Candida krusei sepsis secondary to oral colonization in a hemopoietic stem cell transplant recipient

Area of Science:

• Medical Mycology
• Infectious Diseases
• Hematology

Background:

• Non-albicans Candida species are increasingly recognized as significant pathogens in immunocompromised patients.
• Fluconazole prophylaxis is common in hemopoietic stem cell transplant (HSCT) recipients but may select for resistant yeasts.
• Candida krusei is intrinsically less susceptible to fluconazole.

Observation:

• A patient undergoing autologous HSCT developed sepsis.
• The sepsis was caused by Candida krusei.
• Pre-existing oral colonization with Candida krusei was identified as the source.

Findings:

• This case demonstrates Candida krusei sepsis in an autologous HSCT patient.
• The infection originated from endogenous oral flora.
• This highlights the risk of non-albicans Candida infections despite fluconazole prophylaxis.

Implications:

• Clinicians should consider non-albicans Candida species, like C. krusei, in HSCT patients with breakthrough fungal infections.
• Surveillance for oral colonization may be important in high-risk patients.
• Alternative or augmented antifungal strategies may be needed for fluconazole-prophylaxed HSCT recipients.