{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:19:51Z","timestamp":1767845991097,"version":"3.49.0"},"reference-count":25,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Candida krusei empyema is a rare but serious manifestation of invasive candidiasis, characterized by intrinsic resistance to fluconazole, biofilm formation, and high mortality, with limited case-level data to inform management. This review aims to systematically identify and synthesize all reported English-language cases of Candida krusei empyema from January 2005 to June 2025 using PubMed, ScienceDirect, OVID MEDLINE, and Gale OneFile and perform descriptive analysis on them. Screening, data extraction, and eligibility assessment were performed, and those articles not clearly meeting eligibility criteria were reviewed by additional reviewers with consensus resolution. Seven publications (six individual cases and two cohorts) were included. We additionally describe the clinical course, management, and outcome of a 70-year-old bilateral lung transplant patient who developed persistent C. krusei empyema despite optimized antifungal therapy. Patients ranged from 11 to 74 years of age (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). Empiric fluconazole was switched to caspofungin (3\/4), with others receiving amphotericin B, voriconazole, or combination therapy. Source control varied: chest tube drainage (n = 3), percutaneous catheter (n = 3), and surgical decortication (n = 2). Mortality was 14.3% (1\/7). In the absence of clear guidelines and robust literature, the management approach remains heterogeneous. Optimal care requires early recognition, aggressive multimodal antifungal therapy, and effective source control tailored to patient risk. Standardized antifungal protocols and larger case series are needed to guide clinicians in managing this challenging infection.<\/jats:p>","DOI":"10.3390\/jof11100735","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T11:57:42Z","timestamp":1760529462000},"page":"735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Candida krusei Empyema: A Lung Transplant Case and Systematic Review of the Literature"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3073-7134","authenticated-orcid":false,"given":"Shifa","family":"Karatela","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangeeta","family":"Nair-Collins","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4650-0268","authenticated-orcid":false,"given":"Gabriel","family":"Godart","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Ann","family":"Peacock","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5590-622X","authenticated-orcid":false,"given":"Kelly","family":"Larimore","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Cuthbert","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bala","family":"Munipalli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohit","family":"Chitale","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Durvasula","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8122-2232","authenticated-orcid":false,"given":"Justin","family":"Oring","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/mmy\/myaa031","article-title":"Update on Candida krusei, a potential multidrug-resistant pathogen","volume":"59","author":"Jamiu","year":"2021","journal-title":"Med. Mycol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1086\/591033","article-title":"Secular trends in candidemia-related hospitalization in the United States, 2000\u20132005","volume":"29","author":"Zilberberg","year":"2008","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ejim.2016.06.029","article-title":"Candidemia and invasive candidiasis in adults: A narrative review","volume":"34","author":"Antinori","year":"2016","journal-title":"Eur. J. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"myad132","DOI":"10.1093\/mmy\/myad132","article-title":"Pichia kudriavzevii (Candida krusei): A systematic review to inform the World Health Organisation priority list of fungal pathogens","volume":"62","author":"Nguyen","year":"2024","journal-title":"Med. Mycol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Escamilla, J.E., January, S.E., and Vazquez Guillamet, R. (2023). Diagnosis and Treatment of Fungal Infections in Lung Transplant Recipients. Pathogens, 12.","DOI":"10.3390\/pathogens12050694"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s12281-021-00424-8","article-title":"Fungal Infection and Prevention in Lung Transplant","volume":"15","author":"Pennington","year":"2021","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Malinovsk\u00e1, Z., \u010conkov\u00e1, E., and V\u00e1czi, P. (2023). Biofilm Formation in Medically Important Candida Species. J. Fungi, 9.","DOI":"10.3390\/jof9100955"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e0170924","DOI":"10.1128\/aac.01709-24","article-title":"Genomic analyses reveal high diversity and rapid evolution of Pichia kudriavzevii within a neonatal intensive care unit in Delhi, India","volume":"69","author":"Jain","year":"2025","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1099\/00222615-41-5-295","article-title":"Candida krusei: Biology, epidemiology, pathogenicity and clinical manifestations of an emerging pathogen","volume":"41","author":"Samaranayake","year":"1994","journal-title":"J. Med. