[Significance of the presence of Candida sp. in bronchopulmonary secretions. Contribution of pulmonary biopsy]

Abstract

Candida SP is often found in broncho-pulmonary secretions (expectorations, bronchial aspirations, bronchiolo-alveolar lavage...); however, its presence even in massive amounts, is difficult to interpret. Is it a sign of broncho-pulmonary candidosis or mouth-pharynx contamination? The different clinical and biological elements, in particular immunology in immunodepressed patients, bring little information. In this article, we present the retrospective study of 18 patients hospitalized in Pneumology Department of Tenon Hospital for severe extensive pneumopathy of unexplained origin. In these patients, for the most part immunodepressed, Candida sp was found in large amounts in at least a sample (expectorations [5] and/or bronchial aspirations [4] and/or bronchiolo-alveolar lavage [12]. No lesion suggestive of candidiasis was found during bronchial endoscopy carried out for these different samples. In pulmonary biopsy with diagnostic in view, these yeasts were found only in one patient. In this patient, as C. tropicalis was associated with Pneumocystis carinii and Cryptococcus neoformans, it was difficult to know the respective part of each of these agents in pulmonary symptomatology. In the other 17 cases, the direct examination and cultures were negative. The presence of Candida sp in the different broncho pulmonary secretions is not synonymous of bronchopulmonary candidiasis; likely it is, in most cases, a sign of contamination of mouth-pharynx origin.