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In the present report, we describe an unusual case of mixed infection of Candida albicans and Talaromyces marneffei in the oral cavity and oropharynx with cutaneous involvement. On the CHROMagar Candida plate, green colonies (identified as C. albicans) and tiny violet colonies (identified as T. marneffei) grew from the throat swab after incubation for 96 hours. 10 clinical isolates of T. marneffei were used to verify their color production on CHROMagar Candida. All colonies were violet on the fourth, seventh and ninth day incubated at 37 °C. T. marneffei appears violet on the CHROMagar Candida plate, but it may be easily ignored because of its slow growth and small colony size, especially after incubation for 48 hours. Therefore, when using CHROMagar Candida plate to detect specimens in AIDS patients, special attention must be paid to detect non–yeasts such as T. marneffei for up to 96 hours.

There are no studies on Candida colonization and micropeptides of saliva in any patient. Therefore, we studied the effects of the salivary antimicrobial peptide histatin 5 on oral fungal colonization, subjects were subdivided into Down syndrome (D) and normal (N) groups by age: N-1 and D-1, age &lt, 20 years, N-2 and D-2, age &gt, 40 years. Histatin 5 concentration in saliva was measured by enzyme-linked immunosorbent assay. Oral Candida species were identified using CHROMagar Candida. Candida colonization was significantly enhanced in the D-1 and D-2 groups compared to the N-1 and N-2 groups. There was no predominant difference in salivary histatin 5 concentration between the D-1 and N-1 groups, but it was significantly lower in the D-2 group than in the N-2 group. Only in the N-2 group was there a correlation between the concentration of histatin 5 and total protein, while no correlation was found in the other groups. In elderly patients with Down syndrome, the decrease in histatin 5 shown in this study may lead to oral Candida colony formation. Therefore, the results of this study suggest that a deficiency of the antimicrobial peptide histatin 5 could possibly induce oral Candida infection in DS.

Non-albicans Candida species are emerging in the nosocomial environment, with the multidrug-resistant (MDR) species Candida auris being the most notorious example. Consequently, rapid and accurate species identification has become essential. The objective of this study was to evaluate five commercially available chromogenic media for the presumptive identification of C. auris. Two novel chromogenic formulations, CHROMagar Candida Plus (CHROMagar) and HiCrome C. auris MDR selective agar (HiMedia), and three reference media, CandiSelect (Bio-Rad), CHROMagar Candida (CHROMagar), and Chromatic Candida (Liofilchem), were inoculated with a collection of 9 genetically diverse C. auris strains and 35 strains from closely related comparator species. After 48 h of incubation, the media were evaluated for their ability to detect and identify C. auris. All media had the same limitations in the differentiation of the more common species Candida dubliniensis and Candida glabrata. Only on CHROMagar Candida Plus did C. auris colonies develop a species-specific coloration. Nevertheless, the closely related pathogenic species Candida pseudohaemulonii and Candida vulturna developed a similar appearance as C. auris on this medium. CHROMagar Candida Plus was shown to be superior in the detection and identification of C. auris, with 100% inclusivity for C. auris compared to 0% and 33% for the reference media and HiCrome C. auris MDR selective agar, respectively. Although C. vulturna and C. pseudohaemulonii can cause false positives, CHROMagar Candida Plus was shown to be a valuable addition to the plethora of mostly molecular methods for C. auris detection and identification.

Background and Method The aim of this prospective study was to evaluate the adherence frequency of Candida albicans and non-albicans Candida species in newborn babies with Cleft Lip and Palate (CLP) who receive presurgical orthopedic therapy with Nasoalveolar Molding (NAM) appliances. This study comprised of 25 CLP newborns including 8-right unilateral, 8-left unilateral and 7-bilateral CLP. First swab samples were taken from the hard palate when the baby was referred and renewed after 3 days. Following the 7th day of delivery of NAM appliance, the swab samples were retaken from both the hard palate and the NAM appliance. Samples were renewed with 2-month intervals. The last swab samples were taken one month after the surgery. Oral swabs were cultured on CHROMagar Candida medium for the growth of yeasts. Results There were no statistically significant differences between the time points regarding C. albicans proliferation frequency and severity rates on the palate. No significant difference was found due to the type of cleft and sex in terms of candidal colonization. A constant increase in proliferation frequency of non-albicans on the palatal mucosa was observed between all of the time points. Although the results were insignificant, there was a constant increase in C. albicans proliferation which presented a decrease following primary lip surgery. Conclusion The appliance might not only cause an increase in the colonization of C. albicans but also provide the continuation of the colonization. Therefore, mouth cleaning is important even after primary lip surgery.

