Non-Candida Yeasts Fungemia in Cancer Patients. Issue 5 (September 2015)

• Record Type: Journal Article
• Authors: Prodhan, Tajul; Yacoub, Abraham Tareq; Jones, Lily; Mai, Jane; Greene, John
• Is Part Of: Infectious diseases in clinical practice. Volume 23:Issue 5(2015:Sep.)
• Publication Date: 2015-09
• Subjects: Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Periodicals; Electronic journals; 616.9
• DOI: 10.1097/IPC.0000000000000271
• Languages: English
• ISSNs: 1056-9103

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>This study examined the characteristics and risk factors associated with non-<italic>Candida</italic> fungemia. It is important to diagnose early and distinguish from <italic>Candida</italic> species because of the high mortality rate in non-<italic>Candida</italic> yeast fungemia.</p> </sec> <sec> <title>Materials and Methods</title> <p>We performed a retrospective analysis of patients with cancer from 1999 to 2014 at Moffitt Cancer Center in Tampa, Florida with a positive blood cultures for non-<italic>Candida</italic> yeast. Nine patients were identified. Types of malignancy included both hematological and solid tumors. All patients received cytotoxic chemotherapy and were on prophylactic antifungal therapy. Five patients were diagnosed with <italic>Trichosporon</italic> species. Risk factors included prolonged neutropenia, hematological malignancy, hematopoietic stem cell transplantation (HSCT), chemotherapy and immunosuppressive therapy. We found a very high mortality rate in patients with non-<italic>Candida</italic> yeast fungemia with refractory and end-stage cancer. This demonstrated the need for early identification of non-<italic>Candida</italic> fungemia. In addition, many of these patients had prolonged neutropenia and a refractory malignancy as significant risk factors.</p> </sec> <sec> <title>Results</title> <p>There were 9 patients with positive blood cultures for non-<italic>Candida</italic> yeasts in our study. The most common non-<italic>Candida</italic> yeasts were <italic>Trichosporon</italic> species. The majority of the patients had a hematological malignancy. All patients received cytotoxic chemotherapy, and most of them were refractory to treatment with end-stage hematological malignancy. Prolonged neutropenia was found in the majority of the patients receiving chemotherapy.</p> <p>All patients were receiving potent antifungal therapy, such as liposomal amphotericin B, micafungin, posaconazole, or voriconazole, either alone or in combination, when breakthrough infection occurred. The central venous catheter was removed in all patients. However, prolonged fungemia persisted in all patients despite removal. We found a very high mortality rate in patients with non-<italic>Candida</italic> yeast fungemia with refractory malignancy. Yeast-related sepsis was the cause of death in most of the patients. Ongoing neutropenia was found at the time of death in most of the patients with yeast-related death.</p> </sec> <sec> <title>Conclusions</title> <p>Non-<italic>Candida</italic> yeast fungemia is rare but associated with significant mortality. They usually occurred as breakthrough fungemia while on antifungal prophylaxis. Thus, in vitro susceptibility testing should be performed on all isolates, and antifungal therapy should be modified or broadened pending identification and susceptibly results. Without resolution of neutropenia and oncologic control of the malignancy, outcomes are poor.</p> </sec> </abstract>