A 56-year-old man hospitalized in the intensive care unit is being evaluated for fever. He was admitted 8 days ago with respiratory failure and has had a complicated hospital course, including mechanical ventilation, central venous line placement, and broad-spectrum antibiotic therapy. The patient has a history of HIV and a hematologic malignancy. His last chemotherapy session was 2 weeks ago. Chest x-ray does not reveal a new infiltrate, and urine cultures are negative for infection. Blood cultures grow pseudohyphae-producing yeast species with an ability to form germ tubes. Which of the following most likely directly contributed to the development of fungemia in this patient?

Question

A 56-year-old man hospitalized in the intensive care unit is being evaluated for fever.  He was admitted 8 days ago with respiratory failure and has had a complicated hospital course, including mechanical ventilation, central venous line placement, and broad-spectrum antibiotic therapy.  The patient has a history of HIV and a hematologic malignancy.  His last chemotherapy session was 2 weeks ago.  Chest x-ray does not reveal a new infiltrate, and urine cultures are negative for infection.  Blood cultures grow pseudohyphae-producing yeast species with an ability to form germ tubes.  Which of the following most likely directly contributed to the development of fungemia in this patient?

Quizplus · Accepted Answer

Eductional Objective: Local defense against Candida is performed by T cells, whereas systemic infection is prevented by neutrophils.  For this reason, localized candidiasis is common in patients who have HIV, but neutropenic individuals are more likely to have the systemic form of the disease.

A 56-Year-Old Man Hospitalized in the Intensive Care Unit Is