A shift to Candida non-albicans infections has been noted during the last years, and the emergence of multi-resistant Candida auris has complicated their management. The aim of this study was first to compare the performance of the novel chromogenic medium CHROMagar™ Candida Plus (CHROMagar, France) with CHROMagar™ Candida (Becton Dickinson, Germany) for the presumptive identification of Candida species; and then, to evaluate its utility in the detection of C. auris in surveillance samples. CHROMagar™ Candida Plus showed a good performance compared with the reference medium CHROMagar™ Candida. Sensitivity and specificity were 100% in both media for tested species at 48 h of incubation, except for Candida glabrata and Candida lusitaniae. Furthermore, the new medium allows a reliable presumptive identification of C. auris, as a new specific color for this species is assigned (light blue with a blue halo), obtaining a sensitivity and specificity of 100% at 36 h of incubation.

Twenty-nine Candida isolates were assessed with green-coloured colonies using CHROMagar Candida medium with a positive germ-tube test. Based on morphological and biochemical tests, 29 strains were isolated from the oral cavity of children with leukaemia who were undergoing chemotherapy in Basrah, Iraq. Three (10.3%) of them were identified as Candida africana. Identification of the isolated yeasts was further confirmed at the molecular level by amplifying the internal transcribed spacer sequencing (ITS) region of rDNA comprising the ITS1-5.85-ITS2 regions of fungal rRNA genes. This study represented the first recovery of C. africana from the oral cavity for immunocompromised patients with leukaemia and considered the first record of species in Iraq.

Objective: Determine if there is an association between the presence of Candida albicans and the denture stomatitis type in patients who attend to the aged center of Chiclayo – July 2012. Materials and Methods: 58 patients with removable dental prostheses diagnosed clinically with denture stomatitis were evaluated. A palatal mucosal swab was performed and then cultured directly in the medium of the CHROMagar Candida culture at 37 ° C for 48 hours. The crop that tested positive for Candida albicans were submitted to germ-tube testing. Results: A total of 35 (60%) cultures tested positive for Candida albicans, with grade III of denture stomatitis being 100% associated with Candida albicans (n = 3), grade II presented 70.8% (n=17). The total prosthesis was more involved in the presence of Candida albicans (65.5%) with no statistical significance, p= 0.591. Conclusions: There is association between the denture stomatitis and Candida albicans. Key words: Candida albicans; denture st

AimsThe present study was undertaken to evaluate the discrimination ability of six chromogenic media in presumptive yeast identification.MethodsWe analysed 108 clinical isolates and reference strains belonging to eight different species: Candida albicans,Candida dubliniensis, Candida tropicalis, Candida krusei, Candida glabrata, Candida parapsilosis,Candida lusitaniae and Trichosporon mucoides.ResultsC. albicans, C. tropicalis and C. krusei could be distinguished from one another in all the tested chromogenic media, as predicted by the manufacturers. In addition, C. albicans could be distinguished from C. dubliniensis on BBL CHROMagar Candida, Kima CHROMagar Candida and Brilliance Candida, and C. parapsilosis could be identified on CHROMATIC Candida agar, CHROMOGENIC Candida agar, and Brilliance Candida agar.ConclusionsBrilliance Candida provided the widest discrimination ability, being able to discriminate five out of the seven Candida species tested. Interestingly, C. tropicalis and C. krusei could be already distinguished from each other after 24 hours of incubation.

Candida auris is an emerging, multidrug-resistant yeast that can spread rapidly in healthcare settings. Phenotypic switching has been observed in other Candida species and can potentially interfere with correct identification. The aim of this study is to address misidentification of C. auris by describing alternate phenotypes after broth enrichment and subculturing on CHROMagar Candida. Each isolate displayed different frequencies of phenotypic switching, suggesting a strain to strain variability. Increased knowledge of the multiple phenotypes of C. auris increases the chance of isolating and identifying C. auris by reducing the risk of discarding false negative alternate colony morphologies.

