Candida parapsilosis bloodstream infection1

The T2Candida Panel was used to assess for the presence of disease and continuation of antifungal therapy, despite negative blood cultures.

Discussion


Rapid molecular diagnostics such as T2MR technology may help with prognosis of invasive candidiasis. For our case, the T2Candida Panel was utilized upon follow up to assess clearance of candidemia along with clinical symptoms.

Presentation

A 69-year-old man with history of testicular cancer, chronic kidney disease, anemia, gangrenous gallbladder, status post cholecystectomy, hypertension, hyperlipidemia, type 2 diabetes mellitus, paroxysmal atrial fibrillation, heart failure with reduced ejection fraction and implantable  cardioverter defibrillator (ICD), and aortic valve disease s/p mechanical aortic valve replacement who presented with fatigue, fever, diarrhea, emesis, febrile to 102.3 degree Fahrenheit with a blood pressure of 93/43 mm Hg, heart rate of 64 bpm, and respiratory rate of 18 breaths/min. 

Evaluation and Treatment Decision


Initial Diagnosis: Initially diagnosed with Candida parapsilosis bloodstream infection and treated with liposomal amphotericin B at 5 mg/kg/day. After developing acute kidney injury, therapy was changed to micafungin 150 mg intravenous (IV) daily.


Blood Cultures and Echography: Repeat blood cultures continued to grow Candida parapsilosis 10 days after admission. A trans-esophageal echocardiogram (TEE) revealed fibrin stranding on the mechanical aortic valve. Due to his multiple comorbidities, he was not deemed safe for surgical intervention.


Updated Therapy: Micafungin 150 mg IV daily and fluconazole 400 mg orally daily


Discharge Plan: A peripherally inserted central catheter (PICC) was placed, and the patient was discharged from the hospital to complete micafungin IV for 12 weeks plus fluconazole oral combination therapy.


T2Candida Panel – Initial Result: Six weeks after negative blood cultures, a T2Candida Panel was ordered, which still detected the presence of Candida parapsilosis. However, all repeat fungal blood cultures remained negative, and the patient had improved overall. 


T2Candida Panel – Second Result: 18 weeks after blood cultures became negative, a repeat T2Candida Panel was negative for any Candida species while on chronic suppression with fluconazole.


One year later, the patient currently remains alive and doing well on oral fluconazole suppressive therapy at 200 mg daily.


Decision making based on T2Candida Result


The T2Candida Panel was used to assess for the presence of disease and the continuation of antifungal therapy, despite negative blood cultures.

 

1. Ahuja, Tania, Karen Fong, and Eddie Louie. "Combination antifungal therapy for treatment of Candida parapsilosis prosthetic valve endocarditis and utility of T2Candida Panel®: A case series." IDCases 15 (2019): e00525.

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