CANDIDA ALBICANS (MONILIA ALBICANS) INFECTION WITH BLOOD STREAM INVASION; REPORT OF A CASE WITH A STRAIN CLINICALLY RESISTANT TO SULFONAMIDE DRUGS AND TO PENICILLIN IN VITRO
Though systemic, infection with Monilia is not rare, only 5 cases of blood stream infection with this fungus were found in the literature. All of these occurred in drug addicts, and all ended fatally showing mycotic endocarditis at autopsy. In 4 patients the organism was Candida parakrusei, and in the 5th, C. guilliermondi.[long dash]The case here reported was a 43-yr. old railroad worker who gave a previous history of attacks of cough, dyspnea and wheezing. Prior to entry he developed a severe acute bronchitis which yielded to sulfadiazine, but C. albicans was isolated from his blood stream 5 times in spite of adequate chemotherapy. Positive cultures were also obtained from the bronchial secretions, pharynx, urine and feces. After intraven. NaI the blood culture became negative in 24 hrs. and remained so for 31/2 months. In vitro tests showed the organisms to be resistant to penicillin. Urinary symptoms present for several yrs. were difficult to evaluate. No lesions were demonstrable in the kidneys, but chronic inflammation of the bladder seen by cystoscopic examination, coupled with positive ureteral cultures and sterile prostatic fluid, suggested renal moniliasis. The patient was discharged on the 16th hospital day, and returned to work . some time later in spite of slight cough. Urine and throat cultures continued to be positive. C. albicans was also isolated from the throats of the patient''s wife and daughter. The former had a cough for 6 months but no clinical study of her condition was made. This seems to be the first instance of blood stream infection with C. albicans to be demonstrated during life.