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A5594 - Fatal Outcome in a Patient with Cystic Fibrosis and Candia Blankii Infection: A Case Report
Author Block: C. L. Grizales1, D. Duarte1, J. Escobar2, P. Perez3, J. A. Patiño3, L. Fernandez4, C. S. Leib5, Biomedical Research Group in Thorax; 1Pediatric Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 2Pediatric Resident, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 3Pediatric Infectology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 4Interventional Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 5Medical Research, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia.
INTRODUCTION In spite of the increasing survival rates in cystic fibrosis (CF) patients in the last few years, isolation of Candida species for diagnostic and therapeutic purposes still remains a challenge. We present the case of a patient with cystic fibrosis and Candida blankii isolation in bronchial secretions, resistant to treatment, progressive clinical deterioration and fatal outcome. CASE REPORT A 9 year-old patient with CF (genotype Phe508del/X) in multidisciplinary care at our institution, with previous isolations of Candida albicans, Aspergillus fumigatus and methicillin-sensitive Staphylococcus aureus, presents with a new case of exacerbated pulmonary disease. Bronchoscopy with bronchoalveolar lavage detects yeast, identified molecularly as Candida blankii. Multiple anti-fungal pharmacological agents such as Fluconazole, Amphotericin B, Itraconazole and Voriconazole are initiated, but the clinical deterioration continued. 5 months after the initial isolation and in spite the therapeutic efforts the patient develops ventilatory failure requiring supportive care in the pediatric intensive care unit (ICU). A new bronchoalveolar lavage is executed, revealing severe endobronchitis associated with abundant purulent bloody material. Direct microscopy with Gram stain reports moderate growth of blastoconidia compatible with Candida blankii. The patient passes away in the pediatric ICU. DISCUSSION Candida blankii is a type of yeast discovered more than 50 years ago that has been found in different mammal species and artisanal cheeses. However, little is known about its role in exacerbations of patients with CF. Only one case has been reported before in Argentina, in which Candida Blankii was isolated in a 14 year old patient managed with Itraconazole, with adequate response and a positive outcome. In our case, the patient does not improve in spite of multiple anti-fungal therapies, progressing to ventilatory failure and death. It is important to emphasize in the multidisciplinary care of patients with CF, with an active search for airway-colonizing agents and pathogens in such a way that adequate therapeutic options are guaranteed for these patients.