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Colonization of nasal ulcers as a source of Candida parapsilosis fungemia
Abstract:
Candida parapsilosis fungemia secondary to nasal colonization following application of nasal prongs for oxygen therapy developed in a 61-year-old man with known chronic lymphocytic leukemia and pulmonary infiltrates. Amphotericin B controlled the candidal infection, but the patient died of complications related to Aspergillus pneumonitis, intra-abdominal mucormycosis, and leukemia. The source of candidal infection was probably a combination of nasal ulceration resulting from oxygen administration by nasal prongs and alteration of the normal mucosal flora by multiple broad-spectrum antibiotics. Oxygen administration by mask to patients at risk of opportunistic infections may help obviate this potential complication, with its attendant danger of spread to the brain and cavernous sinuses. We discuss the rarity of triple infection with these three organisms.
Insights
A patient with chronic lymphocytic leukemia developed Candida fungemia from nasal oxygen prongs. This rare triple infection highlights risks of opportunistic pathogens in immunocompromised patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Nasal colonization with Candida parapsilosis can lead to fungemia, especially in immunocompromised patients.
- Oxygen therapy via nasal prongs may cause mucosal damage, facilitating fungal invasion.
- Broad-spectrum antibiotics can disrupt normal flora, increasing susceptibility to opportunistic infections.
Observation:
- A 61-year-old man with chronic lymphocytic leukemia and pulmonary infiltrates developed Candida parapsilosis fungemia.
- The fungemia was secondary to nasal colonization, likely from nasal prongs used for oxygen therapy.
- The patient experienced a rare triple infection involving Candida, Aspergillus, and Mucor species.
Findings:
- Amphotericin B effectively treated the Candida fungemia.
- The patient ultimately succumbed to complications from Aspergillus pneumonitis, intra-abdominal mucormycosis, and leukemia.
- Nasal ulceration from oxygen prongs and antibiotic-induced dysbiosis were probable sources of candidal infection.
Implications:
- Oxygen administration via mask may reduce the risk of nasal colonization and subsequent fungemia in at-risk patients.
- Clinicians should be vigilant for rare, polymicrobial opportunistic infections in immunocompromised individuals.
- Understanding the interplay between medical devices, antibiotics, and host immunity is crucial for preventing severe fungal infections.