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Candida krusei Empyema: A Lung Transplant Case and Systematic Review of the Literature

Summary

Candida krusei is a dangerous fungus that can cause fluid buildup around the lungs (empyema), particularly in transplant patients. Unlike common fungal infections that respond to fluconazole, this species is naturally resistant to this drug, making it harder to treat. The fungus forms protective biofilms that shield it from treatment, requiring combination antifungal medications and sometimes surgery to drain the fluid and remove infected tissue for successful recovery.

Background

Candida krusei empyema is a rare but serious manifestation of invasive candidiasis characterized by intrinsic fluconazole resistance, biofilm formation, and high mortality. The condition is particularly concerning in immunocompromised patients, including lung transplant recipients. Limited case-level data exists to inform optimal management strategies.

Objective

To systematically identify and synthesize all reported English-language cases of Candida krusei empyema from January 2005 to June 2025 and describe the clinical course, management, and outcomes of a lung transplant patient with persistent C. krusei empyema despite optimized antifungal therapy.

Results

Seven publications describing nine published cases of C. krusei empyema were identified; with the addition of one new case, ten total cases were analyzed. Patients ranged from 11 to 74 years old with predisposing factors including esophageal perforation (n=4), post-lung transplant events (n=2), and community-acquired empyema (n=1). Treatment included combination antifungal therapy with echinocandins or voriconazole and source control via drainage or surgery, with overall mortality of 14.3% directly attributable to infection.

Conclusion

Candida krusei empyema is a rare but severe invasive fungal infection requiring early detection, individualized antifungal regimens often involving drug combinations, and timely effective source control. The absence of standardized evidence-based guidelines necessitates larger datasets and consolidated case-level data to inform optimal treatment strategies.
  • Published in:Journal of Fungi,
  • Study Type:Systematic Review with Case Report,
  • Source: 10.3390/jof11100735, PMID: 41149925
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