Candida haemulonii Complex Species, Brazil, January 2010–March 2015

infection have been reported in immunosuppressed persons, both in HIV/AIDS patients (manifesting as pulmonary infection in 1 patient and disseminated disease in the other) (6). In our study, the im-munocompromised patient with M. arupense tenosynovitis received canakinumab, a relatively new biologic agent with a prolonged selective IL-1 β-blockade. Even though the contribution of canakinumab in this case is confounded by concomitant immune deficiencies (natural killer cell deficiency , high-dose corticosteroids), the temporal association between initiation of canakinumab and the onset of symptoms raises concern of a possible association. Animal studies have shown that IL-1 plays a key role in host resistance to mycobacterial infections by regulating Th1/Th2 immune responses and inducing granuloma formation (9). Clinical trials and systematic reviews assessing the safety of IL-1 inhibitors, including anakinra, rilonacept, and canakinum-ab, have not shown that these drugs lead to an increased risk of tuberculosis or other mycobacterial infections (10). Nonetheless, our report provides increased evidence that M. arupense is an emerging cause of tenosynovitis and that it is potentially associated with immunosuppression. Tenosynovitis caused by Mycobacterium arupense in a patient with diabetes mellitus. et al. Mycobacterium arupense pulmonary infection: antibiotic resistance and restriction fragment length polymorphism analysis. of the wrist caused by Mycobacterium arupense in an immunocompetent patient: a unique case. et al. Mycobacterium arupense flexor tenosynovitis: case report and review of antimicrobial susceptibility profiles for 40 clinical isolates. Cheever A, et al. Caspase-1 independent IL-1 beta production is critical for host resistance to Mycobacterium tuberculosis and does not require TLR signaling in vivo. et al. Effectiveness and tuberculosis-related safety profile of interleukin-1 blocking agents in the management of Behçet's disease. To the Editor: The epidemiology of yeast infections is evolving, and species in the Candida haemulonii complex have been identified as a cause of candidiasis (1). In 2012, C. haemulonii complex was reclassified as 2 species and 1 variety: C. haemulonii (former group I), C. duobushaemu-lonii (former group II) and C. haemulonii var. vulnera (1). Despite the growing knowledge about the biology and clinical relevance of these pathogens, species-specific data comparing clinical and microbiological aspects are lacking. We describe the clinical and microbiological characteristics of patients from 5 hospitals in São Paulo, Brazil, whose cultures were positive for the C. haemulonii complex species. During January 2010–March 2015, samples from case-patients in 5 hospitals affiliated with the University of São Paulo were cultured; samples positive for C. hae-mulonii were further analyzed. …