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Invasive infection due to Candida krusei in immunocompromised patients not treated with fluconazole
Abstract:
Candida krusei is a cause of invasive candidiasis (IC), with numerous cases reported among leukemia patients after bone marrow transplantation and treatment with fluconazole. The relation between fluconazole therapy and IC remains controversial. In a retrospective review covering 5 years, we identified 203 cases of IC, 71 (35%) of which were due to non-albicans species. Eight cases were caused by C. krusei: four of the patients involved had leukemia, two had breast cancer, one had end-stage liver disease, and one had undergone abdominal trauma. None of these patients received fluconazole. Surveillance cultures detected colonization with C. krusei before the onset of symptoms in seven cases. The median time from colonization to IC diagnosis was 10 days. Of six patients with neutropenia, five were neutropenic at IC diagnosis. Concomitant infections were common; four patients had both bacteremia and invasive aspergillosis. C. krusei was considered the immediate cause of five of the seven deaths among this group of patients. These eight cases extend the range of immunocompromised conditions in which IC caused by C. krusei develops in the absence of fluconazole therapy.
Insights
Candida krusei causes invasive candidiasis (IC) in immunocompromised patients, even without fluconazole therapy. This study highlights C. krusei as a cause of death in non-neutropenic patients with various cancers and trauma.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- Candida krusei is an opportunistic fungal pathogen.
- Invasive candidiasis (IC) is a serious infection, particularly in immunocompromised individuals.
- The role of fluconazole in Candida krusei infections is debated.
Purpose of the Study:
- To investigate cases of invasive candidiasis caused by Candida krusei.
- To determine risk factors and outcomes associated with C. krusei infections.
- To assess the occurrence of C. krusei IC in the absence of fluconazole therapy.
Main Methods:
- Retrospective review of 203 invasive candidiasis cases over 5 years.
- Identification of causative fungal species.
- Analysis of patient demographics, underlying conditions, and treatment.
Main Results:
- Eight cases of C. krusei IC were identified, none received fluconazole.
- Patients had various conditions: leukemia, breast cancer, liver disease, abdominal trauma.
- Seven cases showed prior C. krusei colonization; median time to IC was 10 days.
- Concomitant infections (bacteremia, aspergillosis) were frequent.
- C. krusei was implicated in 5 of 7 deaths.
Conclusions:
- Candida krusei can cause invasive infections in diverse immunocompromised hosts without prior fluconazole exposure.
- Early detection of C. krusei colonization may aid in preventing IC.
- C. krusei poses a significant mortality risk, especially with co-infections.