Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Abstract

Background Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood. Objective To elucidate the clinical features of Candida empyema. Methods We retrospectively reviewed the cases of 128 patients with culture-positive empyema. Results These 128 patients included 7 whose cause of empyema was esophago-or gastropleural fistula. Empyema was due to Candida species in 5 of the 7 patients. Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. None of these 5 patients had esophageal candidiasis. Among the 121 other patients with empyema not due to esophago-or gastropleural fistula, no patient had empyema due to Candida. Conclusion We believe that the empyema in these 5 patients was caused by normal commensal Candida species entering the pleural cavity when the fistula between the gastrointestinal tract and pleural cavity was formed. Isolation of Candida species can be an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.

CandidaEmpyema Thoracis at a Hospital in Taiwan

“…This epidemiologic finding was similar to that in previous studies [8,9]. In one study of 73 clinical fungal isolates from pleural effusions, C. albicans was the most frequent isolate (n = 28, 38%), followed by C. glabrata (n = 13, 18%) and C. tropicalis (n = 13, 18%) [7].…”

“…In one study of 73 clinical fungal isolates from pleural effusions, C. albicans was the most frequent isolate (n = 28, 38%), followed by C. glabrata (n = 13, 18%) and C. tropicalis (n = 13, 18%) [7]. Another study, of five patients with Candida empyema thoracis, found that four cases were caused by C. albicans and one by C. glabrata [9]. In the present work, we found one patient (Case 2) with a concomitant P. aeruginosa infection.…”

“…Blood stream infection and urinary tract infection are the most common types of invasive candidiasis [6]. Recently, another rare clinical entity, Candida spp.-associated empyema thoracis, has been emerging [7][8][9][10][11]. However, knowledge about this clinical entity is limited.…”

Isolated secondary fungal infections of pleural cavity

“…Maliginite, immun supresyon, kemoradyoterapi, uzun süreli antibiyotik kullanımı gibi nedenlerle bronkopulmoner yayılım görülebilmektedir [5]. Kandida pnömonisi genellikle AİDS veya transplant alıcısı olan hastalar ile özefagial ve gastroplevral fistülü olan hastalarda izlenmekte olup, tanısı güçlükle konur [3,[5][6][7][8].…”

“…Literatürde tedavi yaklaşımı dekortikasyon sonrası tüp torakostomi ve plevral irrigasyondur [5,[7][8][9]. Plevral aspergilloz akut ve kronik aspergillus ampiyemi olarak 2 klinik formda izlenir [10].…”