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Electrophoretic karyotype analysis of sequential Candida parapsilosis isolates from patients with persistent or
1Department of Clinical Pathology, Chonnam National University Medical School, Kwangju, South Korea. shinjh@chonnam.ac.kr
Abstract:
We assessed the genetic relatedness of sequential isolates of Candida parapsilosis during persistent or recurrent fungemia and the effect of central venous catheter (CVC) removal. Serial isolates of C. parapsilosis were obtained from 17 patients with persistent or recurrent fungemia over periods of up to 5 months. Forty-eight C. parapsilosis isolates from the blood of 17 patients were analyzed by electrophoretic karyotyping (EK) with pulsed-field gel electrophoresis (PFGE), revealing 25 different karyotypes. The strains sequentially isolated from each of seven patients whose fungemia resolved following CVC removal had the same karyotype. Two patients with fungemia that cleared without CVC removal each had two sequential isolates with different karyotypes. In six (75%) of the eight patients whose fungemia was recurrent even after CVC removal, the karyotypes of the pre- and post-CVC removal isolates were different, implying the emergence of a new strain. Overall, the sequential strains from each patient had identical karyotypes in 53% (9 of 17) of the patients and two different karyotypes in 47% (8 of 17). This study shows that EK with PFGE is useful for investigating persistent or recurrent fungemia due to C. parapsilosis and that recurrent fungemia due to C. parapsilosis is more likely caused by reinfection with a second strain.
Insights
Genetic analysis of sequential Candida parapsilosis isolates reveals central venous catheter removal impacts fungemia recurrence. Recurrent fungemia after catheter removal often indicates reinfection with a new strain.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Persistent or recurrent fungemia caused by Candida parapsilosis poses a significant clinical challenge.
- The role of central venous catheters (CVCs) in the persistence and recurrence of fungemia is not fully understood.
- Understanding the genetic relatedness of sequential isolates is crucial for effective patient management.
Purpose of the Study:
- To assess the genetic relatedness of sequential Candida parapsilosis isolates from patients with persistent or recurrent fungemia.
- To evaluate the impact of central venous catheter (CVC) removal on the genetic profile of C. parapsilosis strains.
- To differentiate between relapse and reinfection in cases of recurrent fungemia.
Main Methods:
- Electrophoretic karyotyping (EK) using pulsed-field gel electrophoresis (PFGE) was employed to analyze the genetic profiles of 48 C. parapsilosis isolates from 17 patients.
- Serial blood isolates were collected over periods of up to 5 months from patients experiencing persistent or recurrent fungemia.
- Karyotype analysis was correlated with clinical outcomes, including CVC removal and fungemia resolution.
Main Results:
- Twenty-five distinct karyotypes were identified among the 48 C. parapsilosis isolates.
- In 7 out of 17 patients, fungemia resolved after CVC removal, and sequential isolates shared the same karyotype, suggesting a single strain origin.
- Recurrent fungemia, especially after CVC removal, was frequently associated with different karyotypes (75% of cases), indicating reinfection with a new strain.
Conclusions:
- Electrophoretic karyotyping with PFGE is a valuable tool for investigating persistent and recurrent fungemia caused by Candida parapsilosis.
- Recurrent fungemia due to C. parapsilosis is often a result of reinfection with a distinct strain, particularly following CVC removal.
- The findings highlight the importance of considering strain dynamics in managing C. parapsilosis fungemia and inform strategies for preventing recurrence.