Candida krusei pneumonia as a complication of a tuboovarian abscess treatment – case report
Abstract
Background: Frequency of infections, caused by Candida glabrata and Candida krusei, which are more resistant to fluconazole, is increasing among hospitalised patients, especially among patients in intensive care units (ICU). Systemic Candida infections are particularly dangerous. Pneumonia, caused by Candida species, most commonly albicans, rarely others, is a serious infection especially for immunocompromised patients. It’s often fatal. We present a case report of a serious lung infection with fluconazole resistant Candida krusei in a 42-year-old previously healthy patient with perforated tuboovarian abscess (TOA), consecutive severe sepsis and septic shock. Patient used intrauterine device (IUD) for 17 years without any gynaecological controls. Ascending genital infection with E.colli and Staph. chromogenes led to TOA. In spite of empirical antibiotic treatment, surgical and intensive care supportive therapy of affected organs, patient’s condition critically deteriorated until exact fungus specification was made and specific antifungal therapy for Candida krusei with voriconazol was started. After that patient’s condition improved.
Conclusions: Connection between patient’s age, IUD use duration and severity of the pelvic inflammatory disease (PID) was seen as multiorgan septic dysfunction with dominant lung failure. Candida pneumonia is rare with non-neutropenic patients. Especially with »non albicans« species. We believe Candida krusei infection in our patient is related to general weakness and immunocompromised condition because of prolonged and severe PID. Candida krusei infection needs immediate specific antifungal treatment. It was the first Candida krusei infection in our ICU.
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References
Lin MY, Carmeli Y, Zumsteg J, Flores LE, Tolentino J, Sreeramoju P et all. Prior antimicrobal therapy and risk for hospital acquired Candida glabrata and Candida krusei fungemia: a case case control study. Antimicrob Agents Chemother 2005; 49: 4555–60.
Petrocheilou-Paschou V, Georgilis K, Kontoyannis D, Nanas J, Prifti H, Costopoulos H, et al. Pneumonia due to Candida krusei. Clin Microbiol Infect 2002; 8: 806–9.
Mikamoto H, Ninomiya M, Tamaya T. Tuboovarian abscess caused by Candida glabrata in a febrile neutropenic patient. J Infect Chemother 2003; 9: 257–9.
Viberga I, Odlind V, Berglund L. Older age is a risk factor for pelvic inflammatory disease in intrauterine device users. Acta Obstet Gynecol Scand 2005; 84: 1202–7.
Halperin R, Lvinson O, Yaron M, Bukovsky I, Schneider D. Tuboovarian abscess in older woman: is a womans’s age a risk factor for failed response to conserrvative treatment? Gynecol Obstet Invest 2003; 55: 211–5.
Felz MW, Apostol CJ. Fatal pneumococcal sepsis from tuboovarian abcsess. JAABFP 2004; 17: 68–70.
King JA, Olsen TG, Lim R, Nycum LR. Pseudomonas aeruginosainfected IUD associated with pelvic inflammatory disease. A case report. J Reprod Med 2002; 47: 1035–7.
Tsanadis G, Kalantaridou SN, Kaponis A, Paraskevaidis E, Zikopoulos K, Gesouli E, et all. Bacteriological cultures of removed intrauterine devices and pelvic inflammatory disease. Contraception 2002; 65: 339–42.
Reron A, Huras H, Was K. Severe infectious complications after an excessively long use of intrauterine device. Ginekol Pol 2003; 74: 371–6.
Seshadri S, Kirwan J, Neal T. Perimenopausal pneumococcal tubo-ovarian abscess — a case report and review. Infect Dis Obstet Gynecol 2004; 12: 27–30.
Steen R, Shapiro K. Intrauterine contraceptive devices and risk of pelvic inflammatory disease: standard of care in high STI prevalence settings. Reprod Health Matters 2004; 12: 136–433.
Harun R, Nayar S, Thum YL. Bacteriological study of extracted IUCDs. Malays J Reprod Health 1989; 7: 131–7.
Pappas PG, Rex JH, Sobel JD. Guidelines fot treatment of candidiasis. Clin Infec Dis 2004; 38: 161–89.
Weigand MA, Lichtenstern C, Bottiger BW. Antifungal therapy in Surgical ICU patients. In: Vincent JL, ed. Yearbook of intensive care and emergency medicine. March, 2006: Brusselles, Belgium, 21–4.
Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonisation and subsequent infection in critically ill surgical patients. Ann Surg 1994; 220: 751–8.
Nucci M, Anaissei E. Revisiting the source of candidemia: skin or gut? Clin Infect Dis 2001; 33: 1959–67.
Du Pont H, Bourichon A, Paugam-Burtz C, Mantz J, Desmonts JM. Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis? Crit Care Med 2003; 31: 752–7.
Sandoven P, Qvist H, Skovlund E, Giercksky KE. Significance of Candida recovered from intraoperative specimens in patients with intraabdominal perforations. Crit Care Med 2002; 30: 541– 7.
Eggimann P, Francioli P, Bille J. Fluconazole prophylaxis prevents intra abdominal candidiasis in high risk surgical patients. Crit Care Med 1999; 27: 1066–71.
Eiggimann P, Pittet D. Candida colonisation index in management of critically ill patients. In: Vincent JL, ed. Yearbook of intensive care and emergency medicine March, Brusselles, Belgium, 2006: 21–4.
Weinberger M, Leibovici L, Perez S, Samra Z, Ostfeld I, Levi I, et al. Characteristics of candidaemia with Candida albicans compared with non albicans Candida species and predictors of mortality. J Hosp Infect 2005; 61: 146–54.
Carmelli Y, Eliopoulus GM, Samore MH. Antecedent treatment with different antibiotic agents as a risk factor for vankomycin resistant Enterococcus. Emerg Infect Dis 2002; 8: 802–7.
Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y. Fluoroquinolones and the risk for methicillin resistant Staphylococous aureus in hospitalized patients. Emerg Infec Dis 2003; 9: 1415–229.
Almirante B, Rodriguez D, Park BJ, Cuenca-Estrella M, Planes AM, Almela M, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 2005; 43: 1829–35.
Piarroux R, Grenouillet F, Balvay P, Tran V, Blasco G, Millon L, et all. Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med. 2004; 32: 2443–9.
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