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Chest Infections |

Unusual Cause of Empyema, Failure of Immunity Response?

Michal Svarc*, MD; Vratislav Sedlak, MD; Vladimir Koblizek, PhD; Frantisek Salajka, PhD; Jakub Novosad, PhD
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Fakultni Nemocnice Hradec Kralove, Hradec Kralove, Czech Republic


Chest. 2012;142(4_MeetingAbstracts):250A. doi:10.1378/chest.1390283
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Abstract

SESSION TYPE: Infectious Disease Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Community acquired pneumonia is one of the leading cause of hospitalization worldwide. Parapneumonic pleural effusions are seen in approximately 35-40% of patients, and almost 10% require drainage. The number of all cases of pneumonia in the world rises as well as the rate of unusual etiological agents including opportunistic pathogens, such as Canida Albicans. Immune response is vital for surviving the pneumonia, which remains potentially fatal even in 21st century.

CASE PRESENTATION: 55 years old woman with no significant medical history had been admitted to our pulmonary department because of community acquired pneumonia. Despite of combined antibiotic therapy the health state of the patient worsened and loculated pleural effusions occur. The change of antibiotics and drain insertion followed by local application of fibrinolytics lead to little improvement and another drain had to be inserted. Other sources of infection and pulmonary embolism were excluded. The sputum, blood samples and BAL show only Candida albicans. After switching the antibiotics to fluconazole the patient recovers very quickly.

DISCUSSION: The gastroscopy shows huge mucous candidosis, which is considered not to be a focus, but a part of systemic infection. Although Candida Albicans is an opportunistic pathogen, largely harmful to immunocompromised patients. No immunodeficiency including HIV infection and tumor was discovered in this case. Immunologist assumes role of CARS syndrome in development of overwhelming systemic Candida infection.

CONCLUSIONS: CARS syndrome (Compensatory Anti-inflammatory Response Syndrome) qualifies counter-regulatory mechanisms initiated to limit the overzealous inflammatory process in patients with infectious (sepsis) or non-infectious systemic inflammatory response syndrome (SIRS). The major consequence of CARS is the modification of the immune status that could favor the enhanced susceptibility of patients to nosocomial infections. This seems to be the scenario of our case too, where initial CAP of unknown origin lead to SIRS followed by huge Candida infection due to suppressed immune response according to CARS syndrome.

1) Compensatory anti-inflammatory response syndrome Minou Adib-Conquy; Jean-Marc Cavaillon, Unit Cytokines & Inflammation, Institut Pasteur, Paris, France, www.thrombosis-online.com

2) A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis. 2003; 37(5):634-43 (ISSN: 1537-6591) Pappas PG; Rex JH; Lee J; Hamill RJ; Larsen RA; Powderly W; Kauffman CA; Hyslop N; Mangino JE; Chapman S; Horowitz HW; Edwards JE; Dismukes WE; University of Alabama at Birmingham

3) Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988-2002. Fry AM, Shay DK, Holman RC, Curns AT, Anderson LJ. Source Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA. afry@cdc.gov JAMA, Dec 7 2005

DISCLOSURE: The following authors have nothing to disclose: Michal Svarc, Vratislav Sedlak, Vladimir Koblizek, Frantisek Salajka, Jakub Novosad

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Fakultni Nemocnice Hradec Kralove, Hradec Kralove, Czech Republic

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