Background Candida auris is unique due to its multidrug resistance and misidentification as Candida haemulonii by commercial systems. Its correct identification is important to avoid inappropriate treatments. Aims To develop a cheap method for differentiating C. auris from isolates identified as C. haemulonii by VITEK2. Methods Fifteen C. auris isolates, six isolates each of C. haemulonii and Candida duobushaemulonii , and one isolate of Candida haemulonii var. vulnera were tested using CHROMagar Candida medium supplemented with Pal's agar for better differentiation. Results On CHROMagar Candida medium supplemented with Pal's agar all C. auris strains showed confluent growth of white to cream colored smooth colonies at 37 °C and 42 °C after 24 and 48 h incubation and did not produce pseudohyphae. The isolates of the C. haemulonii complex, on the contrary, showed poor growth of smooth, light-pink colonies at 24 h while at 48 h the growth was semiconfluent with the production of pseudohyphae. C. haemulonii complex failed to grow at 42 °C. Conclusions We report a rapid and cheap method using CHROMagar Candida medium supplemented with Pal's agar for differentiating C. auris from isolates identified as C. haemulonii by VITEK2.

Objective: To compare the biofilm of Candida albicans found in bases of total dentures. Study Design: Four groups of users of total denture were grouped according to time of use: 1 to 2 months (n = 13), 3 to 9 months (n = 13), 30 to 39 months (n = 13), and more than 39 months (n = 13). After clinical examination and physical evaluation of the prosthesis, samples of the oral mucosa, hard palate as well as the surface total denture were collected with sterilized swabs, and sown in CHROMagar Candida medium to identify species at 37°C for 48 hours. The identification of the species was using the API 20 method. Results: The results revealed the presence of Candida albicans and other types of strains in the biofilm of the total denture with more than 3 months of use, but without a significant difference between the presence of xerostomia and the type of hygiene, with the presence of strains. Conclusion: There is a significant difference between the time of total denture use and the amount of colony-forming units.

Background: Accurate speciation of the clinical yeast isolates is essential to a targeted treatment. Objectives: The aim of this study was to identify and determine the frequency of uncommon and rare yeast species causing fungal infections that may be misidentified. Methods: During a 10-month period, yeast isolates collected from patients referring to or hospitalized in some educational hospitals in Tehran, Iran, were included in this study. In addition to conventional methods such as direct microscopy and culture on CHROMagar Candida, molecular methods including PCR-RFLP and ITS-sequencing were used for the accurate identification of the yeast strains. Results: Among 930 yeast isolates recovered from normally sterile and other clinical specimens, a total number of 27 strains were identified as uncommon Candida species and three were identified as rare non-Candida species yeasts. They included C. kefyr (n = 12), C. lusitaniae (n = 8), C. intermedia (n = 3), C. orthopsilosis, C. guilliermondii, and Trichosporon asahii (each n = 2), and Magnusiomyces capitatus (n = 1). Conclusions: The isolation of less common or rare yeast species, which can cause a variety of infections from superficial to systemic infections, is increasingly reported. Since this uncommon yeast species may exhibit low susceptibility to some antifungal agents, the use of reliable methods for accurate screening of these yeasts is necessary.

