Genetic and Developmental Disorders: Fellow Case Report Poster - Genetic and Developmental Disorders |

Cystic Fibrosis Exacerbation Due to Candida FREE TO VIEW

Matthew Bernens, MD; Enrique Calvo-Ayala, MD
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Eastern Virginia Medical School, Norfolk, VA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):638A. doi:10.1016/j.chest.2016.08.731
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SESSION TITLE: Fellow Case Report Poster - Genetic and Developmental Disorders

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Cystic Fibrosis (CF) exacerbations are typically triggered by episodes of bronchopneumonia caused by airway colonizing organisms. Treatment is usually antibacterial and targeted at pathogens which are identified via sputum cultures. Candida species are generally considered airway colonization.

CASE PRESENTATION: A 36 year old male with a history of CF (Delta F508), CF-related diabetes mellitus and pancreatic exocrine insufficiency was admitted to a tertiary hospital with atypical chest pain, dyspnea and moderate hemoptysis. He underwent a CT angiogram which was negative for pulmonary emboli but did reveal some patchy bilateral upper lobe airspace disease superimposed on chronic parenchymal changes. A flexible bronchoscopy revealed no active bleeding. He was treated with a course of broad spectrum antibacterials for 2 weeks, based on prior sputum cultures (Table 1). He had little improvement in symptoms and required multiple hospitalizations over the next 6 weeks. Workup included negative Acid Fast Bacteria sputum cultures and a normal IgE level. He remained on extended courses of various IV antibiotics with little improvement. At this point, his sputum cultures continued to grow Pseudomonal species, but also revealed Candida parapsilosis. As a result, he was started on a course of fluconazole. Two weeks later he had a dramatic improvement in his FEV1 from a low of 30% predicted prior to fluconazole to 43% predicted after treatment. (Figure 1, red box). Review of his exacerbation and culture history revealed several prior episodes of exacerbation refractory to treatment. During those episodes his cultures also grew Candida and his FEV1 responded to treatment with antifungals. (Figure 1)

DISCUSSION:Candida species do not generally cause CF exacerbations and are typically considered an airway colonizer. With the exception of immunocompromised patients, they seldom cause invasive pulmonary infections. However, a prior study revealed increased exacerbation rates in patients colonized with Candida.1 In our case, the patient had a history of refractory exacerbations and his pulmonary function improved after treatment with antifungals.

CONCLUSIONS: This case suggests that Candida species may play a role in CF exacerbation and may not simply be an airway colonizer. Further research is needed, but it may be appropriate to treat CF exacerbations with antifungals if cultures demonstrate the presence of Candida species.

Reference #1: Chest. 2010 Nov;138(5):1186-95. doi: 10.1378/chest.09-2996. Epub 2010 May 14.

DISCLOSURE: The following authors have nothing to disclose: Matthew Bernens, Enrique Calvo-Ayala

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