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TUBERCULOSIS INFECTION MIGHT INCREASE THE RISK OF INVASIVE CANDIDIASIS IN AN IMMUNOCOMPETENT PATIENT.

Chen XH, Gao YC, Zhang Y, Tang ZH, Yu YS, Zang GQ - Rev. Inst. Med. Trop. Sao Paulo (2015 May-Jun)

Bottom Line: The 19-year-old man complained of month-long fever and lower back pain.He also had a history of scalded mouth syndrome.Symptoms improved considerably after antifungal and antituberculous therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

ABSTRACT
Deep Candida infections commonly occur in immunosuppressed patients. A rare case of a multiple deep organ infection with Candida albicans and spinal tuberculosis was reported in a healthy young man. The 19-year-old man complained of month-long fever and lower back pain. He also had a history of scalded mouth syndrome. Coinfection with Mycobacterium tuberculosis and Candida albicans was diagnosed using the culture of aspirates from different regions. Symptoms improved considerably after antifungal and antituberculous therapy. This case illustrates that infection with tuberculosis might impair the host's immune system and increase the risk of invasive candidiasis in an immunocompetent patient.

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Related in: MedlinePlus

A. Whole-Body positron emission tomography/computed tomography(PET/CT) showing increased uptake of [18F]FDG appear in right neck,liver, right psoas major area respectively (arrows). B. The brownfluids were drained from the liver under B-mode ultrasonography inducted.C. Microphotography of Candida albicans Gramstaining 1000×.
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f01: A. Whole-Body positron emission tomography/computed tomography(PET/CT) showing increased uptake of [18F]FDG appear in right neck,liver, right psoas major area respectively (arrows). B. The brownfluids were drained from the liver under B-mode ultrasonography inducted.C. Microphotography of Candida albicans Gramstaining 1000×.

Mentions: Laboratory results included a leukocyte count of 14800×103/mm3,serum glucose level of 143 mg/dL, blood urea nitrogen of 40 mg/dL and creatinine levelof 1.7 mg/dL. Inflammatory markers were elevated with an erythrocyte sedimentation rate(ESR) of 120 mm/h and C-reactive protein (CRP) level of 11.1 mg/L. Both a tuberculinskin test and human immunodeficiency virus (HIV) antibody exam were negative.Comprehensive immunological studies, including serum immunoglobulins and complementlevels, tests for cell-mediated immunity (NK, CD3, CD4, CD8, CD4/CD8 and CD19) andautoantibody tests, were normal. 1, 3-β-D-glucan assay levels and the galactomannan testwere normal. Blood cultures were also negative. Whole-body positron emissiontomography/computed tomography (PET/CT) revealed multiple abscesses in the right of thepatient's neck, liver and right psoas major area respectively (Fig.1A); and there was a raised uptake of [18F] FDG invertebral bodies of T11, T12 and L1. Consequently, percutaneous abscess drainage wasconducted on the upper body using B-mode ultrasonography and drained brown fluids (30mL, 280 mL and 130 mL, respectively, Fig.1B) weresent to the microbiology lab. Also, drainage tubes were inserted into abscesses in theliver and psoas major, but were removed after no drainage took place. Results of theChromagar Candida Medium (Chromagar, France) cultures were positive for Candidaalbicans (Fig. 1C), but no acid-fastbacilli were detected. The germ tube test was positive and the documented diagnosisusing API 20C Aux systems (BioMeriux, France) was Candida albicans,which was sensitive to amphotericin B, fluconazole, itraconazole, voriconazole,caspofungin and 5-fluorocytosine. Based on antifungal guidelines and susceptibilitytests, he was treated with intravenous 35 mg amphotericin B daily (0.5 mg/kg per day).The patient responded to antifungal therapy and his fever abated after ten days oftreatment. Abscess detection using B-mode ultrasonography revealed that the extent ofinfection in the upper body had greatly decreased at the end of three-week antifungaltherapy.


