---
title: "Wickerhamomyces anomalus Pseudo-Outbreak Linked to Contaminated Sterile Lubricating Gel in South A"
id: "cdc-emerging-infectious-diseases-journal-2-wickerhamomyces-anomalus-pseudo-outbreak-associated-with-medical-lubricating"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-2-wickerhamomyces-anomalus-pseudo-outbreak-associated-with-medical-lubricating"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article"
published_at: "2026-08-18T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Wickerhamomyces anomalus Pseudo-Outbreak Linked to Contaminated Sterile Lubricating Gel in South A
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-2-wickerhamomyces-anomalus-pseudo-outbreak-associated-with-medical-lubricating
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article)
- **Published At:** 2026-08-18T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- A nationwide review identified 426 patients with culture-confirmed **Wickerhamomyces anomalus** in South Africa during January 1, 2022–April 29, 2024, with a marked cluster of 346 cases (81%) during May–November 2023. - Case-patients generally lacked objective evidence of invasive infection, supporting a **pseudo-outbreak** rather than true clinical disease. - The majority of isolates were from urine (49%) and blood (18%); Gauteng Province reported the largest absolute number of cases and Western Cape the most sterile-site isolates. - Clinical review of 52 patients showed many cultures were considered contamination; procedures such as urinary catheterization and endotracheal intubation were common among patients with positive cultures. - Laboratory testing recovered heavy fungal growth from sealed sachets of a sterile lubricating gel (Lubri-A), and 24 isolates were obtained from gel batches; 62 clinical isolates were cultured. - Species identification used chromogenic agar and MALDI-TOF; antifungal susceptibility testing used Sensititre YeastOne and CLSI M57S epidemiologic cutoff values. - Fluconazole MIC50 was 2 μg/mL for both clinical and gel isolates; most isolates were wild-type for fluconazole and other azoles and for micafungin. Amphotericin B MICs were <1 μg/mL for most isolates; flucytosine MICs differed between clinical and gel isolates. - Whole-genome sequencing was performed on isolates and analyzed with a fungal phylogenomics pipeline; the dataset included 95 genomes, 72 of which were outbreak-associated in the provided text. - Investigators implicated contaminated sterile lubricating gel as the source; a nationwide product recall corresponded with a decline in reported cases. - Specific genomic clustering details, some sequencing results, and full attribution of patient outcomes to W. anomalus were not fully reported in the supplied source text.
## Clinical Analysis & Structured Key Points
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[EID Journal](https://wwwnc.cdc.gov/eid/) 2. [Volume 32](https://wwwnc.cdc.gov/eid/early-release) 3. [Early Release](https://wwwnc.cdc.gov/eid/early-release#issue-1345) 4. [Main Article](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article) * [Facebook](https://www.facebook.com/sharer/sharer.php?u=%2Feid%2Farticle%2F32%2F9%2F26-0608_article "Share to Facebook") * [Twitter](http://twitter.com/share?url=%2Feid%2Farticle%2F32%2F9%2F26-0608_article&text= "Share to Twitter") * [LinkedIn](https://www.linkedin.com/shareArticle?url=%2Feid%2Farticle%2F32%2F9%2F26-0608_article&title= "Share to LinkedIn") * [Syndicate](https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent//eid/article/32/9/26-0608_article "Embed this Page") [ Emerging Infectious Disease journal ISSN: 1080-6059 ](https://wwwnc.cdc.gov/eid/) _Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 9—September 2026 ##### _Dispatch_ ### _Wickerhamomyces anomalus_ Pseudo-Outbreak Associated with Medical Lubricating Gel, South Africa, 2023–2024 On This Page [The Study](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article) * * * [Conclusions](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article) * * * [Suggested Citation](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article) Figures [Figure 1](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-f1) * * * [Figure 2](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-f2) Tables [Table](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-t1) Downloads [Appendix ](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-app1.pdf) * * * [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/9/26-0608.