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Pulmonary Involvement in Patients with Hematological Malignancies pp 349–356Cite as

Candida Pneumonia in Patients with Hematological Neoplasia

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Abstract

Candida isolation from respiratory secretions rarely indicates invasive candidiasis and should not be treated with antifungal therapy. In contrast to pneumonia, colonization of the airway (or contamination of respiratory samples with oropharyngeal material) is extremely common. Whereas positive cultures from respiratory secretions are frequently used as indications to start antifungal therapy, multiple studies (including autopsies) consistently demonstrate poor predictive value at Candida isolation from lower respiratory secretions, including bronchoalveolar lavage (BAL). Diagnosis of Candida pneumonia requires histopathologic confirmation. Due to the extremely common finding of Candida in respiratory secretions, the lack of specificity (even using bronchoscopy) and the rarity of Candida pneumonia, a decision to treat with antifungal agents should never be based merely on respiratory tract cultures. Candida pneumonia (and lung abscess) is extremely uncommon.

Supported in part by CIBERES 06/06/0036, AGAUR 09/SGR/920

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References

  1. Daly JS, Finberg RW (2008) Acute infection in the immunocompromised host. In: Irwin RS, Rippe JM (eds) Irwin and Rippe’s intensive care medicine, 6th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. von Eiff M, Roos N, Fegeler W et al (1996) Hospital-acquired candida and aspergillus pneumonia – diagnostic approaches and clinical findings. J Hosp Infect 32:17–28

    Article  Google Scholar 

  3. Galvan B, Mariscal F (2006) Epidemiologia de la candidemia en UCI. Rev Iberoam Micol 23:12–15

    Article  Google Scholar 

  4. Vélez L, Correa LT, Maya MA et al (2007) Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia: analysis of a protocol. Respir Med 101:2160–2167

    Article  PubMed  Google Scholar 

  5. Rossini F, Verga M, Pioltelli P et al (2000) Incidence and outcome of pneumonia in patients with acute leukemia receiving first induction therapy with anthracycline-containing regimens. Haematologica 85:1255–1260

    PubMed  CAS  Google Scholar 

  6. Pappas PG, Rex JH, Sobel JD (2004) Infectious diseases Society of America. Guidelines for treatment of candidiasis. Clin Infect Dis 38:161–189

    Article  PubMed  Google Scholar 

  7. Kishikawa H, Tojima H, Tokudome T (1997) Microscopic polyangiitis and pulmonary fibrosis in a patient who died of Candida pneumonia and intra-alveolar hemorrhage. Nihon Kyobu Shikkan Gakkai Zasshi 35:915–920 [Japanese – Abstract]

    PubMed  CAS  Google Scholar 

  8. Martin GS, Mannino DM, Eaton S et al (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554

    Article  PubMed  Google Scholar 

  9. Trick WE, Fridkin SK, Edwards JR et al (2002) National Nosocomial Infections Surveillance System. Secular trend of hospital-acquired candidemia among intensive care unit patients in the united states during 1989–1999. Clin Infect Dis 35:627–630

    Article  PubMed  CAS  Google Scholar 

  10. Mohsenifar Z, Chopra SK, Johnson BL et al (1979) Candida pneumonia: experience with 20 patients. West J Med 131: 196–200

    PubMed  CAS  Google Scholar 

  11. Haron E, Vartivarian S, Anaissie E et al (1993) Primary Candida pneumonia. Experience at a large cancer center and review of the literature. Medicine (Baltimore) 72:137–142

    CAS  Google Scholar 

  12. Masur H, Rosen PP, Armstrong D (1977) Pulmonary disease caused by Candida species. Am J Med 63:914–925

    Article  PubMed  CAS  Google Scholar 

  13. Schröter GP, Hoelscher M, Putnam CW et al (1977) Fungus infections after liver transplantation. Ann Surg 186: 115–122

    Article  PubMed  Google Scholar 

  14. Buff SJ, McLelland R, Gallis HA et al (1982) Candida albicans pneumonia: radiographic appearance. AJR Am J Roentgenol 138:645–648

    PubMed  CAS  Google Scholar 

  15. Petrocheilou-Paschou V, Georgilis K, Kontoyannis D et al (2002) Pneumonia due to Candida krusei. Clin Microbiol Infect 8:806–809

    Article  PubMed  CAS  Google Scholar 

  16. Menezes AV, Sigesmund DA, Demajo WA et al (1994) Mortality of hospitalized patients with Candida endophthalmitis. Arch Intern Med 154:2093–2097

    Article  PubMed  CAS  Google Scholar 

  17. Pittet D, Monod M, Suter PM et al (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758

    Article  PubMed  CAS  Google Scholar 

  18. Bär W, Hecker H (2002) Diagnosis of systemic Candida infections in patients of the intensive care unit. Significance of serum antigens and antibodies. Mycoses 45:22–28

    Article  PubMed  Google Scholar 

  19. Voss A, Hollis RJ, Pfaller MA et al (1994) Investigation of the sequence of colonization and candidemia in nonneutropenic patients. J Clin Microbiol 32:975–980

    PubMed  CAS  Google Scholar 

  20. Almirante B, Rodríguez D, Park BJ, Barcelona Candidemia Project Study Group et al (2005) 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 43: 1829–1835

    Article  PubMed  Google Scholar 

  21. Sickles EA, Greene WH, Wiernik PH (1975) Clinical presentation of infection in granulocytopenic patients. Arch Intern Med 135:715–719 [Abstract]

