Candida empyema thoracis at a hospital in Taiwan

We conducted a study of the clinical manifestations and outcomes of empyema thoracis caused by Candida spp. in hospitalized patients.

We identified patients who from January 2010 to June 2012 had signs of inflammation, such as fever and leukocytosis, and concomitant positive cultures of Candida spp. from specimens of pleural fluid. We reviewed retrospectively the medical records of all such patients.

Eight of the patients in whom we identified fever and leukocytosis with concomitant positive pleural fluid cultures of Candida spp. were found to have Candida empyema thoracis. Candida albicans was the most common species causing empyema (n=4), followed by C. glabrata (n=3) and C. tropicalis (n=1). Among the eight patients with Candida empyema thoracis, malignant disease was the most common underlying disease. Seven of the eight patients' episodes of Candida empyema thoracis (87.5%) were classified as health care-associated infections. One patient had a mixed infection with Candida spp. and Pseudomonas aeruginosa. None of the patients had concomitant candidemia. Fluconazole was the antifungal agent used most commonly in treating the patients, and all of the patients had drainage of pleural effusions, including tube thoracostomy in five patients and drainage through a pigtail catheter in three patients. One patient underwent video-assisted thoracic surgery for the management of empyema thoracis, and the patients' overall in-hospital mortality was 62.5%.

Although Candida empyema thoracis is encountered rarely, it can develop in immunocompromised patients and can be associated with a high mortality rate.