Objective: Usage of catheter, prosthesis, treatment with extendedspectrum antibiotics for a long time, organ transplantation andimmunodeficiency enhanced invasive Candida infections. Quite a few chromogenic mediawere developed for rapid identification of yeasts, recently. We aimed tocompare performances of CHROMagar Candida (CHROMagar, France) and RosachromCandida Agar II (Gül Biyoloji Laboratuvarı, Turkey) for the identification ofthe yeast species.Material and Method: Totally 66 isolates including 22 C. glabrata, 16 C. tropicalis,10 C. albicans, nine C. parapsilosis, four C. kefyr, two Saprochaete capitata, two Trichosporonspp., one C. lusitaniae isolatedfrom various clinical specimens between September–October 2015 in MycologyLaboratory of our hospital were included. The colonies of the isolates wereevaluated by considering the colony morphology, color and the existence of haloaround the colony by two different people after 24 and 48 hours.Results: The isolates grew well on both chromogenic media, andshowed clearly distinguished colonies. The sensitivity and specificity valuesfor C. albicans were detected as 100%for CHROMagar Candida; 70-80% and 94.6-96.4% for Rosachrom Candida, at 24 and48 hours, respectively. These values for C.tropicalis were 100% for CHROMagar Candida; 43.7–50 % and 98-100 % forRosachrom Candida, respectively.Conclusion: CHROMagar Candida whichcan identify, C. albicans, C. tropicalis and C. glabrata with high sensitivity and specificity rates wasconcluded as a reliable medium for identification of Candida species. RosachromCandida may be thought to be an alternative to CHROMagar Candida for C. albicans identification but itsperformance in identification of C.tropicalis was not found sufficient., Amaç: Kateter, protez kullanımı,uzun süren geniş spektrumlu antibiyotik tedavileri, organ nakli ve immünyetersizlik gibi faktörler invazif Candida enfeksiyonlarında artışa nedenolmaktadır. Son yıllarda hızlı maya identifikasyonunu sağlamak amacıyla birçok kromojenikbesiyeri geliştirilmiştir. Bu çalışmada maya suşlarının tür düzeyindetanımlanmasında iki farklı kromojenik besiyeri olan CHROMagar Candida(CHROMagar, Fransa) ile Rosachrom Candida Agar II’nin (Gül BiyolojiLaboratuvarı, Türkiye) performanslarının karşılaştırılması amaçlandı.Gereç ve Yöntem: Çalışmaya, Eylül – Ekim 2015tarihleri arasında hastanemiz Mikoloji Laboratuvarında çeşitli klinikörneklerden soyutlanan 22 C. glabrata,16 C. tropicalis, 10 C. albicans, dokuz C. parapsilosis, dört C. kefyr, iki Saprochaete capitata, iki Trichosporonspp., bir C. lusitaniae olmaküzere toplam 66 suş alındı. Suşların her iki kromojenik besiyerindeki kolonimorfolojisi ile rengi ve koloni etrafında halenin varlığı, 24. ve 48. saatlerdeiki farklı kişi tarafından değerlendirildi. Bulgular: Çalışmaya alınan izolatlarıntümü her iki kromojenik besiyerinde de ayırt edilebilen koloniler şeklinde iyiüreme gösterdi. C. albicans için24.-48. saatlerde duyarlılık ve özgüllük değerleri sırası ile CHROMagar Candidaiçin %100 ve Rosachrom Candida için %70-80 ile %94,6-96,4 olarak saptandı. Budeğerler, C. tropicalis izolatlarındasırası ile CHROMagar Candida için %100; Rosachrom Candida için %43,7–50 ve%98-100 idi. Sonuç: CHROMagar Candida, C. albicans, C. tropicalis ve C. glabratatürlerini doğru identifiye etmede gösterdiği yüksek duyarlılık ve özgüllükoranları nedeniyle Candida türlerinin identifikasyonu için uygun bir besiyeriolarak belirlendi. Rosachrom Candida besiyerinin ise, C. albicans identifikasyonunda CHROMagar Candida besiyerinealternatif olarak düşünülebileceği ancak C.tropicalis identifikasyonundaki performansının yeterli olmadığı görüşünevarıldı.

Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton–Dickinson, UK), assimilation of carbon compounds ID32C (bioMerieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.

Pathogenic Candida species are detected in clinical infections. CHROMagar™ is a phenotypical method used to identify Candida species, although it has limitations, which indicates the need for more sensitive and specific techniques. Infrared Spectroscopy (FT-IR) is an analytical vibrational technique used to identify patterns of metabolic fingerprint of biological matrixes, particularly whole microbial cell systems as Candida sp. in association of classificatory chemometrics algorithms. On the other hand, Soft Independent Modeling by Class Analogy (SIMCA) is one of the typical algorithms still little employed in microbiological classification. This study demonstrates the applicability of the FT-IR-technique by specular reflectance associated with SIMCA to discriminate Candida species isolated from vaginal discharges and grown on CHROMagar™. The differences in spectra of C. albicans, C. glabrata and C. krusei were suitable for use in the discrimination of these species, which was observed by PCA. Then, a SIMCA model was constructed with standard samples of three species and using the spectral region of 1792-1561cm-1. All samples (n=48) were properly classified based on the chromogenic method using CHROMagar™ Candida. In total, 93.4% (n=45) of the samples were correctly and unambiguously classified (Class I). Two samples of C. albicans were classified correctly, though these could have been C. glabrata (Class II). Also, one C. glabrata sample could have been classified as C. krusei (Class II). Concerning these three samples, one triplicate of each was included in Class II and two in Class I. Therefore, FT-IR associated with SIMCA can be used to identify samples of C. albicans, C. glabrata, and C. krusei grown in CHROMagar™ Candida aiming to improve clinical applications of this technique.

