Thoracic empyema due to Candida albicans

Baradkar, VP; Mathur, M; Kulkarni, SD; Kumar, Simit

doi:10.4103/0377-4929.41699

Cited by 16 publications

(14 citation statements)

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“…On the basis of this experience, we investigated previous clinical reviews of Candida empyema, of which there have been a limited number (6,7), and several sporadic case reports (8)(9)(10)(11)(12)(13). These patients often suffered from esophageal rupture and showed mixed infection with oropharyngeal organisms (8)(9)(10)(11)(12)(13). Thus, we hypothesized that isolation of Candida species from the pleural fluid of empyema might be a useful marker for suspecting esophago-or gastropleural communication.…”

Section: Introductionmentioning

confidence: 99%

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

Ishiguro¹,

Takayanagi²,

Ikeya

et al. 2010

Intern. Med.

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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.

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Section: Introductionmentioning

confidence: 99%

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

Ishiguro¹,

Takayanagi²,

Ikeya

et al. 2010

Intern. Med.

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“…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].…”

Section: Discussionunclassified

“…A.fumigatusun neden olduğu plevral fungal enfeksiyonlarda kronikleşme süreci-ne daha sık rastlanmaktadır. Bu hastalarda fibrotik skar dokusu oluşumu ve rezidüel boşluğun çok geniş olması nedeniyle ıtrakanazol dokulara çok iyi nüfus edemez ve tedavi genellikle başarısız olur [6]. Serimizdeki 5 hastamızda kronikleşme izlenmedi.…”

Section: Discussionunclassified

Isolated secondary fungal infections of pleural cavity

Ergin

Yeginsu²,

Zeybek³

et al. 2013

J Clin Exp Invest

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Objectives: Pleural fungal infections are rare, but the incidence has been increasing with immunosuppressant diseases and use of immunosuppressive medications. In this report, we present 6 patients with pleural effusions that have been determined fungal infection. Methods:The medical records of patients with followed and treated due to fungal infection of the pleural were retrospectively reviewed. Result:The 6 cases whom was 58 of the value median for age were treated as surgical and medical due to fungal infection of the pleural cavity. Dyspnea, cough and chest pain were the most common symptoms. Fever, night sweats and expectoration are relatively rare. In 4 patients, the infections of pleural cavity developed on the bases of rheumatoid arthritis, tuberculosis, pleural mesothelioma and esophagopleural fistula. In two patients had isolated fungal infections. Cultural positivity was seen in 5 patients. Fungal hyphae were determined by cytopathology in all of the patients.As a surgical procedure, all of the patients underwent decortication or pleural biopsy and pleural irrigation. In all patients, antifungal agents were added to surgical procedures. Full recovery of infection was seen in 5 patients. One patient died. Conclusion:In immunosuppressive patients, the incidence of pleural effusions due to or associated with fungal infections are more common. Addition to culture of pleural fluid, histopathological evaluation of pleura will aid diagnosis. J Clin Exp Invest 2013; 4 (4): 468-471Key words: Lung, fungal infection, pleural effusion ÖZET Amaç: Plevral mantar enfeksiyonları nadirdir. İmmünsup-resif hastalıkların ve immünsupresif tedavilerin artışı ile plevral mantar enfeksiyonlarının insidansı da artmaktadır. Bu klinik çalışmada, plevral mantar enfeksiyonuna bağlı plevral effüzyon izlenen hastalar literatür verileri eşliğinde gözden geçirildi.Yöntemler: Plevral mantar enfeksiyonu nedeniyle takip ve tedavi edilen hastalara ait medikal kayıtlar retrospektif olarak gözden geçirildi. Bulgular:Yaş median değeri 58 yıl olan 6 vaka plevral kavitenin mantar enfeksiyonu nedeni ile cerrahi ve medikal tedavi aldı. Radyolojik değerlendirmelerde tüm hastalarda değişik derecede plevral efüzyon izlendi. Hastalar sıklıkla dispne, öksürük ve göğüs ağrısı daha nadir ateş, gece terlemesi semptomlarına sahipti. Plevral mantar enfeksiyonu; 6 hastanın 4'ünde romatoid artrit, tüberküloz, mezotelyoma ve özefagoplevral fistüle sekonder geliş-mişti. İki hastada ise izole mantar enfeksiyonu saptandı. Hastaların tümünde plevral dokunun histopatolojik değer-lendirilmesi ile fungal hifler rapor edildi. Mikrobiyolojik olarak mantar kültür pozitifliği 5 hastada bildirildi. Hastalara cerrahi işlem olarak dekortikasyon, plevral biopsi, primer özefagial onarım ile yaklaşıldı. Tüm hastalara cerrahi iş-lemin yanı sıra antifungal ajanlar parenteral tedaviye eklendi. Beş hastada tam bir iyileşme izlenirken, bir hasta kaybedildi.Sonuç: İmmünsupresif veya genel durumu bozuk hastalarda, mantar enfeksiyonlarına bağlı radyolojik tetkiklerde sıklı...