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.14202\/vetworld.2021.1608-1614","article-title":"Morphological characteristics of Candida albicans, Candida krusei, Candida guilliermondii, and Candida glabrata biofilms, and response to farnesol","volume":"14","author":"Sachivkina","year":"2021","journal-title":"Vet. World."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1089\/sur.2008.073","article-title":"Infections caused by Candida krusei in five transplant and two surgical patients","volume":"10","author":"Bonatti","year":"2009","journal-title":"Surg. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s11046-010-9277-6","article-title":"On a fatal case of Candida krusei pleural empyema in a pregnant woman with spontaneous esophagus perforation","volume":"169","author":"Cascio","year":"2010","journal-title":"Mycopathologia"},{"key":"ref_13","first-page":"DD01","article-title":"A fatal case of fungal empyema due to Candida krusei and Candida tropicalis: A rare occurrence with an atypical presentation","volume":"8","author":"Srinivasnakshatri","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_14","first-page":"8039803","article-title":"Candida krusei Empyema Thoracis: A Community-Acquired Infection Requiring a High Index of Suspicion","volume":"2018","author":"Bukamur","year":"2018","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106749","DOI":"10.1016\/j.ijscr.2021.106749","article-title":"Hybrid transthoracic oesophagectomy due to carcinoma with complications after COVID-19 pneumonia\u2014A case report","volume":"90","author":"Vrba","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1093\/cid\/ciz156","article-title":"Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis","volume":"70","author":"Baker","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"ofaa656","DOI":"10.1093\/ofid\/ofaa656","article-title":"Candida Empyema Thoracis at Two Academic Medical Centers: New Insights Into Treatment and Outcomes","volume":"8","author":"Senger","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2659","DOI":"10.1001\/archinte.160.17.2659","article-title":"Candida krusei fungemia. An escalating serious infection in immunocompromised patients","volume":"160","author":"Abbas","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","article-title":"Global guideline for the diagnosis and management of candidiasis: An initiative of the ECMM in cooperation with ISHAM and ASM","volume":"25","author":"Cornely","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e13623","DOI":"10.1111\/ctr.13623","article-title":"Candida infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"Aslam","year":"2019","journal-title":"Clin. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/1469-0691.12039","article-title":"ESCMID* guideline for the diagnosis and management of Candida diseases 2012: Non-neutropenic adult patients","volume":"18","author":"Cornely","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_22","unstructured":"Ouyang, J., and Andes, D. (2025). Novel Therapeutic Approaches to Control Fungal Biofilms. Fungal Biofilms and Related Infections, Springer."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sutar, Y., Nabeela, S., Singh, S., Alqarihi, A., Solis, N., Ghebremariam, T., Filler, S., Ibrahim, A.S., Date, A., and Uppuluri, P. (2022). Niclosamide-loaded nanoparticles disrupt Candida biofilms and protect mice from mucosal candidiasis. PLoS Biol., 20.","DOI":"10.1371\/journal.pbio.3001762"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ni\u00f1o-Vega, G.A., Padr\u00f3-Villegas, L., and L\u00f3pez-Romero, E. (2024). New Ground in Antifungal Discovery and Therapy for Invasive Fungal Infections: Innovations, Challenges, and Future Directions. J. Fungi, 10.","DOI":"10.3390\/jof10120871"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/s41586-025-08678-9","article-title":"A polyene macrolide targeting phospholipids in the fungal cell membrane","volume":"640","author":"Deng","year":"2025","journal-title":"Nature"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/10\/735\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T12:37:48Z","timestamp":1760531868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/10\/735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,13]]},"references-count":25,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jof11100735"],"URL":"https:\/\/doi.org\/10.3390\/jof11100735","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,13]]}}}