Candida speciation is vital for epidemiology and management of candidiasis. Nonmolecular conventional methods often fail to identify closely related germ tube positive yeasts from clinical specimens. The present study was conducted to identify these yeasts and to highlight issues in conventional versus molecular methods of identification. A total of 98 germ tube positive yeasts from high vaginal swabs were studied over a 12-month period. Isolates were examined with various methods including growth at 42 °C and 45 °C on Sabouraud dextrose agar (SDA), color development on CHROMagar Candida medium, chlamydospore production on corn meal agar at 25 °C, carbohydrate assimilation using ID 32C system, and polymerase chain reaction using a single pair of primers targeting the hyphal wall protein 1 (Hwp1) gene. Of all the isolates studied, 97 were molecularly confirmed as C. albicans and one isolate was identified as C. dubliniensis. No C. africana was detected in this study. The molecular method used in our study was an accurate and useful tool for discriminating C. albicans, C. dubliniensis, and C. africana. The conventional methods, however, were less accurate and riddled with many issues that will be discussed in further details.

This study was conducted to establish associations among the Candida carriage rate, the diversity of Candida species carried and the different caries status of preschool children.Sixty-one children between 2 and 5 years of age were examined by a single expert examiner and were divided into three groups, the caries-free, moderate caries and severe caries groups, according to the criteria of the International Caries Detection and Assessment System II (ICDAS). Saliva samples were obtained from the members of each group and were plated on Sabouraud agar plates to assess the Candida carriage rates. CHROMagar Candida medium was used for the preliminary screening. Biochemical testing or PCR/sequencing was conducted to identify the different Candida species in the samples. The differences observed were considered significant if the p value was0.05.The Candida carriage rate and the number of species of this fungus carried were higher in the group with the highest level of caries severity (p 0.05). Whereas Candida albicans was the most predominant Candida species in the saliva of all of the children, C. dubliniensis was identified only in the most caries-affected group in addition to other rare species of Candida non-albicans.A high salivary Candida carriage rate and the presence of specific species of this fungus (such as C. albicans and C. dubliniensis) appear to be related to the severity of caries experienced by preschool children.

Accurate Candida species identification remains a challenge due to their phenotypic and genotypic similarity. Species belonging to the *psilosis group, are even described as phenotypically indistinguishable. Also, most of the genotypic methods commonly used to discriminate these species are laborious and very expensive. In this work we developed a Fourier-transform infrared spectroscopy with attenuated total reflectance (FTIR-ATR) based method as a reliable alternative for the discrimination between 12 Candida species. The collection comprises 82 clinical isolates obtained from distinct biological products, recovered between 2007 and 2014 in Portugal and Brazil and previously characterised by CHROMagar Candida and PCR-based sequencing techniques. Infrared spectra were analysed with principal component analysis (PCA) and partial least squares discriminant analysis (PLSDA). Results demonstrated that the 12 species could be successfully discriminated by the proposed infrared spectroscopy based method. Noteworthy, the PLSDA model led to the correct identification of 99.6% analysed clinical isolates. This rapid, low cost, and environmental friendly technique proved to be a reliable alternative for the identification of Candida species that share many phenotypic and genotypic characteristics and are often difficult to distinguish., This work was funded by Fundação para a Ciência e a Tecnologia (FCT) under the strategic projects UID/QUI/50006/2013 and UID/BIO/04469/2013 and COMPETE 2020 (POCI-01-0145-FEDER-006684) and the project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462). Sónia Silva was supported by a post-doctoral grant from Fundação para a Ciência e a Tecnologia (SFRH/BPD/111645/2015).

This study was conducted to compare of the yeasts identification results obtained with two new systems using the MALDI-TOF MS technique with the ones obtained using the routine identification methods of Candida spp. in clinical microbiology laboratories. All 124 Candida spp. isolates were recovered from the routine examination of clinical specimens in microbiological laboratories and collected in the Centre of Quality Control in Microbiology in Warsaw (Poland). Our findings confirm the high agreement (98%) of fungal identification using the standard, biochemistry laboratory methods and mass spectrometry technique.

