Emergence of a Candida krusei isolate with reduced susceptibility to caspofungin during therapy

Abstract

Clinical failure associated with reduced susceptibility to caspofungin has been described in Candida albicans and C. parapsilosis. We report a case of Candida krusei infection that progressed despite caspofungin therapy. Reduced microbial susceptibility to all three echinocandins (caspofungin, anidulafungin, and micafungin) was noted but was not associated with mutations in FKS1.

FIG. 1.

Fundoscopic appearance of right eye lesion (indicated by the arrows) at presentation (A) and after 2 weeks of liposomal amphotericin B followed by 4 weeks of voriconazole (B).

FIG. 2.

HinfI restriction endonuclease digestion patterns of C. krusei isolates. Lane 1, unrelated C. krusei isolate; lane 2, patient's blood isolate; lane 3, patient's throat isolate. A DNA molecular size ladder (kb) is shown to the left of the gel.