title: Isolation of Candida species is an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.
abstract: BACKGROUND
  Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood.
  
  
  OBJECTIVE
  To elucidate the clinical features of Candida empyema.
  
  
  METHODS
  We retrospectively reviewed the cases of 128 patients with culture-positive empyema.
  
  
  RESULTS
  These 128 patients included 7 whose cause of empyema was esophago- or gastropleural fistula. Empyema was due to Candida species in 5 of the 7 patients. Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. None of these 5 patients had esophageal candidiasis. Among the 121 other patients with empyema not due to esophago- or gastropleural fistula, no patient had empyema due to Candida.
  
  
  CONCLUSIONS
  We believe that the empyema in these 5 patients was caused by normal commensal Candida species entering the pleural cavity when the fistula between the gastrointestinal tract and pleural cavity was formed. Isolation of Candida species can be an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya. ishiguro.takashi@pref.saitama.lg.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishiguro
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ikeya
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yoshioka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Eishin
authors.initials: E
authors.lastname: Hoshi
authors.forename: Toshiko
authors.initials: T
authors.lastname: Hoshi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kawabata
mesh_terms: D000368:Aged; D002176:Candida albicans / Q000302:isolation & purification*; D041221:Candida glabrata / Q000302:isolation & purification*; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology*; D004947:Esophagus / Q000293:injuries / Q000382:microbiology*; D005260:Female; D005747:Gastric Fistula / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged