, Volume 182, Issue 3–4, pp 397–402 | Cite as

A Case Report of Penile Infection Caused by Fluconazole- and Terbinafine-Resistant Candida albicans



Candida albicans is the most common pathogen that causes balanoposthitis. It often causes recurrence of symptoms probably due to its antifungal resistance. A significant number of balanitis Candida albicans isolates are resistant to azole and terbinafine antifungal agents in vitro. However, balanoposthitis caused by fluconazole- and terbinafine-resistant Candida albicans has rarely been reported. Here, we describe a case of a recurrent penile infection caused by fluconazole- and terbinafine-resistant Candida albicans, as well as the treatments administered to this patient. The isolate from the patient was tested for drug susceptibility in vitro. It was sensitive to itraconazole, voriconazole, clotrimazole and amphotericin B, but not to terbinafine and fluconazole. Thus, oral itraconazole was administrated to this patient with resistant Candida albicans penile infection. The symptoms were improved, and mycological examination result was negative. Follow-up treatment of this patient for 3 months showed no recurrence.


Candida albicans Penile infection Resistance Terbinafine Fluconazole Itraconazole 



This work was kindly supported by the Guangdong Natural Science Foundation (2015A030310035) and Guangdong Provincial Health Research Fund (A2013388).

We sincerely thank Dr. Mai Junhua for his assistance in English revision.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.


  1. 1.
    Dockerty WG, Sonnex C. Candidal balano-posthitis: a study of diagnostic methods. Genitourin Med. 1995;71(6):407–9.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Alsterholm M, Flytström I, Leifsdottir R, et al. Frequency of bacteria, Candida and malassezia species in balanoposthitis. Acta Derm Venereol. 2008;88(4):331–6.PubMedGoogle Scholar
  3. 3.
    Lisboa C, Ferreira A, Resende C, Rodrigues AG. Infectious balanoposthitis: management, clinical and laboratory features. Int J Dermatol. 2009;48(2):121–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Hombalkar NN, Vaze D, Guha P, et al. Devastating penile mycosis leading to penile gangrene. Urology. 2013;82(3):704–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Li Bing-Kun, Wang Xiang, Ding Qiang. A case report of severe Aspergillus flavus penile infection. Asian J Androl. 2009;11(5):638–40.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Odds Frank C. In Candida albicans, resistance to flucytosine and terbinafine is linked to MAT locus homozygosity and multilocus sequence typing clade1. FEMS Yeast Res. 2009;9(7):1091–101.CrossRefPubMedGoogle Scholar
  7. 7.
    Cernicka Jana, Subik Julius. Resistance mechanisms in fluconazole-resistant Candida albicans isolates from vaginal candidiasis. Int J Antimicrob Agents. 2006;27(5):403–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Seifi Z, Azish M, Salehi Z, et al. Candiduria in children and susceptibility patterns of recovered Candida species to antifungal drugs in Ahvaz. J Nephropathol. 2013;2(2):122–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Staniszewska M, Bondaryk M, Swoboda-Kopec E, et al. Candida albicans morphologies revealed by scanning electron microscopy analysis. Braz J Microbiol. 2013;44(3):813–21.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Yang Y, Hu Y, Zhang J, et al. A refractory case of chromoblastomycosis caused by Fonsecaea monorphora. Med Mycol. 2012;50(6):649–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee SC, Lee CW, Shih HJ, et al. Risk factors of mortality and comparative in vitro efficacy of anidulafungin, caspofungin, and micafungin for candidemia. J Microbiol Immunol Infect. 2014;47(3):245–53.CrossRefPubMedGoogle Scholar
  12. 12.
    Perea S, López-Ribot JL, Kirkpatrick WR, et al. Prevalence of molecular mechanisms of resistance to azole antifungal agents in Candida albicans strains displaying high-level fluconazole resistance isolated from human immunodeficiency virus-infected patients. Antimicrob Agents Chemother. 2001;45(10):2676–84.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Feng W, Yang J, Pan Y, Qiao Z, Ma Y. The correlation of virulence, pathogenicity, and itraconazole resistance with SAP activity in Candida albicans strains. Can J Microbiol. 2016;62(2):173–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Kirsch DR, Lai MH, O’Sullivan J. Isolation of the gene for cytochrome P450 L1A1 (lanosterol 14 alpha-demethylase) from Candida albicans. Gene. 1988;68(2):229–37.CrossRefPubMedGoogle Scholar
  15. 15.
    Andreassi L, Bilenchi R. Non-infectious inflammatory genital lesions. Clin Dermatol. 2014;32(2):307–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Mayser P. Mycotic infections of the penis. Andrologia. 1999;31(Suppl. l):13–6.PubMedGoogle Scholar
  17. 17.
    He L, Hao JH, Zhang JH, et al. Detection of minimum inhibitory concentration of 9 antifungal drugs to Candida albicans from Candidal balanoposthitis. Chin J Microecol. 2011;23(9):832–4 (Chinese).Google Scholar
  18. 18.
    Liu S, Hou Y, Chen X, et al. Combination of fluconazole with non-antifungal agents: A promising approach to cope with resistant Candida albicans infections and insight into new antifungal agent discovery. Int J Antimicrob Agents. 2014;43(5):395–402.CrossRefPubMedGoogle Scholar
  19. 19.
    Eddouzi J, Parker JE, Vale-Silva LA, et al. Molecular mechanisms of drug resistance in clinical Candida species isolated from Tunisian hospitals. Antimicrob Agents Chemother. 2013;57(7):3182–93.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Pardini G, De Groot PW, Coste AT, et al. The CRH family coding for cell wall glycosylphosphatidylinositol proteins with a predicted transglycosidase domain affects cell wall organization and virulence of Candida albicans. J Biol Chem. 2006;281(52):40399–411.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Yongxuan Hu
    • 1
  • Yanqing Hu
    • 1
  • Yan Lu
    • 1
  • Shiyun Huang
    • 1
  • Kangxing Liu
    • 1
  • Xue Han
    • 1
  • Zuhao Mao
    • 1
  • Zhong Wu
    • 1
  • Xianyi Zhou
    • 1
  1. 1.Department of Dermatology and VenerologyThe 3rd Affiliated Hospital of Southern Medical UniversityGuangzhouChina

Personalised recommendations