INVASIVE INFECTION DUE TO CANDIDA-KRUSEI IN IMMUNOCOMPROMISED PATIENTS NOT TREATED WITH FLUCONAZOLE

Candida krusei is a cause of invasive candidiasis (IC), with numerous cases reported among leukemia patients after bone marrow transplantati on and treatment with fluconazole. The relation between fluconazole th erapy 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 t he patients involved had leukemia, two had breast cancer, one had end- stage liver disease, and one had undergone abdominal trauma. None of t hese patients received fluconazole. Surveillance cultures detected col onization 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. Conc omitant infections were common; four patients had both bacteremia and invasive aspergillosis. C. krusei was considered the immediate cause o f five of the seven deaths among this group of patients. These eight c ases extend the range of immunocompromised conditions in which IC caus ed by C. krusei develops in the absence of fluconazole therapy.