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article) Related Articles [Global Spread of _Trichophyton indotineae_](https://wwwnc.cdc.gov/eid/article/32/9/26-0463_article) * * * [_W. anomalus_ Infections among Injecting Drug Users](https://wwwnc.cdc.gov/eid/article/32/9/25-1817_article) * * * [_T. indotineae_ Dermatophytosis, Singapore, 2025](https://wwwnc.cdc.gov/eid/article/32/6/25-1606_article) * * * [More articles on Fungal](https://wwwnc.cdc.gov/eid/spotlight/fungal) Caroline Maluleka[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#comment) , Husna Ismail, Liliwe Shuping, Ruth Mpembe, Gift Sandhleni, Serisha Naicker, Tsidiso Maphanga, and Nelesh P. Govender Author affiliation: National Institute for Communicable Diseases, Johannesburg, South Africa (C. Maluleka, H. Ismail, L. Shuping, R. Mpembe, G. Sandhleni, S. Naicker, T. Maphanga, N.P. Govender); University of Witwatersrand School of Pathology, Johannesburg (C. Maluleka, L. Shuping, T. Maphanga, N.P. Govender) [Suggested citation for this article](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#suggestedcitation) ### Abstract A nationwide investigation identified 426 patients with _Wickerhamomyces anomalus_ fungal cultures in South Africa; most cases clustered during May–November 2023. Case-patients lacked evidence of infection, indicating a pseudo-outbreak. Genomic and laboratory analyses implicated contaminated sterile lubricating gel. A nationwide product recall resulted in a decline in reported cases. _Wickerhamomyces anomalus_ , an environmental ascomycetous yeast, is associated with healthcare-associated outbreaks among critically ill or immunocompromised patients, but its sources are rarely identified ([_1_](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#r1 "1")–[ _5_](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#r5 "5")). Contaminated medical gel has been implicated in healthcare-associated outbreaks caused by water-associated bacteria ([_6_](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#r6 "6")–[ _11_](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#r11 "11")). In November 2023, the National Institute for Communicable Diseases (NICD) was alerted to an unusually high frequency of _W. anomalus_ isolation at a laboratory in KwaZulu-Natal Province, South Africa. Two hospitals in the Western Cape Province separately identified 2 clusters during July–August 2023. One cluster was associated with recent central venous catheter placements through which blood cultures subsequently were collected; a sterile lubricating gel (Lubri-A sterile lubricating jelly; Electro-Spyres, [External Link](https://www.electrospyres.com)) was used in the ultrasound-guided catheter insertion procedure and was a suspected source of pseudo-infections. We investigated the extent, source, and clinical relevance of a nationwide pseudo-outbreak. ### The Study We reviewed National Health Laboratory Service (NHLS) records for patients at public-sector healthcare facilities with culture-confirmed _W. anomalus_ from any specimen type during January 1, 2022–April 29, 2024. We removed repeat isolates from the same patient within 30 days. We contacted laboratories to determine whether increased detection coincided with introduction of the Vitek MS system (bioMérieux, [External Link](https://www.biomerieux.com)). We retrospectively collected clinical case data at 2 hospitals. We received _W. anomalus_ isolates cultured from clinical specimens and unopened sterile lubricating gel sachets in circulation at healthcare facilities. We subcultured the isolates onto chromogenic agar (Candida CHROMagar, [External Link](https://www.chromagar.com)) and incubated them in ambient air at 35–37°C for 18–24 hours. We confirmed species identification by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI BioTyper; Bruker, [External Link](https://www.bruker.com)). We performed antifungal susceptibility testing by using the Sensititre YeastOne method (Thermo Fisher Scientific, [External Link](https://www.thermofisher.com)). We interpreted MICs by using the Clinical and Laboratory Standards Institute M57S epidemiologic cutoff values ([_12_](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#r12 "12")). We analyzed whole-genome sequences, generated by the NextSeq platform (Illumina, [External Link](https://www.illumina.com)), by using FungiPhyloGen pipeline ( [External Link](https://zenodo.org/records/18121445)). We assessed sequence quality by using FASTQC version 0.11.9 ( [External Link](https://sourceforge.net/projects/fastqc.mirror/files/v0.11.9)) and MultiQC version 1.13 ( [External Link](https://github.com/MultiQC/MultiQC/releases)), followed by trimming with TrimGalore version 0.6.7 ( [External Link](https://github.com/FelixKrueger/TrimGalore/releases)). We aligned filtered reads to a reference strain from the United States (_W. anomalus_ NRRL Y-366-8) ([_13_](https://wwwnc.cdc.gov/eid/article/32/9/26-0608_article#r13 "13")) by using BWA version 0.7.19 ( [External Link](https://github.com/lh3/bwa/releases)). We annotated high-confidence single-nucleotide polymorphisms (SNPs) (allele frequency >0.85) and used them for distance matrix generation and phylogenetic reconstruction with IQ-TREE version 2.2.0.3 ( [External Link](https://iqtree.github.io)) by using 1,000 bootstrap replicates to assess clade support. Figure 1 ![Annotated epidemic curve of Wickerhamomyces anomalus infection cases, by epidemiologic week, South Africa, January 