Candida albicans fungaemia following traumatic urethral catheterisation in a paraplegic patient with diabetes mellitus and candiduria
treated by caspofungin.
For all cases of suspected UTI, urine culture was done by semi-quantitative technique on cysteine lactose electrolyte deficient medium (CLED agar--(Hi-Media, Mumbai)6 and quantitative unspun wet mount microscopy done to detect pyuria (> lpus cell/7 high power fields of well mixed uncentrifuged urine samples) (6), bacteriuria, haematuria or candiduria
Our patient received curative therapy (negative repeat cultures) for disseminated candidiasis (candidemia, candiduria
, and empyema) with caspofungin and fluconazole of adequate duration.
Discontinuation of a urinary catheter can result in clearance of candiduria in almost 40% of patients; however, there is only a 20% chance of candiduria clearance in patients with candidemia.
Treatment of asymptomatic candiduria in patients who are not neutropenic has never been demonstrated to alter clinical outcome, and recurrence is common.
Candiduria in neutropenic patients, critically ill patients in the ICU, and organ transplant recipients may indicate disseminated candidiasis and should be treated for 7-14 days.
No clear cutoff for candiduria
has been established (6), and there is inadequate information regarding asymptomatic candiduria
in healthy individuals.
3] The common underlying diseases of candiduria include diabetes mellitus, urinary tract abnormalities, urinary catheter, prolonged antibiotic therapy, steroids, immunosuppressive therapy, malignancy and malnutrition.
A fungus ball can originate from agglutination of a necrotic tissue nucleus (papillary necrosis), mucosus debris and foreign or lithiasic debris; this can then lead to a urinary tract obstruction and hydronephrosis, which is a very rare complication of candiduria.
Nosocomial bacteriuria or candiduria develops in up to 25% of patients requiring a urinary catheter for [is greather than or equal to] 7 days, with a daily risk of 5% (5-7).
If intercurrent antimicrobial therapy is not given, the level of bacteriuria or candiduria almost uniformly increases to [is greater than] [10.