Concurrent Subcutaneous Candidal Abscesses and Pulmonary Cryptococcosis in a Patient with Diabetes Mellitus and a History of Corticosteroid Therapy

Kakeya, Hiroshi; Izumikawa, Koichi; Yamada, Koichi; Narita, Yusuke; Nishino, Tomoya; Obata, Yoko; Takazono, Takahiro; Kurihara, Shintaro; Kosai, Kosuke; Morinaga, Yoshitomo; Nakamura, Shigeki; Imamura, Yoshifumi; Miyazaki, Taiga; Tsukamoto, Misuzu; Yanagihara, Katsunori; Takenaka, Motoi; Tashiro, Takayoshi; Kohno, Shigeru

doi:10.2169/internalmedicine.53.1409

Cited by 9 publications

(5 citation statements)

References 39 publications

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“…This allows for opportunistic infections and is hypothesized to be the relationship between cryptococcal infection and DM. [60][61][62] Culture of appropriate respiratory samples is the gold standard for the diagnosis of cryptococcal infection hence it comes as no surprise that it was the most commonly favored diagnostic modality in this study. The use of CrAg detection for confirming the diagnosis was also widely favored because it is more convenient for all hospital settings and takes a shorter duration of time.…”

Section: Discussionmentioning

confidence: 87%

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Cryptococcosis complicating diabetes mellitus: a scoping review

Nsenga

Kajjimu

Olum

et al. 2021

Therapeutic Advances in Infection

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Background: A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented. Objective: The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM. Methods: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded. Results: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% ( n = 18) of the cases. Median age was 60.5 (range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% ( n = 18). Among those with meningitis mortality was 36.2%. Conclusion: A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.

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Section: Discussionmentioning

confidence: 87%

“…This allows for opportunistic infections and is hypothesized to be the relationship between cryptococcal infection and DM. 60–62…”

Section: Discussionmentioning

confidence: 99%

Cryptococcosis complicating diabetes mellitus: a scoping review

Nsenga

Kajjimu

Olum

et al. 2021

Therapeutic Advances in Infection

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“…This has also been observed by Glavey et al, 39 in their cross-sectional study, and Madhumati and Rajendran. 40 Kakeya et al 41 and Fardet et al 42 reported an increased risk of susceptibility to opportunistic infections in patients exposed to corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and antifungal susceptibility of gastrointestinal candidiasis among diabetic patients: A cross-sectional study

Oyom

Okello

Acam

et al. 2020

African Journal of Laboratory Medicine

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Background Gastrointestinal candidiasis is the most predominant opportunistic human mycosis, especially in diabetic patients. There is a global increase in antifungal resistance coupled with a rarity of information on antifungal susceptibility profiles in Uganda. Objective This study aimed to determine the occurrence and antifungal susceptibility of gastrointestinal candidiasis in diabetic patients. Methods Stool and fasting blood specimens were obtained from randomly sampled consenting patients with diabetes mellitus at St. Francis Hospital Nsambya in Kampala, Uganda to determine Candida infection, fasting blood glucose and glycated haemoglobin levels. Susceptibility testing was performed on Muller Hilton agar supplemented with 2% glucose and 0.2 µ g of methylene blue, using the E-test diffusion method. Results Among the 241 patients included in the analyses, the overall prevalence of gastrointestinal candidiasis was 15.4% ( n = 37). Candida albicans (62.16%, n = 23) was the predominant species, followed by Candida glabrata (18.92%, n = 7), Candida tropicalis (8.11%, n = 3), Candida krusei (5.41%, n = 2) and Candida dublinensis (5.41%, n = 2). Resistance was observed with miconazole (48.65%), clotrimazole (18.92%) and fluconazole (8.11%). No resistance to itraconazole and nystatin was observed. Gastrointestinal candidiasis was associated with poor glucose control ( p ≤ 0.001), prior use of antibiotics ( p ≤ 0.001), antifungals ( p ≤ 0.001) and corticosteroids ( p ≤ 0.001) and was more common among female patients ( p = 0.01). Conclusion Occurrence of gastrointestinal candidiasis was relatively low among our participants, and infection was associated with poor glucose control, female sex and use of antifungals, antibiotics and corticosteroids.

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“…To the best of our knowledge, there have only been 10 other reports of Candida species subcutaneous abscesses in patients >15 years old from 1963 to March 2022 [ 1 , 3 - 11 ]. These case reports are summarized in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Candida , which is opportunistic pathogenic yeast, is a very common fungus in the mouth and the gut that can cause systemic invasive fungal infections in humans, especially in immunocompromised patients. However, the subcutaneous candidal abscess is very rare, even in immunocompromised patients [ 1 ]. Management of such abscesses involves the administration of effective antifungal therapy and targeted source control [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Chest Abscess Caused by Candida albicans Infection Following Laparoscopic Cholecystectomy in an Immunocompetent Patient: A Case Report

Yoshihara¹,

Kurihara²,

Hori³

et al. 2022

Cureus

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Cases of subcutaneous abscess due to Candida albicans ( C. albicans ) infection are rare, even among immunocompromised patients. To our knowledge, there have only been eleven reports of such cases in adults, all of which presented with comorbidities of immunodeficiency, prior antibiotic administration, or skin breakdown following traumatic episodes or iatrogenic procedures. We report a rare case of a 42-year-old Japanese woman with a subcutaneous abscess due to C. albicans infection. The patient was referred to our hospital with a chief complaint of gradually worsening lower left-sided chest pain. Nine months before admission, she underwent laparoscopic cholecystectomy (Lap-C) for acute cholecystitis at another hospital. She developed fever and was treated with cefotiam for three days followed by cefoperazone/sulbactam for four days. One week after Lap-C, she began to feel pain in the lower left side of her chest. The chest pain worsened gradually and the fever persisted until two months before admission. On admission, enhanced chest computed tomography revealed a left chest subcutaneous abscess located between the seventh and ninth rib. She underwent surgical percutaneous drainage, and the abscess cavity was cleaned. The pus culture revealed C. albicans , but the blood cultures were negative. We administered intravenous micafungin (150 mg daily) for 10 days, followed by oral fluconazole (600 mg daily). She experienced telogen effluvium during the period of fluconazole treatment but recovered after the cessation of fluconazole. We also present a short review of the literature relating to subcutaneous candidal abscesses in patients over 15 years old.

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Concurrent Subcutaneous Candidal Abscesses and Pulmonary Cryptococcosis in a Patient with Diabetes Mellitus and a History of Corticosteroid Therapy

Cited by 9 publications

References 39 publications

Cryptococcosis complicating diabetes mellitus: a scoping review

Cryptococcosis complicating diabetes mellitus: a scoping review

Prevalence and antifungal susceptibility of gastrointestinal candidiasis among diabetic patients: A cross-sectional study

Subcutaneous Chest Abscess Caused by Candida albicans Infection Following Laparoscopic Cholecystectomy in an Immunocompetent Patient: A Case Report

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