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Journal of Antimicrobial Chemotherapy (2000) 46, 291-295
© 2000 The British Society for Antimicrobial Chemotherapy

Brief reports

Development of simultaneous resistance to fluconazole in Candida albicans and Candida dubliniensis in a patient with AIDS

Markus Ruhnkea,*, Andrea Schmidt-Westhausenb and Joachim Morschhäuserc

a Universitätsklinikum Charité Campus Virchow Klinikum, Abteilung für Innere Medizin, Humboldt Universität zu Berlin, D-13353 Berlin; b Zentrum für Zahnmedizin, Universitätsklinikum Charité, D-13353 Berlin and c Zentrum für Infektionsforschung, Universität Würzburg, D-97070 Würzburg, Germany

In this report, we describe a patient with recurrent episodes of oral candidosis who finally suffered from fluconazole-refractory oral and oesophageal candidosis. The patient was monitored for 4 years until his death from AIDS. During the observation period, persistent colonization with both Candida albicans and Candida dubliniensis was observed. From the appearance of the first episode of oral candidosis, the patient was treated with fluconazole for 18 months. The infection became unresponsive to fluconazole 400 mg/day. In vitro susceptibility testing revealed the development of resistance to fluconazole in C. albicans and C. dubliniensis. Molecular typing confirmed the persistence of the same C. albicans and C. dubliniensis strains which developed resistance after up to 3 years of asymptomatic colonization. This observation demonstrates that Candida spp. other than C. albicans may develop resistance to fluconazole in a patient who is repeatedly exposed to the drug.

* Correspondence address. Charité Campus Virchow-Klinikum der Humboldt-Universität, Department of Medicine, Division of Haematology/Oncology, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49-30-450-59268; Fax: +49-30-450-59910; E-mail: markus.ruhnke{at}charite.de


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