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

Summary

Candida krusei is a dangerous yeast that causes a serious lung infection called empyema, where pus collects around the lungs. This infection is particularly difficult to treat because the yeast is resistant to common antifungal drugs like fluconazole and can form protective biofilms. This systematic review identified only ten cases of this rare infection in the medical literature, showing how uncommon but serious it is, and found that patients need aggressive treatment with multiple antifungal medications combined with surgical drainage to survive.

Background

Candida krusei empyema is a rare but serious manifestation of invasive candidiasis characterized by intrinsic fluconazole resistance, biofilm formation, and high mortality rates. The organism is increasingly reported in non-albicans Candida infections, particularly in immunocompromised patients. 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.

Results

Seven publications (six individual cases and two cohorts) were included, totaling nine published cases plus one new case for a total of ten. Patients ranged from 11 to 74 years (median 62.5 years). Predisposing factors included esophageal perforation (n=4), post-transplant hemorrhage (n=1), community-acquired empyema (n=1), and thoracic surgery (n=1). Treatment varied including caspofungin, amphotericin B, voriconazole, and combination therapy. Overall mortality was 14.3% (1/7) from empyema directly, with 42.8% all-cause mortality.

Conclusion

Candida krusei empyema is a rare but severe infection requiring early recognition, aggressive multimodal antifungal therapy, and effective source control. The absence of clear guidelines results in heterogeneous management approaches. Standardized antifungal protocols and larger case series are needed to optimize clinical outcomes.
  • Published in:Journal of Fungi,
  • Study Type:Systematic Review with Case Report,
  • Source: PMID: 41149925, DOI: 10.3390/jof11100735
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