    Article  PubMed  CAS  Google Scholar 

  22. Vincent JL, Anaissie E, Bruining H et al (1998) Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. Intensive Care Med 24:206–216

    Article  PubMed  CAS  Google Scholar 

  23. Yeo SF, Zhang Y, Schafer D et al (2000) A rapid, automated enzymatic fluorometric assay for determination of D-arabinitol in serum. J Clin Microbiol 38:1439–1443

    PubMed  CAS  Google Scholar 

  24. Allaouchiche B, Coronel B, Gagnieu MC et al (2004) Cytokine levels in bronchoalveolar lavage fluid and blood of neutropenic patients with pneumonia. Bull Cancer 91: 77–80

    Google Scholar 

  25. Petri MG, König J, Moecke HP, Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research et al (1997) Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med 23:317–325

    Article  PubMed  CAS  Google Scholar 

  26. De Bellis P, Bonfiglio M, Gerbi G et al (2003) High-dose fluconazole therapy in intensive care unit. Minerva Anestesiol 69:145–152

    PubMed  Google Scholar 

  27. Heussel CP, Kauczor HU, Heussel GE et al (1999) Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 17:796–805

    PubMed  CAS  Google Scholar 

  28. Syrjälä H, Broas M, Suramo I et al (1998) High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis 27:358–363

    Article  PubMed  Google Scholar 

  29. Weinberger M, Sacks T, Sulkes J et al (1997) Increasing fungal isolation from clinical specimens: experience in a university hospital over a decade. J Hosp Infect 35:185–195

    Article  PubMed  CAS  Google Scholar 

  30. Azoulay E, Timsit JF, Tafflet M et al (2006) Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest 129:110–117

    Article  PubMed  Google Scholar 

  31. El-Ebiary M, Torres A, Fàbregas N et al (1997) Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med 156:583–590

    PubMed  CAS  Google Scholar 

  32. Rello J, Esandi ME, Díaz E et al (1998) The role of Candida sp isolated from bronchoscopic samples in nonneutropenic patients. Chest 114:146–149

    Article  PubMed  CAS  Google Scholar 

  33. Penack O, Beinert T, Buchheidt D, German Society of Hematology and Oncology et al (2006) Management of sepsis in neutropenia: guidelines of the infectious diseases working party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 85: 424–433

    Article  PubMed  Google Scholar 

  34. Benoit DD, Vandewoude KH, Decruyenaere JM et al (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31: 104–112

    Article  PubMed  Google Scholar 

  35. Garnacho-Montero J, Díaz-Martín A, Cayuela-Dominguez A (2008) Management of invasive Candida infections in non-neutropenic critically ill patients: from prophylaxis to early therapy. Int J Antimicrob Agents 32(Suppl 2): S137–S141

    Article  PubMed  CAS  Google Scholar 

  36. Deray G (2002) Amphotericin B nephrotoxicity. J Antimicrob Chemother 49(Suppl 1):37–41

    PubMed  CAS  Google Scholar 

  37. White MH, Bowden RA, Sandler ES et al (1998) Randomized, double-blind clinical trial of amphotericin B colloidal dispersion vs. amphotericin B in the empirical treatment of fever and neutropenia. Clin Infect Dis 27:296–302

    Article  PubMed  CAS  Google Scholar 

  38. Eriksson U, Seifert B, Schaffner A (2001) Comparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours: randomised controlled trial. BMJ 322:579–582

    Article  PubMed  CAS  Google Scholar 

  39. Ellis ME, al-Hokail AA, Clink HM et al (1992) Double-blind randomized study of the effect of infusion rates on toxicity of amphotericin B. Antimicrob Agents Chemother 36: 172–179

    PubMed  CAS  Google Scholar 

  40. Chen H, Suda KJ, Turpin RS et al (2007) High- versus low-dose fluconazole therapy for empiric treatment of suspected invasive candidiasis among high-risk patients in the intensive care unit: a cost-effectiveness analysis. Curr Med Res Opin 23:1057–1065

    Article  PubMed  CAS  Google Scholar 

  41. Pappas PG, Kauffman CA, Andes D et al (2009) Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 48:503–535

    Article  PubMed  CAS  Google Scholar 

  42. Mora-Duarte J, Betts R, Rotstein C, Caspofungin Invasive Candidiasis Study Group et al (2002) Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 347:2020–2029

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Critical Care Department, Hospital Pablo Tobon Uribe, Calle 78B #69-240 Medellín (Antioquia), Colombia - Suramérica, 43007, Tarragona, Spain

    Carlos Carvajal

  2. Critical Care Department, Hospital Vall d’Hebron, CIBERES,Vall D’Hebron Institut Recerca (VHIR), Universitat Autonoma de Barcelona, Ps Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Jordi Rello

  3. Department of Intensive Care Medicine, Intensive Care Unit, Royal Brisbane and Women’s Hospital, Herston Road, Brisbane, Australia

    Jeffrey Lipman

  4. Burns, Trauma, Critical Care Research Centre, University of Queensland, St Lucia, Australia

    Jeffrey Lipman

Authors
  1. Carlos Carvajal
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  2. Jordi Rello
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  3. Jeffrey Lipman
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Corresponding author

Correspondence to Jordi Rello .

Editor information

Editors and Affiliations

  1. Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010, France

    Elie Azoulay

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Carvajal, C., Rello, J., Lipman, J. (2011). Candida Pneumonia in Patients with Hematological Neoplasia. In: Azoulay, E. (eds) Pulmonary Involvement in Patients with Hematological Malignancies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15742-4_28

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  • DOI: https://doi.org/10.1007/978-3-642-15742-4_28

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