Candida guilliermondii fungemia in a critically ill trauma patient

Objective: To report a case of fungemia caused by Candida guilliermondii in a non-neutropenic 17-year-old critically ill trauma patient. Case Summary: Few case reports and small surveys have reported invasive infection caused by C. guilliermondii, most of which has occurred in immunocompromised populations. We present the case of a 17-year-old trauma patient who developed fungemia with C. guilliermondii during his intensive care unit stay. While he had multiple risk factors for the development of candidemia, this was an atypical finding, considering that this patient was not neutropenic. Due to the variable resistance patterns with this species of Candida, mean inhibitory concentration testing was requested, which demonstrated susceptibility to fluconazole. The patient was thus treated with fluconazole and his fungemia resolved without relapse. Discussion: C. guilliermondii accounts for 1-5% of cases of non-albicans Candida. While C. guilliermondii typically does not cause invasive infection, it has been associated with severe, life-threatening candidiasis in immunocompromised patients. Due to its low incidence, guidelines for the management of C. guilliermondii infections have not been well established and specific risk factors have not been identified. While risk factors specific to C. guilliermondii may mimic established risk factors for candidal fungemia in general, an important aspect to consider in the treatment of this fungus is its unique resistance profile compared with other non-albicans species. Conclusions: This case illustrates the development of an uncommon fungal pathogen in a non-immunocompromised host, compared with previously published cases series. Susceptibility testing is recommended to prevent therapeutic failures due to varying resistance patterns with C. guilliermondii.

Duke Scholars

Author Sean Paul Montgomery Trauma, Acute, and Critical Care Surgery