Summary The Malassezia genus comprises yeasts whose natural habitat is the skin of humans and warm-blooded animals. They are responsible for various pathological aspects. The study of these yeasts has been postponed for many years due to its nutritional requirements and its morphological variability. Molecular biology methods led to a taxonomic revision of this genus and to a new interest for its clinical importance. The Dixon medium supports not only the growth of these yeasts but also gives morphological and physiological pathognomonic characters. In comparison with modified Dixon, the medium of Leeming and Notman is more adapted to the conservation of the species. A system of identification, based on assimilation tests of non-ionic detergents such as tweens and cremophor EL on Sabouraud dextrose agar, was very useful. It makes possible a definition of characteristic patterns for the various species of Malassezia . Recently a kit of identification of nine species was developed. This method is based on the production of precipitation on a modified Chromagar Candida .

The purpose of this study was to devise an algorithm utilizing chromogenic media for the detection and presumptive identification of Candida species in a clinical microbiology laboratory. In order to select one chromogenic medium, a limited evaluation of 3 commercially available yeast chromogenic media: BBL CHROMagar Candida, Bio- Rad CandiSelect 4, and Oxoid OCCA, was conducted with 12 C. albicans, 8 C. glabrata, 10 C. tropicalis, and 9 C. krusei. The presumptive species identification after 48 hours of incubation on BBL and Bio-Rad media were comparable, with more than 80% of the Candida species correctly identified, and both were superior to Oxoid. An algorithm based on use of chromogenic media for the rapid presumptive identification of C. albicans, C. tropicalis, C. krusei, and C. glabrata was developed for routine use in the microbiology laboratory. A presumptive identification is available within 24 to 48 hours utilizing this algorithm.

In clinical laboratories, isolation of Candida species is generally based on the culture of specimens on Sabouraud dextrose agar. This strategy does not allow species identification on primary culture and makes it difficult to detect mixed cultures. Chromogenic media contain substrates that react specifically with different Candida species, and partly overcome these difficulties. Objectives The aim of this study was to compare two chromogenic media: (i) CandiSelect4 (C4), a new medium developed for direct identification of C. albicans and presumptive identification of C. krusei , C. tropicalis and C. glabrata (ii) CHROMagar Candida (CH), a medium licensed for direct identification of C. albicans , and presumptive identification of C. tropicalis and C. krusei , and employed in our laboratory since 2002. Materials and methods Altogether, 533 clinical specimens were seeded on both media. Identification on C4 was compared to that achieved on CH, API 32 C test or an in-house C. glabrata rapid identification test. Results Discrepant positive cultures occurred in 16 samples and were shared equally between C4 and CH. The ability of both media to detect associations was equivalent, with 34 associations identified with C4 and CH. No discrepancy was observed with respect to identification of C. albicans . C4 identified six of six C. krusei , but false-negative identification of C. tropicalis occurred in 2/11 cases and false-positive identification of C. glabrata occurred in 2/34 cases. Conclusions The overall performance of C4 and CH appeared almost identical during a two-month comparison in the clinical mycology setting.

The appearance of Candida albicans in three patients made physicians investigate an outbreak. Outbreak description and microbiologic screening: Case 1 developed C. albicans in the placenta culture and in the blood culture carried out on the 8th day of birth. Four days after this candidemia, C. albicans was recovered in a catheter tip of a second neonate (case 2) and finally five days later other newborn (case 3) developed C. albicans in the hemoculture. After that, the hands of all caregivers as well as case 3's incubator, case 1's mother, and from all nine neonates in the unit were studied with swabs. A wet mount was done to all swabs and then they were cultured in Chromagar Candida and SDA. All C. albicans were studied by RAPD. RAPD study showed that C. albicans recovered from placenta and blood cultures of case 1, the catheter tip of case 2 and the blood culture of case 3, resulted to be identical and these yeasts were related to the C. albicans from the mouth of case 1 mother and the mouth of another colonized newborn. C. albicans was not found in the others swabs. The isolations of identical C. albicans allowed to suppose the horizontal transmission from the case 1, that had acquired it congenitally. Not only isolation of unusual Candida species would be an alert. Despite patients' personal factors to justify a fungal infection, the recovery of C. albicans in a short period of time should warn physicians about the possibility of a horizontal transmission.

