DEVELOPMENT OF FLUCONAZOLE RESISTANCE IN CANDIDA-ALBICANS CAUSING DISSEMINATED INFECTION IN A PATIENT UNDERGOING MARROW TRANSPLANTATION

Oral candidiasis due to azole-resistant Candida albicans is an increas ing problem in patients with AIDS who received prolonged periods of fl uconazole prophylaxis. Infection with CT. albicans is also frequent in patients undergoing transplantation. However, azole resistance has no t been appreciated as a major problem for these patients, presumably b ecause they receive a relatively short duration of fluconazole prophyl axis. We describe a case of disseminated candidiasis due to fluconazol e-resistant C, albicans in a patient following marrow transplantation. Restriction fragment length polymorphism analysis with use of the C. albicans strain-specific Ca3 probe was performed on sequential isolate s. Identical banding patterns were obtained, thereby confirming that a fluconazole-susceptible endogenous C. albicans acquired azole resista nce during a brief exposure to the drug and subsequently caused dissem inated infection. This observation raises questions regarding the inci dence, significance, and mechanism of azole resistance in fungi causin g infection in this population.