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Almost 75% of women experience vulvovaginal Candida infection at least once during their lifetime and 90% of these infections are due to Candida albicans (Marchaim et al. 2012). Both diagnosis and ...

Background Local and systemic use of azole derivatives are common in the treatment of vulvovaginal candidiasis. However, there are cases unresponsive to these agents. Herein, we present treatment and follow-up of a patient with fluconazole–itraconazole and voriconazole-resistant recurrent vaginal candidiasis. Methods A 37-year-old woman with no comorbidity used topical and oral antifungal/antibacterial medications (including fluconazole and itraconazole) in the treatment of recurrent vulvovaginitis, was hospitalized due to continuous complaints. Intense, white-colored, odorless vaginal discharge was observed on physical examination. Urine and vaginal swab samples were taken for mycological and bacteriological culture. Metronidazole (500 mg 3x1 i.v.) and high dose fluconazole (600 mg/day i.v.) were initiated empirically for the possibility of dose-dependent resistant Candida infection, but there was no clinical response. Results Candida albicans was isolated in vaginal swab culture, but response to systemic fluconazole treatment for one week was inadequate. Antifungal susceptibility test was performed by microdilution method according to CLSI M27A3 guidelines and MIC values were reported respectively; fluconazole 4 µg/mL (SDD), itraconazole 1 µg/mL (R), posaconazole 0.06 µg/mL (WT), voriconazole 0.25 µg/mL (SDD), anidulafungin ≤ 0.015 µg/mL (S), amphotericin B 0.06 µg/mL (WT). For the resistance mechanism, point mutation in the ERG11 gene and MDR1 and MDR2 from efflux pumps were investigated and only the G464S mutation was detected in the ERG11 gene. Treatment was switched to IV anidulafungin (200 mg on day 1 followed by 100 mg/day). Clinical response was achieved in the patient whose complaints were reduced, and there was no Candida in the repeated vaginal swab culture taken on day 3 of treatment. The patient was discharged after 2 weeks of treatment. She had no recurrence after 2 years follow-up. Conclusion It should be kept in mind that resistant strains may be responsible for recurrent and unresponsive vulvovaginal candidiasis cases. Although there is no case report in which anidulafungin is used for treatment and it should be kept in mind that the anidulafungin is also in the treatment as it is summarized. Disclosures All authors: No reported disclosures.

Giriş: Tüberküloz genel olarak akciğerlerde görülmekle birlikte tüm organları etkileyebilmektedir. Ancak akciğer dışı tutulum olduğunda tanı koymak, akciğer tutulumundan daha zordur. Mycobacterium tuberculosis’in izole edilmesi, ekstrapulmoner tüberküloz (EPTB) tanısında altın standart olmasına karşın, özellikle EPTB’de bakteriyolojik izolasyon oranı düşüktür. Eğer M. tuberculosis elde edilebilirse, hastalığın epidemiyolojik özellikleri ve ilaç duyarlılığı hakkında bilgi vermektedir. Materyal ve Metod: Bu çalışmada, 2009-2016 yılları arasında mikobakteriyoloji laboratuvarında M. tuberculosis izole edilen ekstra pulmoner örnekler değerlendirilmiştir. İzole edilen bakterilerin genotiplerin belirlenme işlemi ve ilaç duyarlılık testleri yapılmıştır. Spoligotipleme, daha önce tarif edilen standart bir teknik kullanılarak gerçekleştirilmiştir. Bulgular: Çalışma süresince 165 hastaya ait 171 ekstrapulmoner örnekte M. tuberculosis (75 erkek, 90 kadın, ortalama yaş: 53.35 ± 19.92) kültürde üretilmiştir. Birden fazla ekstrapulmoner organ tutulumu 6 hastada mevcuttur. En yaygın EPTB şekli 60 hastada lenf nodu, 32 hastada plevral tüberküloz ve 25 hastada kemik tüberkülozdur. Yedi hasta insan immün yetmezlik virüsüyle infekte olmak üzere 44 hastada immün yetmezlik saptanmıştır. Tüberküloz ilaç direnci 175 örneğin 21’inde tespit edilmiştir. Rifampisin direnci 7 örnekte, yüksek düzeyde izoniazid direnci 11 örnekte ve rifampisin ve izoniazid direnci (çoklu ilaç direnci) 6 örnekte gösterilmiştir. Tüberküloz hastalarının farklı örneklerinden elde edilen 135 klinik izolatın genetik profili Spoligotyping kullanılarak belirlenmiştir. Majör Spoligotipler, T (n= 62; %45.9), LAM7-TUR (ST41) (n= 11; %8.1) ve H1 (n= 9; %6) genotipleridir. Sonuç: En yaygın EPTB şekli, kültürle kanıtlanmış hastalarda lenf nodu tüberkülozudur. Bu hasta grubunda, çoklu ilaç direnci oranı düşüktür (%3.6). Spoligotip T (%45.9) en sık görülen genetik profil olarak tespit edilmiştir., Introduction: Tuberculosis is seen generally in the lungs. Besides, all organs in the body can be affected by tuberculosis. Diagnosis of extra pulmonary tuberculosis (EPTB) is more difficult than pulmonary tuberculosis (PTB). Although, the isolation of Mycobacterium tuberculosis is gold standard of diagnosis of EPTB, the rate of bacteriologic isolation is low especially in EPTB. If M. tuberculosis is detected, it gives some information about the epidemiological features of the disease and drug susceptibility. Materials and Methods: in this study, extra pulmonary samples isolated M. tuberculosis in mycobacteriology laboratory were evaluated between 2009-2016. the identification of the genotype of isolated bacteria and drug sensitivity tests were conducted. Spoligotyping was accomplished using a standard technique as described previously. Results: During the study period, M. tuberculosis were cultured in 171 extra pulmonary samples of 165 patients (75 male, 90 female, mean age: 53.35 ± 19.92). Initial direct microscopically examination was revealed M. tuberculosis in 44 patients. There were more than one extra pulmonary organ involvement in six patients. the most common EPTB forms were lymph node TB in 60 patients, pleural tuberculosis in 32 patients and bone tuberculosis in 25 patients. Immunosuppression was detected in 44 (%26.6) patients. Among these, seven patients were infected with HIV. in 21 of 175 samples, drug resistance was detected. Rifampicin resistance in 7 samples, high level isoniazid resistance in 11 samples and rifampicin plus isoniazid resistance (multiply drug resistance) in 6 samples were demonstrated. One hundred thirty-five clinical isolates were cultured from tuberculosis patient’s different samples, of which the genetic profile was determined by using Spoligotyping. the major Spoligotypes were T (n= 62; 45.9%), LAM7-TUR (ST41) (n= 11; 8.1%) and H1 (n= 9; 6%) genotypes. Conclusion: the most common EPTB form was lymph node tuberculosis in culture proven patients. in these patients group, multiply drug resistance rate was low (3.6%). Spoligotypes T (45.9%) was detected as most common genetic profile.