Hematogenous dissemination of Candida dubliniensis causing spondylodiscitis and spinal abscess in a HIV-1 and HCV-coinfected patient

Abstract

We report a case of spondylodiscitis and spinal abscess following haematogenous dissemination of the emerging yeast Candida dubliniensis in a human immunodeficiency virus-1 (HIV-1) and hepatitis C virus (HCV)-coinfected patient. Although C. dubliniensis is considered less virulent compared to its closest known relative Candida albicans, reports of severe fungal infections are increasing. This case indicates that the pathogenicity of C. dubliniensis may be higher than previously believed. Therefore fungal infections caused by this dimorph fungus should be kept in mind in immunocompromised patients with spondylodiscitis and spinal abscess.

Circumferential iris lesions in a male with cirrhosis caused by Candida dublinensis endophthalmitis

“…Risk factors include intravenous drug abuse, presence of a central venous catheter (CVC), total parenteral nutrition, administration of broad-spectrum antimicrobials, recent abdominal surgery, neutropenia, glucocorticoid therapy and diabetes [1]. In our case, intravenous drug use is probably the risk factor [4]. C. albicans has been the predominant species isolated and C. dubliniensis is a rare cause [5].…”

“…C. dublinensis had been generally considered less virulent than C. albicans as it is susceptible to environmental stressors and produces less hyphae in-vitro than C. albicans [6,7]. Disputing this are increasing reports on infections caused by C. dubliniensis that have hypothesized increased neutrophil migration, phagocytosis, cytokine release and ineffective interleukin-17A production by peripheral blood mononuclear cells as possible reasons [4,8]. Newer methods such as matrix assisted laser desorption ionization – time of flight (MALDI-ToF) and polymerase chain reaction (PCR) have enabled differentiation of closely related species and this could be another reason [8].…”

Lumbar cistern Candida intradural abscess following epidural anesthesia

“…To date, there have only been two reports of spondylodiscitis from C. dubliniensis . [ 6 , 9 ] In the previous reports, one patient was immunocompromised due to HIV and HCV coinfection and the other patient had a history of IV drug abuse and had chronic hepatitis C but was not tested for HIV. In the present study, the patient did not have any documented form of immunosuppression, including negative HIV testing.…”

Candida dubliniensis abscess: A clinical case and a review of the literature

“…There have been multiple, invasive C. dubliniensis infections described in the literature, especially in immunocompromised hosts [11] , [12] or IV drug abusers [13] , [14] , [15] . C. dubliniensis fungemia has been noted in allogeneic hematopoietic stem cell transplant patients as well as those who are post cytotoxic chemotherapy [11] .…”

“…Disseminated C. dubliniensis fungemia with biopsy proven multiorgan involvement in an HIV patient has been described [16] . Other reported cases include C. dubliniensis spondylodiscitis in both HIV-1 patients [12] and intravenous (IV) drug abusers [15] , spinal abscess in an IV drug user [12] , and healthcare-associated catheter-related blood stream infections [17] . In addition, other complications include endocarditis in IV drug abusers [12] and endophthalmitis in both intravenous drug users and patients with no such history [18] , [19] .…”