Abstract
BackgroundWhen Candida species is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role.MethodsIn a convenience sample of patients hospitalized for CAP, we screened for “high-quality sputum” by Gram stain (> 20 WBC/epithelial cell) and performed quantitative sputum cultures. Criteria for a potential etiologic role for Candida included the observation of large numbers of yeast forms on Gram stain, intracellular organisms and > 106 CFU/ml Candida in sputum. We gathered clinical information on cases that met these criteria for possible Candida infection.ResultsSputum from 6 of 154 consecutive CAP patients had large numbers of extra- and intracellular yeast forms on Gram stain, with > 106 CFU/ml Candida albicans, glabrata, or tropicalis on quantitative culture. In all 6 patients, the clinical diagnoses at admission included chronic aspiration. Greater than 105 CFU/ml of a recognized bacterial pathogen (Streptococcus pneumoniae, Staphylococcus aureus, or Pseudomonas) or > 106 CFU/ml of other ‘normal respiratory flora’ (Lactobacillus species) were present together with Candida spp. in every case. Blood cultures yielded Candida in 2 cases, and 1,3-beta-D glucan was > 500 ng/mL in 3 of 3 cases in which it was assayed. Since all patients were treated with anti-bacterial and anti-fungal drugs, no inference about etiology can be derived from therapeutic response.ConclusionsCandida spp. together with a recognized bacterial pathogen or normal respiratory flora may contribute to the cause of CAP in patients who chronically aspirate.
Highlights
When Candida species is found in a sputum culture, clinicians generally dismiss it as a contaminant
When yeast forms are seen on Gram stain and Candida are grown in sputum cultures, they are generally dismissed as oropharyngeal contaminants from colonizing organisms
Clinical findings Six of 154 (3.9%) patients hospitalized for community-acquired pneumonia (CAP) had sputum samples that, based on the above microbiologic criteria, suggested a contributory etiologic role for Candida spp
Summary
When Candida species is found in a sputum culture, clinicians generally dismiss it as a contaminant. A standard teaching amongst infectious disease specialists is that pneumonia due to Candida species is a “very rare event” [1]. These organisms regularly colonize the mouth, and their numbers can increase if antibiotics are given. When yeast forms are seen on Gram stain and Candida are grown in sputum cultures, they are generally dismissed as oropharyngeal contaminants from colonizing organisms. Recent studies have given more attention to a possible pathogenic role in pneumonia for Candida in combination with bacterial pathogens [6,7,8,9]
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