An 11-year-old girl presented to casualty of RL Jalappa hospital with history of pain in abdomen and nausea for two days. There was no history of fever, cough, vomiting and loose stools. Past history revealed that, she had undergone device closure for patent ductusarteriosis (PDA). Her postoperative period was uneventful and followup echocardiography after one year was normal. There was no history suggestive of endocarditis.On examination she was conscious, afebrile and dyspnioec, SpO 2 was 90-92% at room air. Chest examination revealed tracheal shift to right side and decreased chest movements with dull note over the left hemithorax. Mediastinal shift was noted and point of maximal cardiac impulse was located in the right 5 th intercostal space just medial to the mid clavicular line. However on auscultation, heart sounds were normal with no murmurs. On abdominal examination tenderness was localised to the right hypochondrium.On further evaluation chest X-ray showed left sided massive pleural effusion [Table/ Fig-1]. Laboratory investigation showed hemoglobin of 13.6gm%, total leucocyte count of 19,300 cells/ mm 3 and erythrocyte sedimentation rate was 22mm/hr. Diagnostic thoracocentecis was performed; frank pus was aspirated and sent for analysis. Patient was subjected to intercostal drainage; about 2500ml of purulent fluid was drained over 48 hour. She was empirically treated with ceftriaxone and clindamycin. Biochemical analysis of Pleural fluid was suggestive of an exudate with protein of 5g/dL, glucose of 388mg/dL and lactate dehydrogenase of 12,300IU/L. Neutrophilic predominance was observed in pleural fluid cytology. Gramstain of the pus sample revealed gram positive budding yeast cells [Table /Fig-2]. A broad spectrum antifungal agent, Amphotericin-B was added pending culture report. Later culture yielded the growth of non albicans candida which was further speciated as C.krusei and C.tropicalis on chrom agar. These organisms were repeatedly isolated from a second sample of pus showing its clinical significance and satisfying the criteria for fungal empyema [1] Antifungal susceptibility testing was done as per Clinical Laboratory Standards (NCCLS) guideline [2], C.krusei is intrinsically resistant to fluconazole and tropicalis was sensitive to fluconazole aBstRaCt Infections of the pleural cavity remain an important cause of morbidity and mortality despite advancement in diagnostic modalities and therapy. Community acquired empyema thoracis due to Candida species are rarely reported in paediatric literature. We hereby report an interesting case of empyema due to co-infection of Candida krusei with Candida tropicalis. A 11-year-old female child presented with respiratory distress. Chest X-ray showed massive pleural effusion, thoracocentesis showed it as purulent exudate and she was empirically treated with antibiotics. C. tropicalis and C. krusei were isolated from the pus sample proving to be fungal empyema. Inspite of antifungal agents and mechanical ventilation, her general condition rapidly deteriorat...
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