ABSTRACT
BACKGROUND: Yeast with pseudohyphae or those that have been phagocytized by white blood cells are coincidentally found in peripheral blood smears. The clinical diagnostic value and outcome of candidaemia diagnosed from peripheral blood smears (CPBSs) are unclear. CASE PRESENTATION: A 45-year-old man with diabetes and panhypopituitarism for 20 years received 10 mg of hydrocortisone and 100 µg of levothyroxine sodium hydrate daily. He has been admitted seven times because of adrenal failure triggered by infections and was admitted for pneumonia. On day 56, some budding yeast was found microscopically in a peripheral blood smear with May-Giemsa staining. Some of them were phagocytized by white blood cells. The two blood cultures yielded Candida parapsilosis. Despite antifungal treatment and removal of an intravenous catheter, on day 98 (42 days after the candidaemia diagnosis), the patient died. CONCLUSION: We analysed 36 cases including the present case. Almost all CPBS patients (96.5 %, n = 29) were using an intravenous catheter. The most frequently isolated species was C. parapsilosis (35.1 %), followed by C. albicans (29.7 %). The overall mortality rate was 53.6 % (n = 28). The time from the discovery of yeast-like pathogens using peripheral blood smears to death ranged from a few hours to 93 days (median 19 days). The present results suggest that intravenous catheter use and the underlying conditions of patients are responsible for CPBSs. The detection of yeast in peripheral blood smears suggests advanced infections with uncontrollable complications, which means a poor prognosis. Rapid detection methods besides blood culture are needed.
Subject(s)
Blood/microbiology , Candidemia/diagnosis , Candidemia/pathology , Catheter-Related Infections/diagnosis , Catheter-Related Infections/pathology , Cytological Techniques , Candida/classification , Candida/isolation & purification , Diabetes Complications , Fatal Outcome , Humans , Hypopituitarism/complications , Male , Microbiological Techniques , Microscopy , Middle AgedABSTRACT
A 70-year-old man with a history of tongue cancer presented with Fournier's gangrene caused by Listeria monocytogenes serotype 4b. Surgical debridement revealed undiagnosed rectal adenocarcinoma. The patient did not have an apparent dietary or travel history but reported daily consumption of sashimi (raw fish). Old age and immunodeficiency due to rectal adenocarcinoma may have supported the direct invasion of L monocytogenes from the tumour. The present article describes the first reported case of Fournier's gangrene caused by L monocytogenes. The authors suggest that raw ready-to-eat seafood consumption be recognized as a risk factor for listeriosis, especially in cases of skin and soft tissue infection.
Un homme de 70 ans ayant des antécédents de cancer de la langue s'est présenté avec une gangrène de Fournier causée par un Listeria monocytogenes de sérotype 4b. Le débridement chirurgical a révélé un adénocarcinome rectal non diagnostiqué. Le patient n'avait pas d'antécédents alimentaires ou de voyage apparents, mais a déclaré consommer des sashimis (poisson cru) tous les jours.L'âge avancé et l'immunodéficience causée par l'adénocarcinome rectal ont peut-être favorisé l'invasion directe du L monocytogenes par la tumeur. Il s'agit du premier cas déclaré de gangrène de Fournier attribuable au L monocytogenes. Les auteurs proposent d'inclure la consommation de fruits de mer crus prêt-à-manger dans les facteurs de risque de listériose, notamment en cas d'infections de la peau et des tissus mous.
