Candida albicans has historically been responsible for most mucosal and disseminated candidal infections in BMT patients. However, Candida species other than C. albicans have recently been emerging as colonizing and invasive organisms among neutropenic cancer and BMT patients (e.g. C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. lusitaniae ). Here we report the rare isolation of C. kefyr from several blood cultures from two female leukemia patients. A 63 year old patient was undergoing HLA matched unrelated allogeneic stem cell transplantation because of a second relapse of a Ph-chromosome positive acute lymphocytic leukemia (cALL). The patient had a history of eating kefyr milk/dairy products. C. kefyr was detected in mouthwashings and stool specimens of the patient before transplantation, reflecting colonization. During neutropenia following transplantation she developed fever and blood cultures revealed C. kefyr. The C. kefyr septicaemia persisted despite systemic antifungal therapy with fluconazole and liposomal amphotericin B (1 mg per kg body weight). Futhermore, C. kefyr was isolated from a central venous port system and central venous catheters, which were immediately removed. Organ involvement (retina, liver, spleen, heart, lung, CNS) was not observed. However, the patient suffered from a nonspecific/unclear symmetric arthritis of the talocalcanean joints, suggesting Candida arthritis. Serological tests for candidiasis (candida HA and antigen) were always negative. Blood cultures turned negative after starting an antifungal therapy with a combination of intravenous fluconazole (600 mg/day), liposomal amphotericin B (3 mg/kg body weight) and caspofungin (50 mg/day) as well as oral treatment with nystatin. The second patient had an acute myeloid leukemia, AML M4eo, karyotype 46 XX, inv(16), del(8). She relapsed after autologous stem cell transplantation and achieved a second complete remission after one course of relapse chemotherapy with topotecan, mitoxantrone and AraC (MTC). She underwent a second course of MTC chemotherapy and developed fever during neutropenia due to a C. kefyr bloodstream infection. C. kefyr was also detected in mouthwashings. Central venous catheters were removed. Serological tests for candidiasis were negative or borderline (candida HA). Several pulmonal infiltrations were detected but other organs were not involved. After antifungal therapy with amphotericin B blood cultures turned negative. While both patients survived C. kefyr fungaemia, the first patient was infected with a more resistant strain and thus required a more intensive antifungal regimen. It is possible that the occurrence of these infections may be linked to dietary habits and may reflect a growing diversity of Candida species responsible for disseminated infections in neutropenic patients.
Full conference title:
44th Amercian Society of Hematology Annual Meeting
- ASH 44th (2002)