The first case of bloodstream infection by Candida intermedia in Japan: the importance of molecular identification

A 65-year-old Chinese man with diabetes mellitus was admitted to our hospital complaining of bloody sputum, fever, and dyspnea. Despite antibiotic treatment, his condition deteriorated, necessitating mechanical ventilation. Diffuse alveolar hemorrhage was suspected, and steroid therapy was initiated. Although his condition improved and he was extubated, the fever recurred twice, and on both occasions blood cultures yielded yeasts. The yeasts were misidentified as Cryptococcus humicola with a commercially available phenotype test (API ID32C), which did not match the clinical profile, and molecular identification was then performed. The isolates were identified as Candida intermedia by molecular phylogenetic analyses of the chromosomal regions coding for the D1/D2 domain of the large-subunit 26S rRNA gene. The patient responded well to several antifungal agents and was discharged on the 34th hospital day. To our knowledge, this is the first case of C. intermedia infection reported in Japan, and the tenth case reported in the international medical literature.