández-Molina J, Marín P, Tallero E, Mira J. Identificación de levaduras de Interés Clínico en el Medio de Cultivo CHROMagar Candida. Rev Iberoam Micol 1998; 15: 131-5.
30) Kwon-Chung K, JE. B. Medical Micology. Philadelphia: Lea y Febiger, 1992.
31) Bukley HR. Identification of Yeasts In: Evans EGV & Richardson MD. Medical Mycology a Practical Approach. Oxford: IRL-PRESS, 1989: 97-109.
32) Barnett JH, Payne RW, Yarrow D. Yeasts: Characteristics and Identification. London: Cambridge University Press, 1983.
33) De-Hoog GS, Guarro J, Gené J, Figueras MJ. Yeasts and Yeast-Like Fungi: explanatory Chapter, key to the Genera, and Descriptions. In: Atlas of Clinical Fungi. 2nd ed. Utrecht: Centralbureau voor Schimmelcultures, 2000: 125-236.