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[Nosocomial Candida albicans septicemia in parenteral alimentation through a peripheral vein]
Abstract:
Fungal septicaemias during total parenteral nutrition are frequent, but their occurrence during parenteral nutrition via a peripheral vein is uncommon. A case of disseminated candidemia with ocular and renal localizations during parenteral nutrition via a peripheral vein is reported in a 24 year old patient hospitalized for primary cerebellar haemorrhage. The case history showed the importance of early ophthalmologic examination in all septicaemic cases. The diagnosis was confirmed by nine positive blood cultures and immunological tests, but the dosage of soluble antigens remained negative. The part played by a contaminated perfusion bottle out-of-date was suggested, but could not be proved absolutely. The assessment of the immune state could wrongly suggest an acquired immunodeficiency syndrome, for it has been demonstrated that Candida albicans itself had an immunosuppressive activity.
Insights
Disseminated candidemia is rare during peripheral parenteral nutrition. Early ophthalmologic exams are crucial for septicemic cases, as Candida albicans can suppress immunity.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Case Study
Background:
- Fungal septicaemia is common during total parenteral nutrition (TPN).
- Peripheral parenteral nutrition (PPN) rarely leads to fungal infections.
- Candidemia, a serious fungal infection, requires prompt diagnosis and treatment.
Observation:
- A 24-year-old patient with cerebellar hemorrhage developed disseminated candidemia during PPN.
- The infection presented with ocular and renal localizations.
- Early ophthalmologic examination was critical in identifying the infection.
Findings:
- Diagnosis was confirmed by multiple positive blood cultures and immunological tests.
- Soluble antigen testing was negative.
- A contaminated, expired perfusion bottle was suspected but unconfirmed as the source.
- Candida albicans demonstrated immunosuppressive activity, mimicking acquired immunodeficiency syndrome.
Implications:
- Highlights the importance of considering candidemia in PPN patients, even if uncommon.
- Emphasizes the necessity of thorough ophthalmologic evaluations in all septicemic patients.
- Suggests that Candida infections can have immunosuppressive effects, complicating diagnosis and patient assessment.