The First Reported Case of Colonic Infection Caused by Candida tropicalis and a Review of the Literature

Abstract

Lower gastrointestinal tract infections caused by Candida species are rarely reported, and Candida albicans is the only pathogen that has been identified. The author reports a first case of colonic candidiasis caused by Candida tropicalis in a 55-year-old female with diabetes mellitus type 2, diffuse large B-cell lymphoma and neutropenia induced by chemotherapy. Diarrhea and fever were the presenting symptoms. Diagnosis was made based on deep tissue involvement on colonoscopy with biopsy and positive hemoculture. This alerted the physician to be aware of Candida non-albicans as a cause of colonic infection. Fungal culture should always be done to identify specific Candida species, leading to appropriate antifungal therapy. A review of the literature on colonic candidiasis is also presented here.

Inherited CARD9 deficiency in otherwise healthy children and adults with Candida species–induced meningoencephalitis, colitis, or both

“…Interestingly, Candida meningitis has been reported in five patients with inherited CARD9 deficiency 49–51 , whereas two other patients with CARD9 deficiency developed brain abscesses, caused by Exophiala in one patient 52 and possibly by Trichophyton in the other 15 . Candida causes colitis even less frequently than meningo-encephalitis, with only 25 cases reported, in a context of neutropenia, cancer, lymphoma, systemic lupus erythematosus, acquired immunodeficiency syndrome, corticosteroid treatment or preterm neonates 53–61 . We therefore sequenced CARD9 in five unrelated patients: four with Candida spp.…”

Sampling of Candida albicans and Candida tropicalis by Langerin-positive dendritic cells in mouse Peyer’s patches

“…C. albicans is also recognized as one of the dominant colonizers associated with inflammatory bowel diseases (IBD) like Crohn's and Hirschprung-associated enterocolitis [4][5][6][7][8][9] . Another constitute of the normal flora, Candida tropicalis has also been associated with colonic infections in immune compromised patients [10,11].…”

Fungal infection of the colon

“…At present, histoplasmosis, 20 , 21 candidiasis, 13 and zygomycosis 22 – 25 have already been reviewed. In cases of other fungal infections, including cryptococcosis, 26 – 35 penicilliosis, 36 – 38 aspergillosis, 9 , 39 – 44 and paracoccidioidomycosis, 45 – 50 the author summarized case reports, as shown in Tables 1 – 4 .…”

“…Colonic cryptococcosis and zygomycosis often occur in immunocompromised hosts, occurring in 77% 26 – 35 and 67% 22 of infections respectively, while colonic candidiasis, 13 penicilliosis, 36 – 38 and aspergillosis 9 , 39 – 44 exclusively occur in immunocompromised hosts. Risk factors for these infections are malignancy, taking immunosuppressive agents, chemotherapy, neutropenia, AIDS, renal failure, splenectomy, Job’s syndrome, cirrhosis, malnutrition, and diabetes mellitus; however, most colonic penicilliosis patients usually have AIDS.…”

“…are normal commensals of the human gut. 13 , 53 , 54 Aspergillus spp. are ubiquitous, thus sex is also not a risk factor for infection.…”