Non-albicans Candida infections in patients with hematologic malignancies

The epidemiology of invasive Candida infections is characterized by a recent decline in Candida albicans and C. tropicalis with a concomitant increase in the incidence of non-albicans Candida species such as C. glabrata and C. krusei, a phenomenon at least partly ascribed to triazole use. Of particular concern is the recognition that these organisms are multiresistant, adding a new dimension to the challenge of management. C. lusitaniae, though uncommon, mainly presents as breakthrough fungemias in patients on antifungal therapy. C. parapsilosis, an organism of relatively low virulence, plays an increasing role because of its ability to cause intravenous line and hyperalimentation fluid colonization. Emergence of azole-resistant (relative or absolute) Candida species is being met by a new class of antifungal agents namely the echinocandins and a new generation of broad-spectrum triazole agents. This article addresses the biology, epidemiology, prognostic factors, and management of an emerging group of pathogens such as non-albicans Candida.