From: Candida species in community-acquired pneumonia in patients with chronic aspiration
Case | Sputum Gram Stain | Intracellular Yeast/Pseudohyphae | Sputum Culture CFU/ml | WBC/ml Sputum | Blood Culture | Viral PCR | ß-d Glucan pg/ml | Peripheral WBC mm3 | PCT ng/ml | Chest Imaging | Aspiration Risk | Treatment | Outcome |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Many WBC, many yeast, moderate GPR and GPC, rare GNR | Yes/Yes | C. glabrata 2 × 107 Pseudomonas 2 × 105 | 1.5 × 107 | C. albicans | ND | ND | 17,800 | 17.7 | Patchy bilateral opacities | Oropharyngeal dysphagia, PEG, previous admissions for aspiration | Piperacillin-tazobactam Micafungin | Opted for hospice and died within 1 month |
2 | Many WBC, yeast, GPR | Yes/Yes | C. albicans 5 × 106 Lactobacillus gasseri 5 × 107 | 1 × 107 | Negative | Influenza A | > 500 | 15,400 | 0.14 | Diffuse bilateral opacities | Dysphagia, achalasia, documented aspiration | Vancomycin Ceftriaxone Metronidazole Micafungin | Died during admission |
3 | Many WBC, yeast, GPR, few GPC | Yes/No | C. albicans 6 × 106 Lactobacillus kalixensus 4 × 106 | 3.2 × 105 | Negative | ND | > 500 | 4200 | < 0.09 | Bilateral bibasilar opacities | Seizures, suspected aspiration | VancomycinCeftriaxone Metronidazole Trimethoprim-sulfamethaxole Fluconazole | Improved |
4 | Many WBC, yeast, GPC (pairs, chains, clusters) | Yes/Yes | C. albicans 2 × 107 S. aureus 5 × 107 S. pneumoniae 4 × 107 | 9 × 107 | S. aureus C. glabrata* | Influenza A | > 500 | 17,700 | ND | Diffuse bilateral opacities | PEG with pleasure feeds, suspected aspiration | Oseltamivir Piperacillin-tazobactam Nafcillin Fluconazole | Died during admission |
5 | Many WBC, yeast and GPR | Yes/Yes | C. tropicalis 4 × 106 Lactobacillus gasseri 1.6 × 108 | ND | Negative | ND | ND | 28,000 | 4.75 | Bibasilar reticulonodular opacities | Tracheostomy, PEG, suspected aspiration | Vancomycin Cefepime Metronidazole Micafungin | Improved then died within 1 year |
6 | Many WBC, yeast, GPR | Yes/Yes | C. glabrata 1.3 × 108 C. tropicalis 2 × 106 S. aureus 5 × 105 | ND | ND | Negative | ND | 4300 | < 0.09 | Bilateral opacities | Supraglottic squamous cell cancer, chronic dysphagia, suspected aspiration | CeftriaxoneAzithromycin Fluconazole | Improved |