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Respiratory Candida in Patients with Bronchitis, Mucus Plugging, and Atelectasis
Douglas C Johnson1, Suresh K Chirumamilla1, Armando P Paez1
1Department of Medicine, Baystate Medical Center, Springfield MA 01199, USA.
Background:
The significance of Candida in pulmonary secretions is unclear, and usually is regarded as colonization, not contributing to symptoms or disease. Yet, in our experience, Candida seemed associated with chronic sputum, mucus plugging, atelectasis, and poor outcome.
Objective:
The aim of this study is to describe the clinical findings of patients with Candida in pulmonary (sputum or bronchoscopy) secretions and the significance of Candida.
Methods:
Retrospective study of inpatients and outpatients referred for pulmonary consultation with Candida in pulmonary secretions. Clinical parameters and estimates of whether Candida was likely clinically significant, were determined.
Results:
82 inpatients and 11 outpatients were identified, of which 61 (66%) had atelectasis and 68 (73%) bronchoscopies. Of patients having bronchoscopies, 56 (82%) had mucus, and 43 (63%) mucus plugging. Of the inpatients death (or probable death) occurred in 43 (63%), 42 (98%) of which were from definite or probable respiratory failure, with 13 (31%) likely related to mucus plugging, 16 (38%) possibly from mucus plugging, 6 (14%) unknown, and 7 (17%) not due to mucus plugging. Candida was felt likely clinically significant in 57 patients (61%), uncertain significance in 23 (25%), and not significant in 13 (14%). All outpatients had exacerbations, including 7 (64%) within a year.
Conclusion:
Patients requiring pulmonary consultation with Candida in pulmonary secretions often have chronic sputum production, exacerbations, mucus plugging, atelectasis, and death from respiratory failure. Candida was likely clinically significant in most patients. Recommendations to consider Candida in pulmonary secretions as colonization should be reconsidered.
Insights
Candida in pulmonary secretions is often clinically significant, linked to chronic sputum, mucus plugging, and respiratory failure. Reconsidering its role beyond simple colonization is crucial for patient outcomes.
Area of Science:
- Pulmonology
- Infectious Diseases
- Medical Mycology
Background:
- The clinical significance of Candida in pulmonary secretions is often underestimated, typically viewed as mere colonization.
- However, clinical observations suggest an association between Candida and adverse pulmonary outcomes such as chronic sputum, mucus plugging, and atelectasis.
Purpose of the Study:
- To investigate the clinical findings in patients with Candida identified in pulmonary secretions.
- To determine the clinical significance of Candida in these respiratory samples.
Main Methods:
- A retrospective study was conducted on both inpatients and outpatients.
- Patients included had Candida detected in pulmonary secretions (sputum or via bronchoscopy).
- Clinical data were analyzed to assess the likelihood of Candida being clinically significant.
Main Results:
- The study identified 82 inpatients and 11 outpatients with Candida in pulmonary secretions.
- A significant proportion of patients experienced atelectasis (66%) and mucus plugging (63%).
- Candida was deemed clinically significant in 61% of patients, with a notable mortality rate (63%) primarily due to respiratory failure, potentially linked to mucus plugging.
Conclusions:
- Patients with Candida in pulmonary secretions frequently present with chronic sputum, exacerbations, mucus plugging, atelectasis, and a high risk of death from respiratory failure.
- The findings strongly suggest that Candida in pulmonary secretions is often clinically significant, challenging the traditional view of it being solely colonization.
- Clinical guidelines should reconsider the interpretation of Candida in pulmonary secretions.
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