Candida Lipolytica

Invasive fungi infections are an increasing problem in hospital acquired infections and frequently cause death in patients who are immunocompromised and debilitated. Aspergillus and Candida are the two main types of isolates. Candida refers to a group of fungi in which there are many species though only a few are pathogenic. Candida lipolytica was not thought to be one, but recently it has appeared in more cases as an emerging pathogen, though it is a weak one, with reports in both adult and pediatric fungemia cases, as well as being the cause of some refractory oral candidiasis patients. In particular it is linked to catheter-acquired candidemia.

Catheter-acquired candidemia is a problem for patients in intensive care units, receiving surgery, transplants, neonatal care, oncology and burn care. Candidemia has a worrying 38 to 40% mortality rate. For a long time Candida albicans was the main pathogenic species that was isolated from blood specimens, but other non albicans candida species are on the rise including Candida tropicalis, Candida guilliermondii, Candida krusei, Candida lusitaniae and now Candida lipolytica.

At risk patients
Patients more at risk of Candida lipolytica infection are;

  • bone marrow transplant recipients
  • chronic sinusitis
  • hematological disorders such as leukemia
  • vascular catheter-related infections
  • traumatic ocular infections
  • central venous catheter
  • tubercular meningitis
  • patients who are severely immunocompromised

Candida lipolytica has been identified in;

  • refrigerated meat products
  • petroleum products
  • agricultural processing plants
  • soil
  • the mouth
  • pulmonary tree
  • intestines

Case reports of Candida lipolytica

  1. A patient receiving allogeneic bone marrow transplantation had Candida lipolytica recovered from their blood and their central venous catheter. It was susceptible to amphotericin B, itraconazole and fluconazole. In vitro testing found Candida lipolytica is capable of making a large amount of viscid slime which is probably how it is able to adhere to the surface of the catheter.
  2. An 18 year old woman with stage II remission acute lymphoblastic leukemia underwent a bone marrow transplant. Before intensive chemotherapy a central venous catheter was inserted. She was given anti-fungal prophylactic treatment. However on day 46 she had a fever that did not respond to antimicrobials and on day 48 the yeast Candida lipolytica was found in her blood cultures. She was treated with Amphotericin B for 10 days and the blood cultures were negative, but then the fever reappeared and Candida lipolytica was found again. Though there was no tenderness or signs at the catheter site, it was taken out and replaced. The patient then recovered.

Conclusion
In all reported cases of Candida lipolytica it has found to be only weakly virulent and nearly always related to a catheter line. When this is removed and anti-fungal treatment given, the patient responds. Candida lipolytica does not come with a high mortality rate as other hospital-acquired candida species do. It should be included on the list of emerging pathogens and should encourage hospitals to develop better strategies in patient management.

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