TUBERCULOSIS INFECTION MIGHT INCREASE THE RISK OF INVASIVE CANDIDIASIS IN AN IMMUNOCOMPETENT PATIENT.

Chen XH, Gao YC, Zhang Y, Tang ZH, Yu YS, Zang GQ - Rev. Inst. Med. Trop. Sao Paulo (2015 May-Jun)

A. Whole-Body positron emission tomography/computed tomography(PET/CT) showing increased uptake of [18F]FDG appear in right neck,liver, right psoas major area respectively (arrows). B. The brownfluids were drained from the liver under B-mode ultrasonography inducted.C. Microphotography of Candida albicans Gramstaining 1000×.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4544255&req=5

f01: A. Whole-Body positron emission tomography/computed tomography(PET/CT) showing increased uptake of [18F]FDG appear in right neck,liver, right psoas major area respectively (arrows). B. The brownfluids were drained from the liver under B-mode ultrasonography inducted.C. Microphotography of Candida albicans Gramstaining 1000×.
Mentions: Laboratory results included a leukocyte count of 14800×103/mm3,serum glucose level of 143 mg/dL, blood urea nitrogen of 40 mg/dL and creatinine levelof 1.7 mg/dL. Inflammatory markers were elevated with an erythrocyte sedimentation rate(ESR) of 120 mm/h and C-reactive protein (CRP) level of 11.1 mg/L. Both a tuberculinskin test and human immunodeficiency virus (HIV) antibody exam were negative.Comprehensive immunological studies, including serum immunoglobulins and complementlevels, tests for cell-mediated immunity (NK, CD3, CD4, CD8, CD4/CD8 and CD19) andautoantibody tests, were normal. 1, 3-β-D-glucan assay levels and the galactomannan testwere normal. Blood cultures were also negative. Whole-body positron emissiontomography/computed tomography (PET/CT) revealed multiple abscesses in the right of thepatient's neck, liver and right psoas major area respectively (Fig.1A); and there was a raised uptake of [18F] FDG invertebral bodies of T11, T12 and L1. Consequently, percutaneous abscess drainage wasconducted on the upper body using B-mode ultrasonography and drained brown fluids (30mL, 280 mL and 130 mL, respectively, Fig.1B) weresent to the microbiology lab. Also, drainage tubes were inserted into abscesses in theliver and psoas major, but were removed after no drainage took place. Results of theChromagar Candida Medium (Chromagar, France) cultures were positive for Candidaalbicans (Fig. 1C), but no acid-fastbacilli were detected. The germ tube test was positive and the documented diagnosisusing API 20C Aux systems (BioMeriux, France) was Candida albicans,which was sensitive to amphotericin B, fluconazole, itraconazole, voriconazole,caspofungin and 5-fluorocytosine. Based on antifungal guidelines and susceptibilitytests, he was treated with intravenous 35 mg amphotericin B daily (0.5 mg/kg per day).The patient responded to antifungal therapy and his fever abated after ten days oftreatment. Abscess detection using B-mode ultrasonography revealed that the extent ofinfection in the upper body had greatly decreased at the end of three-week antifungaltherapy.

Bottom Line: The 19-year-old man complained of month-long fever and lower back pain.He also had a history of scalded mouth syndrome.Symptoms improved considerably after antifungal and antituberculous therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

ABSTRACT
Deep Candida infections commonly occur in immunosuppressed patients. A rare case of a multiple deep organ infection with Candida albicans and spinal tuberculosis was reported in a healthy young man. The 19-year-old man complained of month-long fever and lower back pain. He also had a history of scalded mouth syndrome. Coinfection with Mycobacterium tuberculosis and Candida albicans was diagnosed using the culture of aspirates from different regions. Symptoms improved considerably after antifungal and antituberculous therapy. This case illustrates that infection with tuberculosis might impair the host's immune system and increase the risk of invasive candidiasis in an immunocompetent patient.

Show MeSH
Related in: MedlinePlus