Fungal Infections Caused by Kazachstania spp., Strasbourg, France, 2007-2020

Abstract

Rare fungal pathogens are emerging as agents of invasive fungal infections. We analyzed 13 cases of fungal infections caused by Kazachstania (Arxiozyma) spp. in Strasbourg University Hospital, Strasbourg, France. Among the cases, 4 patients had proven fungal disease (3 cases of invasive fungal disease and 1 mucocutaneous infection) and 9 were colonized by Kazachstania (Arxiozyma) spp. Candida albicans was also isolated from 11 of the 13 patients. None of the patients with proven invasive fungal disease met host criteria, but most had underlying diseases. All strains were identified as K. telluris by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and 3 were confirmed as K. bovina by internal transcribed spacer sequencing. For all tested strains, the MICs for fluconazole were >2 μg/mL. Emergence of this rare fungal infection might be explained by the increasing number of patients with immunocompromised conditions and gastroesophageal diseases.

Keywords: Candida; France; Kazachstania; emerging infection; fungi; invasive fungal disease; yeast.

Figure 1

Clinical and radiologic characteristics of mediastinitis caused by Kazachstania bovina (patient 2), Strasbourg, France. A) Computed tomography image demonstrating stomach ulceration (arrow), mediastinitis, and pleuritis. B) Photograph taken after right-side thoracotomy, showing posterior stomach ulceration (arrow) and false membranes (stars). Culture of biopsy samples grew K. bovina, Candida albicans, C. glabrata, and bacteria.

Figure 2

Macroscopic and microscopic examinations of Kazachstania bovina from a patient in Strasbourg, France. A) Macroscopic aspect of K. bovina on 3 agar media: Sabouraud (top), CHROMID Candida (bioMérieux, https://www.biomerieux.fr) (lower left), and CHROMagar Candida (Becton Dickinson, https://www.bd.com) (lower right). B) K. bovina slide-culture on potato carrot bile agar (incubation for 72 h at 27°C, original magnification ×400), showing spherical to ellipsoidal yeast cells with multilateral budding, without filamentation, and some asci containing ascospores.