Fungal empyema thoracis

A chronic alcohol user was admitted to hospital for the complaints of nausea and vomiting. He was detected to have fever for which he underwent chest X-ray and CT scan which suggested a loculated pleural effusion. The fluid aspiration showed evidence of leukocytosis and high protein content. Aspirate culture was sent for microbiological studies. Sheep blood agar showed growth of small, creamy colonies (Figure 1A). Suspecting fungal empyema, pleural fluid specimen was cultured on Sabouraud’s medium which showed circular, white, elevated pearl-like colonies (Figure 1B). Analytical profile index (API) strip study and fluid fungal culture confirmed growth of four Candida species—Candida albicans, Candida tropicalis, Candida glabrata and Candida krusei (Figures 1C and 2A–D). Patient was initiated on intravenous micafungin 150 mg once daily for 2 weeks with subsequent transition to oral fluconazole for another 2 weeks. (A) Sheep blood agar showed growth of small, creamy colonies. (B) Sabouraud’s medium which showed circular, white, elevated pearl like colonies. (C) API 20 C strip used for identification of yeast isolates. Positive reactions showing cloudy appearance in comparison to the negative control. Microscopic examination of fungal growth of all the Candida species. (A) C.Albicans. (B) C.Tropicalis. (C) C.Glabrata. (D) C.Krusei. In recent years, fungal empyema thoracis is increasingly being recognized.1 In a 57 patients’ study at a single institute, 6 patients had 2 fungal isolates with only 27% reported to have concurrent fungemia. The mortality reported in this study was significantly high (73%). A high degree of suspicion should be kept diagnosing fungal empyema thoracis, as it may present as a community-acquired infection.2 Atypical infections are extremely fatal especially in immunocompromised individuals and hence they need prompt attention.3–5 The article does not contain participation of any human being and animal. Conflict of interest. None declared.