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“…Fungal empyema thoracis is a rare form of this condition with especially high mortality, in which the most frequently isolated fungus is Candida spp [1]. A high index of suspicion is required to diagnose this condition, as it may present as a community-acquired infection [2]. …”

Section: Introductionmentioning

confidence: 99%

Candida krusei Empyema Thoracis: A Community-Acquired Infection Requiring a High Index of Suspicion

Bukamur

Ahmed

Numan

et al. 2018

Case Reports in Infectious Diseases

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Empyema thoracis is a serious condition characterized by the accumulation of purulent fluid in the pleural cavity, typically following a pneumonia, subdiaphragmatic abscess, or esophageal rupture. Fungal empyema thoracis is a rare form of this condition with especially high mortality, in which the most frequently isolated fungus is Candida spp. This article presents a 74-year-old female with Candida krusei pneumonia and a complicated hospital course, initially presenting with nausea, vomiting, and dysphagia. She was initially suspected to have community-acquired pneumonia and was started on azithromycin and ceftriaxone. Worsening respiratory function led to the diagnosis of hydropneumothorax. Pleural fluid and an independent sample of pus and pleural tissue grew Candida krusei, giving the diagnosis of fungal empyema. With further respiratory deterioration, the patient was intubated and switched to piperacillin/tazobactam and micafungin. Decortication with extensive pleural peel and removal of foul-smelling pus and food particles within the chest was performed. This further lead to confirmation of esophageal perforation, and she was started on voriconazole and meropenem. After developing septic shock, the patient was managed with phenylephrine and vasopressin. Finally, after improving she was weaned off pressors and extubated, followed by an esophagogastroduodenoscopy (EDG) with pneumatic balloon dilation and WallFlex stent placement. This patient's case demonstrated an example of empyema thoracis, which required a high index of suspicion since the presentation was with a community-acquired infection. Candida empyema thoracis may be a complication of operation, gastroesophageal fistula, and spontaneous esophageal rupture. On the other hand, the course of this patient's hospital stay progressed from esophageal perforation to Candida krusei pneumonia, empyema, and pneumothorax. Thus, community-acquired fungal empyema should be considered in patients with respiratory symptoms and suspected esophageal perforation; nevertheless, after a diagnosis of fungal empyema, esophageal perforation should also be ruled out in addition to other causes like pneumonia, subphrenic abscess, and hematogenous spread. Improved communication between clinicians and microbiologists can lead to early diagnosis and a reduction in the morbidity and mortality of this condition.

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Thoracic empyema due to Candida albicans

Cited by 16 publications

References 0 publications

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

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

Isolated secondary fungal infections of pleural cavity

Candida krusei Empyema Thoracis: A Community-Acquired Infection Requiring a High Index of Suspicion

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