SUMMARY Infection by Candidaspp. is associated with high mortality rates, especially when treatment is not appropriate and/or not immediate. Therefore, it is necessary to correctly identify the genus and species of Candida. The aim of this study was to compare the identification of 89 samples of Candida spp. by the manual methods germ tube test, auxanogram and chromogenic medium in relation to the ID 32C automated method. The concordances between the methods in ascending order, measured by the Kappa index were: ID 32C with CHROMagar Candida(κ = 0.38), ID 32C with auxanogram (κ = 0.59) and ID 32C with germ tube (κ = 0.9). One of the species identified in this study was C. tropicalis,which demonstrated a sensitivity of 46.2%, a specificity of 95.2%, PPV of 80%, NPV of 81.1%, and an accuracy of 80.9% in tests performed with CHROMagar Candida;and a sensitivity of 76.9%, a specificity of 96.8%, PPV of 90.9%, NPV of 91%, and an accuracy of 91% in the auxanogram tests. Therefore, it is necessary to know the advantages and limitations of methods to choose the best combination between them for a fast and correct identification of Candidaspecies. RESUMO A infecção por Candidaspp. está associada com alta mortalidade, principalmente quando o tratamento não é adequado, nem imediato. Assim, a correta identificação do gênero e espécie é necessária. O objetivo deste trabalho foi comparar 89 amostras de Candidaspp. pelos métodos manuais prova do tubo germinativo, auxanograma e CHROMagar em relação ao método automatizado ID 32C. As concordâncias entre os métodos em ordem crescente, medidas pelo coeficiente de Kappa, foram: ID 32C com CHROMagar Candida(κ = 0,38), ID 32C com auxanograma (κ = 0,59) e ID 32C com tubo germinativo (κ = 0,9). Uma das espécies identificadas neste trabalho foi a C. tropicalis, que demonstrou uma sensibilidade de 46,2%, especificidade de 95,2%, VPP de 80%, VPN de 81,1% e acurácia de 80,9% nos testes com CHROMagar Candidae uma sensibilidade de 76,9%, especificidade de 96,8%, VPP de 90,9%, VPN de 91% e acurácia de 91% nos testes de auxanograma. Portanto, o conhecimento das vantagens e limitações dos métodos é necessário para a escolha da melhor combinação entre os mesmos visando uma rápida e correta identificação das espécies de Candida.

Aim: To measure the agreement of methods for identification of Candida species in oral cavity samples, comparing the CHROMagar Candida, microculture, API 20C AUX and RAPD techniques.Methods: Ninety-one colonies of Candida were isolated and presumptively identified in CHROMagar Candida, submitted to microculture, API 20C AUX and RAPD techniques. After this, agreement among methods using Kappa test was performed.Results: Agreement rates between RAPD and CHROMagar Candida, showed significant accuracy for C. albicans, C. tropicalis, C. dubliniensis and C. krusei (Kappa: 0.760, 0.640, 0.416 and 0.360, respectively, p0.05). The agreement was significant for all identified species when RAPD (OPE-18) and API 20C AUX (pConclusions: API 20C AUX presented the best agreement with molecular random identification and CHROMagar showed good agreement for C. albicans, C. tropicalis, C. dubliniensis and C. krusei identification.

The normal vaginal microbiota is a dynamic system that continually fluctuates under the environmental changes and different physiological conditions. Yeast infections of the vagina are caused by one of the species of fungus called Candida (C.). The study aimed to evaluate the types of mycobiota in women with vulvovaginal candidiasis (VVC) who were performing vaginal douching (VD) or not. Furthermore, it studied the antifungal sensitivity toward different fungi isolated from the vagina. In a cross-sectional study conducted in Assiut University Hospital, Egypt, women with VVC were interviewed regarding relevant history including the habit of VD. Vaginal swabs were obtained and processed by direct microscope and by culture on CHROMagar Candida and other differential media. The types of Candida in women with the habit of VD were compared with those not having this habit. We found that VD habit was practiced by 67.4% of women with VVC, and Candida albicans was the commonest (78.3%) type observed. There was no significant difference in the percentage of non-albicans types between women performing VD (23.6%) and those not reporting this habit (18.9%). Harboring non-albicans types were significantly increased in regular performers of VD compared with those who had this procedure only after sexual intercourse or after the end of menstruation (36.8%,12.5%, and 16.7%, respectively) (P = .048). Thus, vaginal douching does not influence the type of Candida infection involved in VVC. Frequent performance of VD increases the likelihood of having non-albicans types and the resistance to the common antifungal agents.