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Fungaemia Caused by the Rare Yeast Starmerella sorbosivorans: A Case Report with Identification via Molecular

Shunkichi Ikegaki1, Yuka Nagatsuka2,3, Sayaka Ban4

  • 1Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan. ikegaki@gmail.com.

Mycopathologia
|February 16, 2026
PubMed

Insights

This study reports the first case of Starmerella sorbosivorans bloodstream infection in a patient requiring parenteral nutrition. Multilocus sequence analysis confirmed the rare yeast identification, leading to successful antifungal treatment.

Area of Science:

  • Medical Mycology
  • Clinical Microbiology
  • Infectious Diseases

Background:

  • Invasive yeast infections, primarily Candida bloodstream infections, carry high mortality, especially in immunocompromised individuals.
  • Rare yeast species can cause fungaemia, posing diagnostic challenges with conventional methods.
  • Starmerella sorbosivorans (formerly Candida sorbosivorans) is an uncommon yeast species not frequently implicated in human infections.

Purpose of the Study:

  • To document the first case of Starmerella sorbosivorans bloodstream infection.
  • To highlight the diagnostic challenges and the importance of advanced molecular techniques for identifying rare yeast pathogens.
  • To report successful treatment outcomes and antifungal susceptibility profiles for this rare infection.

Main Methods:

  • Case report of a patient with chronic intestinal pseudo-obstruction and a central venous catheter.
  • Initial identification using standard biochemical methods and MALDI-TOF mass spectrometry (MS).
  • Definitive identification through molecular phylogenetic analysis of multiple gene loci (18S rDNA, ITS, 26S rDNA-D1/D2, TEF1α, RPB2) and MALDI-TOF MS.
  • Antifungal susceptibility testing (AST) to determine minimum inhibitory concentrations (MICs).

Main Results:

  • A 39-year-old male patient with a tunnelled central venous catheter developed fever, diagnosed as catheter-related bloodstream infection.
  • Biochemical tests suggested S. magnoliae, but MALDI-TOF MS was inconclusive.
  • Multilocus sequence analysis and MALDI-TOF MS confirmed the isolate as Starmerella sorbosivorans, with 91.3% ITS sequence similarity to the type strain.
  • The patient responded well to treatment with micafungin and liposomal amphotericin B, along with catheter removal.
  • Antifungal susceptibility revealed low MICs for micafungin, amphotericin B, and voriconazole, but high MICs for fluconazole.

Conclusions:

  • Accurate identification of rare yeast species like S. sorbosivorans necessitates advanced molecular methods beyond conventional techniques and standard MALDI-TOF MS libraries.
  • Multilocus sequence analysis is crucial for definitive species identification in challenging clinical cases.
  • Expanding MALDI-TOF MS reference databases with rare and emerging yeast species is vital for improving clinical diagnostic capabilities.
  • Successful treatment outcomes can be achieved with appropriate antifungal agents based on susceptibility testing.
Keywords:
Starmerella sorbosivoransCatheter-related bloodstream infectionMALDI-TOF mass spectrometry

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