Hansenula anomala: a new fungal pathogen. Two case reports and a review of the literature
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A S Klein1, G T Tortora, R Malowitz
1Department of Medicine, School of Allied Health Professions, State University of New York, Stony Brook 11794-8153.
Abstract:
Fungal infections are characteristic of severely immunocompromised patients. Noncandidal yeasts represent a growing proportion of such infections. Risk factors for developing fungal infections include the use and abuse of central venous catheters. Two patients with gynecologic malignant neoplasms became fungemic with Hansenula anomala, a yeast of the Ascomycetes class, after insertion of central venous catheters. Frequent catheter manipulation and prolonged use favored the development of fungemia in both patients. A review of the literature revealed 19 additional cases over the course of four decades, all in hosts with underlying diseases. Thirteen of these cases have been described in the last 18 months, suggesting either increased recognition or increased frequency of infection with this organism. All tested isolates have been susceptible to amphotericin B. Patients have generally responded to catheter withdrawal and amphotericin B administration. Hansenula anomala is an opportunistic pathogen, whose clinical behavior resembles that of Candida species.
Insights
Noncandidal yeast infections, like Hansenula anomala fungemia, are increasing in immunocompromised patients, often linked to central venous catheters. Prompt treatment with amphotericin B and catheter removal is effective.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Fungal infections are a significant concern in immunocompromised individuals.
- Noncandidal yeasts are an emerging cause of fungemia.
- Central venous catheters are recognized risk factors for fungal infections.
Observation:
- Two patients with gynecologic cancers developed Hansenula anomala fungemia post-central venous catheter insertion.
- Both patients had prolonged catheter use and frequent manipulation.
- Literature review identified 19 additional cases of H. anomala fungemia over four decades, with a recent increase.
Findings:
- Hansenula anomala fungemia is associated with underlying diseases and central venous catheter use.
- A recent surge in reported cases suggests increased incidence or recognition.
- All H. anomala isolates tested were susceptible to amphotericin B.
Implications:
- Hansenula anomala should be considered an opportunistic pathogen in at-risk populations.
- Catheter management is crucial in preventing and treating fungemia.
- Amphotericin B and catheter removal represent an effective treatment strategy.