Candida is a common flora found in the mouth, throat and gastrointestinal tract of healthy individuals; although the presence of candida in patients who are acutely or chronically ill may have different clinical implications. This study was performed to define the relationship between the presence of candida in the bronchioalveolar lavage (BAL) and the subsequent development of candida in the blood.
We reviewed the records of 62 patients with BAL positive for candida. All patients with oral thrush and those on antifungal agents were excluded from the study. None of the patients had candidemia prior to the isolation of candida in the BAL. Out of those 62 patients, 37 were male and 25 were female. The mean age was 58.2 (21 to 93). In terms of comorbidity 21 patients out of 62 (33%) were HIV/AIDS, 14 (23%) had lung cancer, 18 (29%) were on mechanical ventilator for more than 7 days.
5 out of 62 patients (8%) developed candidemia, 3 out of those 5 also had candida in the urine leaving only 2 out of 62 patients (3%) with candida both in BAL and blood. These 2 patients developed candidemia within 1 to 6 weeks after confirming candida in the BAL. None of those 5 patients with candidemia had transbronchial biopsy positive for candida. All 5 patients expired.
Since only 2 out of 62 had candida in both BAL and blood, it could be inferred that the isolation of candida in the BAL does not appear to increase the risk of disseminated candida infection. Once candidemia develops the mortality becomes very high. However it is not clear whether death resulted from candidemia; or rather from the associated comorbid conditions.
The isolation of Candida in the BAL does not appear to be of great clinical significance. It does not seem to increase the risk of candidemia. The small sample size might be a limitation in our study. A larger study is required to confirm this result.
Theophilus Ogungbamigbe, None.