Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2014  |  Volume : 57  |  Issue : 4  |  Page : 645-

Candida Parapsilosis in peripheral blood


Neeraj Arora1, Mayur Parihar1, Deepak Mishra1, Sanjay Bhattacharya2, Anupam Chakrapani3,  
1 Department of Laboratory Haematology & Molecular genetics, TATA Medical Center, Kolkata, West Bengal, India
2 Department of Microbiology, TATA Medical Center, Kolkata, West Bengal, India
3 Department of Hematology, TATA Medical Center, Kolkata, West Bengal, India

Correspondence Address:
Dr. Neeraj Arora
Department of Laboratory Haematology and Molecular genetics, TATA Medical Center, Kolkata, West Bengal
India




How to cite this article:
Arora N, Parihar M, Mishra D, Bhattacharya S, Chakrapani A. Candida Parapsilosis in peripheral blood.Indian J Pathol Microbiol 2014;57:645-645


How to cite this URL:
Arora N, Parihar M, Mishra D, Bhattacharya S, Chakrapani A. Candida Parapsilosis in peripheral blood. Indian J Pathol Microbiol [serial online] 2014 [cited 2020 Sep 23 ];57:645-645
Available from: http://www.ijpmonline.org/text.asp?2014/57/4/645/142702


Full Text

Editor,

This case highlights the importance of careful peripheral blood smear (PBS) examination in the diagnosis of rare fungal infections. An adult male with a diagnosis of hypoplastic anaemia underwent allogenic stem cell transplant with an HLA matched sibling and was started on primary graft versus host disease (GVHD) prophylaxis of cyclosporine as per conditioning protocol. He subsequently received oral methyl prednisolone for gut GVHD and oral gancyclovir for CMV viremia. Ninty days post transplant he presented with sudden drop in peripheral blood counts. He had a leukocyte count of 2.9 × 10 9 /L, hemoglobin 73 g/L, and platelets 30 × 10 9 /L. Post transplant day+90 chimerism analysis done to exclude graft rejection, showed 100% donor chimerism. Examination of the PBS from the blood drawn from the venous line showed pancytopenia, intracellular and few extracellular yeast like organisms indicating a fungal sepsis [Figure 1]a, b. Candida parapsilosis was cultured from peripheral blood, suggesting a systemic fungal infection. The patient was treated with Liposomal amphotericin B and the counts recovered subsequently.{Figure 1}

A number of case reports have described the detection of various fungal infections including Candida species (esp C albicans, C glabrata, and C parapsilosis) by PBS, or by the preparation of buffy coat smears, much earlier than the diagnosis usually possible by cultures. [1],[2],[3] Most of these patients described have had hematological malignancies, AIDS, or intestinal obstruction, and the fungaemias in these patients were associated with a high mortality rate (62%). Of the various fungi described Histoplasma capsulatum is the commonest fungi followed C albicans.[1] Most of these reports suggest that PBS examination should be a part of the diagnostic work flow whenever fungemia is suspected. It has been shown earlier that for peripheral blood detection, yeasts need to be at a concentration of 10 5 -10 7 CFU/mL. [4] So PBS examination will be diagnostic only in a small proportion of the cases but in all these cases PBS could be life saving as this information, combined with a careful medical history and a rationalized work-up, may yield a speedy diagnosis, and timely initiation of treatment. However with the advent of automated blood cell analyzers and other sophisticated diagnostic technologies, use of PBS examination for the diagnosis of infectious fungal diseases has reduced. This case illustrates that careful examination of the PBS is still very useful and sometimes can hasten the diagnosis of fungemia, and an early start of antifungal therapy.

References

1Yera H, Poulain D, Lefebvre A, Camus D, Sendid B. Polymicrobial candidaemia revealed by peripheral blood smear and chromogenic medium. J Clin Pathol 2004;57:196-8.
2Handoo A, Nagoti S, Choudhary A. Intraleukocytic Candida is Diagnostic of Pathological Candidemia. Turk J Haematol 2012;29:439-40.
3Nadir E, Kaufshtein M. Images in clinical medicine. Candida albicans in a peripheral-blood smear. N Engl J Med 2005;353:e9.
4Branda JA, Ferraro MJ, Kratz A. Sensitivity of peripheral blood smear review for the diagnosis of Candida fungemia. Arch Pathol Lab Med 2007;131:97-101.