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International Research Journal of Medical Sciences __________________________________________________
Vol. 1(1), 18-19, February (2013)

Mini Review Paper
Pneumonia caused by Candida kefyr in a Pediatric patient with Acute
Lymphoblastic Leukaemia: Case Report
Dinkar A.1, Bhattacharyya S.1, Kumar D.1, Kumar A.2, Gupta P.1, Banerjee G.1 and Singh M.1
1Departments of Microbiology, King George’s Medical University (KGMU), Lucknow-226003, UP, INDIA 2Departments of Pediatrics, King George’s Medical University (KGMU), Lucknow-226003, UP, INDIA Available online at: www.isca.in
Received 10th January 2013, revised 21st January 2013, accepted 5th February 2013 Abstract
Acute lymphoblastic leukaemia (ALL)is one of the commonest malignancies in children. The disease per se and
immunosuppressant cytotoxic drugs administered, together make the patients of ALL very prone to secondary infections.
Yeasts recovered from pulmonary tissue are mostly treated as colonisers and left unreported, though they can also be rarely
responsible for pneumonia, especially in settings of haematological malignancies. Here we report a case of lung infection
due to Candida kefyr in a patient with ALL.
Keywords: ALL, Candida kefyr, immunocompromised.

Introduction
leucocyte count of the patient was 8000/µl and absolute Neutrophil count was 5200/ µl. The patient was put on Acute leukaemia, a tumour of the haematological progenitor Tetracycline, Tramadol, Fluconazole, Vincristine, Methotrexate cells of the Bone marrow, is the commonest paediatric and L-Asparaginase. Sputum sample was collected from the malignancy1. Of this, Acute Lymphoblastic Leukaemia (ALL) patient and sent to the Department of Microbiology for fungal comprises about 75%1. The disease commonly presents with culture. A 10% KOH smear showed multiple budding yeasts as neutropenia, which is a risk factor for secondary infections in well as pus cells, with a Quality (Q) score of +3(plus three). this group of patients2. An absolute neutrophil count of <500/µl Gram stain also showed similar findings. The sample was has been associated with significant risk of infection2. Infect, a inoculated in 2 Saboraud’s Dextrose agar (SDA) slants and patient with febrile neutropenia has a 60% likelihood of being incubated at 370C and 250C separately. After 48 hours of infected3. Most of these are bloodstream infections (BSI), incubation, opaque, smooth white colonies grew on both tubes. although other organs may also be affected3. Pulmonary A Lactophenol Cotton blue (LCB) mount of the colonies infiltrates develop in about 60-80% such patients, according to showed budding yeast cells. A loopful of the growth was scientific literature4. Such infiltrates can be due to infection, streaked onto Corn meal agar by slit inoculation (Dalmau haemorrhage or leukemic involvement of lung parenchyma5. In technique) and incubated at 250C for 48 hours. Germ tube test a study, about 12% of all episodes of infectious pneumonia in and Sugar fermentation and assimilation tests were also ALL are caused by fungi, most commonly by Aspergillus spp.6. performed. The isolate was Germ tube negative and showed Candida spp. is also a known cause of pneumonia in these elongated budding yeasts and pseudohyphae arranged in patients, although the incidence has decreased due to irregular parallel bundles (logs in stream appearance) on high prophylactic antifungal therapy7. power (40X) microscopic examination of the streaked Corn meal agar plate. Glucose, lactose and sucrose were fermented Case Report
but not maltose. Lactose, glucose and sucrose were assimilated but not maltose. Based on these phenotypic characteristics, the A 13 year-old male patient presented in the Paediatric outpatient isolate was identified as Candida kefyr8. Antifungal Department of the Medical University with respiratory distress susceptibility test was done by the disc diffusion technique on and hepatosplenomegaly. The patient was admitted and baseline Mueller-Hinton agar with 2% glucose and 0.5 µg/ml of haematological investigations were performed. Based on bone Methylene blue, as per CLSI protocol9. The yeast isolate was marrow analysis, a diagnosis of B cell ALL was achieved. The susceptible to fluconazole and voriconazole. The sample was patient was suffering from cough and breathlessness since 3 sent on 2 more occasions, which yielded the same results. There months, and also had 2 episodes of haemoptysis. A chest was no bacterial growth in the sputum samples. Blood culture roentgenogram (postero-anterior view) was carried out, which on biphasic media was sterile after 21 days of incubation. The revealed cavitatory lesions in lingular lobe of left lung with patient’s breathlessness improved on fluconazole therapy and patchy fibrosis, along with nodular infiltrates. The total there were no further bouts of haemoptysis. International Science Congress Association
International Research Journal of Medical Sciences ________________________________________________________________
Vol. 1(1), 18-19, February (2013)
Int. Res. J. Medical Sci. Discussion
References
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Identification, 5th Edition, ASM press, Washington DC Conclusion
9. NCCLS, Method for antifungal disk diffusion susceptibility
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junior technician and Dr Akhilesh, Junior Resident, Department
an Emerging Pathogen in Patients with Oncohematological of Microbiology, KGMU for their assistance in identifying the Diseases?, Clin. Inf. Dis., 43, 666–67 (2006)
12. Weichert S., Reinshagen K., Zahn K., Geginat G., Dietz A.
, Kilian A.K., Schroten H. and Tenenbaum T., Candidiasis caused by Candida kefyr in a neonate: Case report, BMC
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International Science Congress Association

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