1, 2022–April 29, 2024. Normally sterile-site specimens were those obtained from anatomical sites expected to be free of viable microorganisms. Nonsterile-site specimens were those obtained from sites normally colonized by microbiota or exposed to the external environment. Lubri-A refers to Lubri-A sterile lubricating jelly \(Electro-Spyres, https://www.electrospyres.com\), Vitek MS to the Vitek MS system \(bioMérieux, https://www.biomerieux.com\). NHLS, National Health Laboratory Service, SAPHRA, South African Health Products Regulatory Authority. ](https://wwwnc.cdc.gov/eid/images/26-0608-F1-tn.jpg) [Figure 1](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-f1 "Figure 1"). Annotated epidemic curve of _Wickerhamomyces anomalus_ infection cases, by epidemiologic week, South Africa, January 1, 2022–April 29, 2024. Normally sterile-site specimens were those obtained from anatomical sites expected to... We identified 426 cases across 7 of 9 provinces in South Africa over the study period ([Figure 1](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-f1)). Before April 1, 2023, the baseline was 2–3 cases per facility per month; 346/426 (81%) cases occurred during May–November 2023. The increase did not coincide with introduction of the Vitek MS system. The most frequent specimen categories were urine (207/426 [49%]) and blood (77/426 [18%]) ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-app1.pdf) Figure 1). Gauteng Province had the highest number of cases (180/426 [42%]), and Western Cape Province had the highest number of cases from sterile sites ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-app1.pdf) Figure 2). Clinical information was available for 52/426 (12%) case-patients ([Table](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-t1)). Median age was 23 years (interquartile range 0–47 years); 31/49 (63%) patients were male, and 21 (37%) female. Among 51 of the 52 patients, _W. anomalus_ was recovered from urine (26 [51%]), tracheal aspirate (13 [26%]), peritoneal dialysis fluid (6 [12%]), and blood (4 [8%]). Among 37 patients with procedure information, 23 (62%) underwent urinary catheterization and 12 (32%) underwent endotracheal intubation; procedures were not mutually exclusive. For 48 patients whose samples were positive for _W. anomalus_ , clinicians considered the positive culture as contamination in 20 (42%) and clinically relevant in 28 (58%) patients: urinary tract infection in 15 (31%), lower respiratory tract infection in 8 (17%), and bloodstream infection in 2 (4%). Antifungal treatment was administered to 10 (23%) of 44 patients for whom treatment information was available. However, objective evidence of infection such as signs of sepsis or elevated levels of inflammatory biomarkers was absent or incompletely documented. Only 5 patients had _W. anomalus_ isolated from subsequent cultures. Among 50 patients with known outcomes, 30 (60%) were discharged, 6 (12%) remained hospitalized, and 14 (28%) died; available data were insufficient to attribute deaths to _W. anomalus_ infection ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-app1.pdf) Figure 2). Of 86 isolates, 62 (72%) were cultured from clinical specimens and 24 (28%) from gel batches. Sealed gel sachets uniformly yielded heavy fungal growth. We confirmed 85 (99%) isolates as _W. anomalus_ ; we excluded 1/86 (1%) _Candida albicans_ isolate. Seventeen clinical isolates and 11 gel isolates underwent susceptibility testing. Fluconazole MIC50 (MIC at which 50% of a specific isolate population is inhibited from growth) was 2 μg/mL for clinical and gel isolates. Fluconazole MICs were 1 μg/mL. Flucytosine MICs were 0.06 μg/mL for all 17 clinical isolates, whereas 9/11 (82%) gel isolates had MICs >64 μg/mL ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-app1.pdf) Table 1). Figure 2 ![Whole-genome SNP phylogeny of Wickerhamomyces anomalus clinical, gel, surveillance, and reference isolates, South Africa. Red box indicates cluster 1; blue box indicates cluster 2. Scale bar indicates mean number of nucleotide substitutions per variable site. Node values represent ultrafast bootstrap support percentages based on 1,000 replicates. GA, Gauteng Province; KZ, KwaZulu–Natal Province; MP, Mpumalanga Province; NA, not applicable; NC, Northern Cape Province; NCBI, National Center for Biotechnology Information; NW, North West Province; WC, Western Cape Province; SNP, single-nucleotide polymorphism; USA, United States.](https://wwwnc.cdc.gov/eid/images/26-0608-F2-tn.jpg) [Figure 2](https://wwwnc.cdc.gov/eid/article/32/9/26-0608-f2 "Figure 2"). Whole-genome SNP phylogeny of _Wickerhamomyces anomalus_ clinical, gel, surveillance, and reference isolates, South Africa. Red box indicates cluster 1; blue box indicates cluster 2. Scale bar indicates mean number... The phylogenetic dataset included 95 genome sequences. Of those, 72 (76%) were current outbreak isolates (GenBank BioProje
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