title: Candida glabrata and Candida tropicalis in an immunocompetent patient: a case report.
abstract: OBJECTIVE
  To report a case of Candida glabrata and tropicalis pneumonia in an immunocompetent patient.
  
  
  METHODS
  A 72-year-old male was transferred from an outside institution due to worsening respiratory status, acute kidney injury secondary to intravenous contrast media, sepsis, and pneumonia with fever and leukocytosis. Upon admission, he was initiated on treatment for hospital-acquired pneumonia, but was also concomitantly tested for many other opportunistic infections due to his recent month-long trip to Ecuador where he participated in a tribal treatment for neuropathy that involved direct exposure to dead guinea pigs. With completion of cultures and bronchoalveolar lavage, C. glabrata was identified in the blood culture and C. glabrata and C. tropicalis in the bronchoalveolar lavage specimen. One month later, he was admitted due to recurrent pneumonia. The patient unfortunately expired during the second admission, due to complications from chronic respiratory pulmonary disease and pneumonia.
  
  
  CONCLUSIONS
  Initially, this patient was treated for hospital-acquired pneumonia, but due to a recent trip to Ecuador, it was soon discovered that this patient had developed an invasive Candida pneumonia. His pulmonary biopsies showed growth of invasive C. glabrata and C. tropicalis, while his blood culture showed C. glabrata. Candida-related lower respiratory tract infections are exceptionally rare in immunocompetent patients and require histopathologic evidence to confirm the diagnosis. A second blood culture showed that the C. glabrata was still present and the patient had worsening leukocytosis, so micafungin was added to his antimicrobial therapy.
  
  
  CONCLUSIONS
  It is understood that pneumonia is rarely caused by Candida species in patients who are admitted to the hospital. However, health care professionals should be aware that Candida pneumonia should be suspected as part of the differential diagnosis even in immunocompetent patients, particularly if they have recently traveled outside the United States.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA lhamilt4@uthsc.edu.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hamilton
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Lockhart
authors.affiliation: Department of Pulmonology, Princeton Baptist Medical Center, Birmingham, AL, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Crain
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D041221:Candida glabrata / Q000302:isolation & purification*; D041022:Candida tropicalis / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000097:blood / Q000382:microbiology*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D011014:Pneumonia / Q000097:blood / Q000382:microbiology*
keywords: Candida; immunocompetent; pneumonia