title: Successful treatment with caspofungin of candiduria in a child with Wilms tumor; review of literature.
abstract: Symptomatic candiduria often occurs in patients with indwelling bladder catheters or immunocompromised host. Isolation of Candida in urine in high-risk patients should primarily be considered as a marker for candidemia. Hematological and genitourinary malignancies are one of the main risk factors associated with Candida urinary tract infections (CUTI). Fluconazole is a choice for initial treatment of CUTI, but it is fluctuate depending on the patient's condition including renal failure, site of urinary infection and Candida species. Poor glomerular filtration is the main disadvantage echinocandins resulting in very low urinary concentrations. Therefore, echinocandins have prohibited their use in CUTI. Up to now, there are only 10 cases reported in the literatures with highly effective echinocandins in CUTI because of high concentrations in the tissue are needed to control invasive fungal disease. Herein, we report a candiduria followed by renal candidiasis caused by Candida albicans in a 6-year-old Iranian male with a history of Wilms tumor in left kidney. Direct examination of urine specimen revealed an infection due to budding yeast cells with numerous pseudohyphae and growths of C. albicans was reconfirmed by sequencing of ITS rDNA region. MICs in increasing order were as follows: caspofungin (0.016μg/ml), voriconazole (0.125μg/ml), amphotericin B (0.25μg/ml), itraconazole (0.5μg/ml) and fluconazole (2μg/ml). It seems that successful treatment with caspofungin owes achieved high renal tissue concentrations that are unrelated to glomerular filtration. In conclusion, predisposing factors for better outcome are more important than treatment of CUTI, therefore, management of UTI is essential for critically patients.
authors.affiliation: Infectious Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: M S
authors.initials: MS
authors.lastname: Rezai
authors.affiliation: Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Vaezi
authors.affiliation: Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: H
authors.initials: H
authors.lastname: Fakhim
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Soleimani
authors.affiliation: Infectious Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: H
authors.initials: H
authors.lastname: Mohammad Jafari
authors.affiliation: Department of Microbiology, Sari Branch, Islamic Azad University, Sari, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Mohseni
authors.affiliation: Invasive Fungi Research Center/Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Iran. Electronic address: badalii@yahoo.com.
authors.forename: H
authors.initials: H
authors.lastname: Badali
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D000077336:Caspofungin; D002648:Child; D054714:Echinocandins / Q000627:therapeutic use*; D006801:Humans; D007492:Iran; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D009396:Wilms Tumor / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin
keywords: Candida albicans; Candida urinary tract infection; Caspofungin; Caspofungine; Infection des voies urinaires à Candida; Tumeur de Wilms; Wilms tumor