, Volume 164, Issue 1, pp 27–33 | Cite as

Identification and in vitro antifungal susceptibility testing of 200 clinical isolates of Candida spp. responsible for fingernail infections

  • Valda Teixeira Figueiredo
  • Daniel de Assis Santos
  • Maria Aparecida Resende
  • Júnia Soares Hamdan


A total of 200 samples of Candida spp. that are responsible for fingernail infections were isolated in Belo Horizonte, MG, Brazil from April 2004 to May 2005. The samples were identified by routine microbiological techniques and had the following distribution: Candida parapsilosis (40.5%), C. albicans (31.5%), C. tropicalis (26%), and C. guilliermondii (2%). We performed in vitro susceptibility tests with ciclopiroxolamine, terbinafine, ketoconazole, itraconazole, and fluconazole using the CLSI (Clinical and Laboratory Standards Institute) and EUCAST (European Committee on Antibiotic Susceptibility Testing) methodologies. The percentages of agreement between the two methodologies varied from 48 to 100% (the percentage increased to more than 60% for the majority of the samples). Percentages of agreement between the methodologies lower than 60% were seen with ketoconazole (57%) and itraconazole (48%) for samples of C. albicans and with fluconazole (54%) for samples of C. tropicalis. In general, we observed higher agreement between the values of the MICs obtained with both methodologies for ciclopiroxolamine and terbinafine for all tested species. With azoles, lower percentages of agreement between the methodologies were observed for samples C. albicans and C. tropicalis.


Candida spp. Antifungal susceptibility CLSI EUCAST 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



This work was supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). We would like to thank Dr. Márcia de Souza Carvalho Melhem as well as Dr. Walderez Szeszs (Instituto Adolfo Lutz). We also extend our thanks to Walquíria Lopes Borges for technical assistance.


