<i>Candida kefyr</i>, an Uncommon but Emerging Fungal Pathogen: Report of Two Cases

Corpus, Kimberly; Hegeman-Dingle, Rozelle; Bajjoka, I

doi:10.1592/phco.24.11.1084.36140

Cited by 13 publications

(4 citation statements)

References 15 publications

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“…Colonization and infection follow a seasonal distribution, with higher rates during the warm months of the year. Our understanding of the epidemiology of C. kefyr has been limited, derived mainly from case reports (12,27,28), laboratorybased analyses (13)(14)(15)(29)(30)(31)(32)(33)(34), and large surveillance registries (11). This body of evidence has suggested that HM patients may be a high-risk group for infection with this organism, albeit C. kefyr is a rare cause of invasive disease.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

et al. 2014

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g Candida kefyr is an emerging pathogen among patients with hematologic malignancies (HM). We performed a retrospective study at Johns Hopkins Hospital to evaluate the epidemiology of C. kefyr colonization and infection in HM patients between 2004 and 2010. Eighty-three patients were colonized and/or infected with C. kefyr, with 8 (9.6%) having invasive candidiasis (IC). The yearly incidence of C. kefyr colonization and candidemia increased over the study period (P < 0.01), particularly after 2009. In 2010, C. kefyr caused 16.7% of candidemia episodes. The monthly incidence of C. kefyr was higher during the summer throughout the study. In a cohort of patients with acute myelogenic leukemia receiving induction chemotherapy, risks for C. kefyr colonization included the summer season (odds ratio [OR], 3.1; P ‫؍‬ 0.03); administration of an azole (OR, 0.06; P < 0.001) or amphotericin B (OR, 0.35; P ‫؍‬ 0.05) was protective. Fingerprinting of 16 isolates by repetitive sequence-based PCR showed that all were different genotypes. The epidemiology of C. kefyr candidemia was evaluated in another hospital in Montreal, Canada; data confirmed higher rates of C. kefyr infection in the summer. C. kefyr appears to be increasing in HM patients, with prominent summer seasonality. These findings raise questions about the effect of antifungal agents and health care exposures (e.g., yogurt) on the epidemiology of this yeast.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

et al. 2014

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“…The successful treatment with voriconazole of keratitis, retinitis, or chorioretinitis due to Candida spp has also been reported (Granados et al 2004; Jang et al 2005; Varma et al 2005). There are several documented cases of a successful response to voriconazole in the treatment of infections caused by uncommon or fluconazole-resistant species (Corpus et al 2004; Fabry et al 2005): non- C. albicans peritonitis in peritoneal dialysis patients (Kleinpeter 2004), and Candida infection of the subacromial bursa (Khazzam et al 2005). …”

Section: Clinical Use Against Fungal Pathogensmentioning

confidence: 99%

Voriconazole in the management of nosocomial invasive fungal infections

Pemán¹,

Salavert²,

Cantón³

et al. 2006

Therapeutics and Clinical Risk Management

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Voriconazole is a new triazole developed for the treatment of life-threatening fungal infections. The drug is available for both oral and intravenous administration; the oral formulation has excellent bioavailability. The side-effect profile of voriconazole presents an acceptable safety and tolerability spectrum: transient visual disturbances, liver enzyme abnormalities, and skin rashes are the most frequently reported side effects but rarely lead to discontinuation. The potential for drug–drug interactions is high, because of its extensive hepatic metabolism. Careful attention to dosage is required, and serum levels and the effects of interacting drugs should be monitored. Review of 25 470 isolates of yeasts and 3216 isolates of filamentous fungi showed voriconazole to have broad-spectrum activity against pathogenic yeasts including intrinsically fluconazole-resistant isolates such as Candida krusei, dimorphic fungi, and opportunistic moulds like Aspergillus spp, amphotericin-B-resistant Aspergillus terreus, Fusarium spp, and Scedosporium apiospermum. It displays excellent clinical efficacy in patients with fluconazole-resistant and -susceptible Candida infections, invasive bone and central nervous system aspergillosis, and various refractory fungal infections. Voriconazole has been approved by the US Food and Drug Administration and by the European Medicines Agency for the treatment of invasive aspergillosis, serious infections caused by Fusarium and S. apiospermum, fluconazole-resistant invasive Candida infections, and candidemia in nonneutropenic patients.

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“…andida kefyr (teleomorph: Kluyveromyces marxianus) has been reported as a rare but potentially increasing cause of invasive candidiasis (IC) (1)(2)(3), especially in patients with hematologic malignancies (2,(4)(5)(6). Isolates of this species have been noted to develop reduced susceptibility to echinocandins, although the majority examined in population analyses remain susceptible (7).…”

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confidence: 99%

Target Enzyme Mutations Confer Differential Echinocandin Susceptibilities in Candida kefyr

Staab

Neofytos

Rhee

et al. 2014

Antimicrob Agents Chemother

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cCandida kefyr is an increasingly reported pathogen in patients with hematologic malignancies. We studied a series of bloodstream isolates that exhibited reduced echinocandin susceptibilities (RES). Clinical and surveillance isolates were tested for susceptibilities to all three echinocandins, and those isolates displaying RES to one or more echinocandins were selected for molecular and biochemical studies. The isolates were analyzed for genetic similarities, and a subset was analyzed for mutations in the echinocandin target gene FKS1 and glucan synthase echinocandin sensitivities using biochemical methods. The molecular typing did not indicate strong genetic relatedness among the isolates except for a series of strains recovered from a single patient. Two unrelated isolates with RES had previously uncharacterized FKS1 mutations: R647G and deletion of amino acid 641 (F641⌬). Biochemical analysis of the semipurified R647G glucan synthase generated differential echinocandin sensitivity (resistance to micafungin only), while the deletion of F641 resulted in a glucan synthase highly insensitive to all three echinocandins. The consecutive isolates from a single patient with RES all harbored the common S645P mutation, which conferred resistance to all three echinocandins. The MIC values paralleled the glucan synthase inhibition kinetic data, although the S645P isolates displayed relatively higher susceptibility to caspofungin (2 g/ml) than the other two echinocandins (>8 g/ml). These findings highlight novel and common FKS1 mutations in C. kefyr isolates. The observation of differential susceptibilities to echinocandins may provide important mechanistic insights for echinocandin antifungals.

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Candida kefyr, an Uncommon but Emerging Fungal Pathogen: Report of Two Cases

Cited by 13 publications

References 15 publications

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

Voriconazole in the management of nosocomial invasive fungal infections

Target Enzyme Mutations Confer Differential Echinocandin Susceptibilities in Candida kefyr

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