Post-mortem findings in patients with repeatedly mycological demonstration of Candida glabrata

In our mycological laboratory we saw an increase in the occurrence of Candida glabrata isolates from 0.5% in 1990 to 22.2% in 1996, mainly isolates of high-risk patients of the intensive care unit and the oncological ward. We were interested to analyse whether this increase in C. glabrata was also demonstrable in a corresponding number of deep-seated candidosis. Eighteen patients were autopsied and examined microscopically. In all patients, repeated occurrence of C. glabrata, with or without C. albicans during the hospital treatment, was found. Serology and fungal cultures of these intensive care/oncological patients were indicative of invasive candidosis. In 12 of these 18 patients, there was no evidence of deep-seated candidosis at autopsy. Three patients had a typical aspergillosis of the lungs, which was not diagnosed during their hospital treatment. In five patients (two of them with an aspergillosis of the lungs), we found sporadic yeast cells in kidney or lung tissue, characterized by size and missing pseudomycelium as C. glabrata. In no case was a cellular intravital defensive reaction against these yeast cells found. Therefore, we interpreted the demonstration of C. glabrata in tissues as a transitory fungaemia and not as a deep-seated C. glabrata mycosis.