  1. 1.
    Rodriguez-Soto ME, CM Fernández-Andreu S Moya-Duque Estudio clinico micologico de onicomicosis en ancianos. Rev Inst Med Trop Sao Paulo 1993;35:213–7.PubMedGoogle Scholar
  2. 2.
    Willemsen M Changing pattern in superficial infections: focus on onychomycosis. F Europ Acad Dermatol Venereol 1993;2 (Suppl 1):6–11.Google Scholar
  3. 3.
    Gautret MH, C Rodier L Kauffmann JL, Jacquemin Case Report and Review: onychomycosis due to Candida parapsilosis. Mycoses 2000;43:433–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC. Diagnóstico Microbiológico. Editora Médica e Científica 2001;1052.Google Scholar
  5. 5.
    Lacaz CS, Porto E, Martins JEC. Leveduroses profundas com especial referência às infecções por Candida. São Paulo: Micologia Médica; 1991. p. 216–225.Google Scholar
  6. 6.
    Van Der Walt, JP, Yarrow D. Methods for the isolation, maintenance, classification and identification of yeasts. In: Kreger-van Rij NJW, editor. The Yeats. Amsterdam: Elsevier Publishers; 1984. p. 45–104.Google Scholar
  7. 7.
    National Committee For Clinical Laboratory Standards. Reference method for broth dilution antifungal susceptibility testing of yeasts Approved standard. 2nd ed, M27A2. Wayne, Pa: National Committee for Clinical Laboratory Standards.Google Scholar
  8. 8.
    Espinel-Ingroff A, Barchiese F, Hazen KC, Martinez-Suares JV, Scalise G. Standardization of antifungal susceptibility testing and clinical relevance. Med Mycol 1998;36 Suppl 1:68–78.PubMedGoogle Scholar
  9. 9.
    Pfaller MA, Barry AL. Evaluation of a novel colorimetric broth microdilution method for antifungal susceptibility testing of yeast isolates. J Clin Microbiol 1994;32:1992–6.PubMedGoogle Scholar
  10. 10.
    Gupta AK, Kohli Y. In vitro susceptibility testing of ciclopiroxolamine, terbinafine, ketoconazole and intraconazole against dermatophytes and nondermatophytes, and evaluation of combination antifungal activity. Br J Dermatol 2003;149:296–305.PubMedCrossRefGoogle Scholar
  11. 11.
    Cuenca-Estrella M, Moore CB, Barchiesi F, Bille J, Chryssanthou E, Denning DW, Donnelly JP, Dromer F, Dupont B, Rex JH, Richardson MD, Sancak B, Verweij PE, Rodriguez-Tudela JL. AFST Subcommittee of the European Committee on Antimicrobial Susceptibility Testing Multicenter evaluation of the reproducibility of the proposed antifungal susceptibility method for fermentative yeasts of the antifungal susceptibility testing Subcommittee of the European Committee on Antimicrobial Susceptibility Testing (AFST-EUCAST). Clin Microbiol Infect 2003; 9:467–474.PubMedCrossRefGoogle Scholar
  12. 12.
    Barry AL, Pfaller MA, Brown SD, Espinel-Ingroff A, Ghannoum MA, Knapp C, Rennie RP, Rex JH, Rinaldi MG. Quality control limits for broth microdilution susceptibility tests of ten antifungal agents. J Clin Microbiol 2000;34:3457–3459.Google Scholar
  13. 13.
    Espinel Ingroff A, Barchiesi F, Cuenca-Estrella M, Pfaller MA, Rinaldi M, Rodriguez-Tudela JL, Verwij PE. (2005) International and Multicenter Comparison of EUCAST and CLSI M27A2 Broth Microdilution Methods for Testing Susceptibilities of Candida spp To Fluconazole, Itraconazole, Posoconazole, and Voriconazole. J Clin Microbiol 43:3884–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Erbagci Z, Tuncel A, Zer, Y, Balci, I. 2005 A prospective epidemiologic survey on the prevalence of onychomycosis and dermatophytosis in male boarding school residents Mycoptahologia 159:347–52.Google Scholar
  15. 15.
    Matsumoto FE, Gandra RF, Ruiz LS, Auler ME, Marques SAV, Pires MFC, Gambale W, Paula CR. Yeasts isolated from blood and catheter in children from a Public Hospital of São Paulo, Brazil. Mycopathologia 2001;154:63–9.CrossRefGoogle Scholar
  16. 16.
    Carrillo-Munoz AJ, Brio S, Alonso R, del Valle O, Santos P, Quindos G. Ciclopiroxolamine: in vitro antifungal activity against clinical yeast isolates International. J Antimicrob Agents 2002;20:375–9.CrossRefGoogle Scholar
  17. 17.
    Abdel-Rahman SM, Nahata MC. Oral terbinafine: a new antifungal agent. Ann Phamacother 1997;31:445–56.Google Scholar
  18. 18.
    Arzeni D, Barchiesi F, Compagnucci P. In vitro activity of terbinafine against clinical isolates of dermatophytes. Med Mycol 1998;36:235–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Segal R, Kritzman A, Cividalli L, David M, Tiqva P. Treatment of Candida nail infections with terbinafine. J Am Acad Dermatol 1996;35:958–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Sanglard D, Ischer F, Monod M, Biller J. Cloning of Candida albicans genes conferring resistance to azole antifungal agents: characterization of CRD2, a new multidrug ABC transporter gene. Microbiology 1997;143:405–16.PubMedCrossRefGoogle Scholar
  21. 21.
    Arthington-Skagg BA, Lee-Yang W, Ciblak MA, Frade JP, Brandt ME, Hajjeh RA, Harrison LH, Sofair AN, Warnock DW. Candidemia Active Surveillance Group Comparison of visual and spectrofotometric methods of broth microdilution MIC end point determination and evaluation of a sterol quantitation method for in vitro susceptibility testing of fluconazole and itraconazole against trailing and nontrailing Candida isolates. Antimicrob Agents Chemother 2002;46:2477–81.CrossRefGoogle Scholar
  22. 22.
    Tornatore MA, Noskin GA, Hacek DM, Obias AA, Peterson LR. Effects of incubation time and buffer concentration on in vitro activities of antifungal agents against Candida albicans. J Clin Microbiol 1997;35:1473–6.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Valda Teixeira Figueiredo
    • 1
  • Daniel de Assis Santos
    • 1
  • Maria Aparecida Resende
    • 1
  • Júnia Soares Hamdan
    • 1
  1. 1.Departamento de Microbiologia, Instituto de Ciências BiológicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil

Personalised recommendations