Candida haemulonii complex, an emerging threat from tropical regions?

PLoS Negl Trop Dis. 2023 Jul 31;17(7):e0011453. doi: 10.1371/journal.pntd.0011453. eCollection 2023 Jul.


Background: Candida haemulonii complex-related species are pathogenic yeasts closely related to Candida auris with intrinsic antifungal resistance, but few epidemiological data are available.

Methodology/principal findings: We analyzed clinical and demographic characteristics of patients with fungemia due to C. haemulonii complex and related species (C. pseudohaemulonii, C. vulturna) reported in France during 2002-2021, and compared them to data of C. parapsilosis fungemia, as they all can be commensal of the skin. We also conducted a study on adult inpatients and outpatients colonized by C. haemulonii complex, managed at the University Hospital of Martinique during 2014-2020. Finally, we performed a literature review of fungemia due to C. haemulonii complex and related species reported in Medline (1962-2022). In total, we identified 28 fungemia due to C. haemulonii complex in France. These episodes were frequently associated with bacterial infection (38%) and high mortality rate (44%), and differed from C. parapsilosis fungemia by their tropical origin, mainly from Caribbean and Latin America. All isolates showed decreased in vitro susceptibility to amphotericin B and fluconazole. In Martinique, we found that skin colonization was frequent in the community population, while colonization was strongly associated with the presence of foreign devices in ICU patients. The literature review identified 274 fungemia episodes, of which 56 were individually described. As in our national series, published cases originated mainly from tropical regions and exhibited high crude mortality.

Conclusions/significance: Multidrug-resistant C. haemulonii complex-related species are responsible for fungemia and colonization in community and hospital settings, especially in tropical regions, warranting closer epidemiological surveillance to prevent a potential C. auris-like threat.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use
  • Candida / genetics
  • Candidiasis* / epidemiology
  • Candidiasis* / microbiology
  • Fungemia* / epidemiology
  • Fungemia* / microbiology
  • Hospitals, University
  • Humans
  • Microbial Sensitivity Tests


  • Antifungal Agents

Supplementary concepts

  • Candida haemulonis

Grants and funding

This work was supported by Santé Publique France (UF, MDO,YLG, KS, RV, SP, TC, EM, AP, MN,NDG,OL) and Institut Pasteur (UF, MDO,YLG, KS, RV, SP, TC, EM, AP, MN,NDG, OL). The funders had no role in study design, data collection, analysis, or interpretation of data.