Short Case Report
Calculus Pyonephrosis with Candida Albicans Infection Case Report An otherwise fit, nondiabetic woman aged 41 presented with a pyonephrosis due to a pure growth of Cundidu ulbicuns. above a recurrent stone, impacted at the pelviuretericjunction. Following pyelolithotomy the kidney was drained by a nephrostomy but the pyrexia failed to resolve and Cundidu albicans was repeatedly grown in the nephrostomy urine. After 8 days a course of 5-fluorocytosine (5-FC) was commenced and blood and urinary drug levels with sensitivity assays demonstrated adequate concentrations. A very rapid resolution of the pyrexia (Fig.) was followed by the eradication of candida from the urine. Follow-up showed one E. coli infection, but no return of the candida. Ureteric reflux was absent.
Comment This patient had a superficial candida infection of the kidney with sparing of the renal parenchyma. Such an infection is very unusual in the absence of diabetes or an impaired immune response. Oral 5-FC, unlike amphotericin B, is well concentrated in the urine and is not known to cause marrow or liver damage, (Davies and Reeves, 1971).
Although candidal resistance to 5-FC has been reported (Shadomy, 1969), it is recommended as the drug of choice provided urinary concentrations and organism sensitivities are monitored. We would like to thank Dr R. R. Davies of the Department of Microbiology, St Mary’s Hospital, for carrying out the bacteriology and for his advice on the management of this patient, and also Professor J. P. Blandy under whose care the patient was admitted.
M. J. KELLY, Addenbrookes Hospital, Cambridge and M. E. Mayo, Institute of Urology, 172 Shqftesbury Avenue, London
References DAVIES. R. R. and REEVES,D. S. (1971). 5-Fluorocytosine and urinary candidiasis. British Medical Journal, 1,577479. SHADOW,S . (1969). In vitro studies with 5-Fluorocytosine. Applied Microbiology, 17, 811-871.
106104-
e 102
5 0
-
100: 98:
I-
9h 94
6
-
1
m
y
Pyelolithotomy
fin v v
Ampicillin 500 mg qid
1
b k n t a m i c i n 80 mg bd
Sulohadimidine I G qid 130
. w w L
w
Calculus Pyonephrosis with Candida Albicans Infection Case Report An otherwise fit, nondiabetic woman aged 41 presented with a pyonephrosis due to a pure growth of Cundidu ulbicuns. above a recurrent stone, impacted at the pelviuretericjunction. Following pyelolithotomy the kidney was drained by a nephrostomy but the pyrexia failed to resolve and Cundidu albicans was repeatedly grown in the nephrostomy urine. After 8 days a course of 5-fluorocytosine (5-FC) was commenced and blood and urinary drug levels with sensitivity assays demonstrated adequate concentrations. A very rapid resolution of the pyrexia (Fig.) was followed by the eradication of candida from the urine. Follow-up showed one E. coli infection, but no return of the candida. Ureteric reflux was absent.
Comment This patient had a superficial candida infection of the kidney with sparing of the renal parenchyma. Such an infection is very unusual in the absence of diabetes or an impaired immune response. Oral 5-FC, unlike amphotericin B, is well concentrated in the urine and is not known to cause marrow or liver damage, (Davies and Reeves, 1971).
Although candidal resistance to 5-FC has been reported (Shadomy, 1969), it is recommended as the drug of choice provided urinary concentrations and organism sensitivities are monitored. We would like to thank Dr R. R. Davies of the Department of Microbiology, St Mary’s Hospital, for carrying out the bacteriology and for his advice on the management of this patient, and also Professor J. P. Blandy under whose care the patient was admitted.
M. J. KELLY, Addenbrookes Hospital, Cambridge and M. E. Mayo, Institute of Urology, 172 Shqftesbury Avenue, London
References DAVIES. R. R. and REEVES,D. S. (1971). 5-Fluorocytosine and urinary candidiasis. British Medical Journal, 1,577479. SHADOW,S . (1969). In vitro studies with 5-Fluorocytosine. Applied Microbiology, 17, 811-871.
106104-
e 102
5 0
-
100: 98:
I-
9h 94
6
-
1
m
y
Pyelolithotomy
fin v v
Ampicillin 500 mg qid
1
b k n t a m i c i n 80 mg bd
Sulohadimidine I G qid 130
. w w L
w
