Chronic Candidal Bronchitis: A Consecutive Series

BACKGROUND: Persistent Candida from fungal cultures of respiratory secretions are often ignored and not treated due to assumptions concerning benign colonization. OBJECTIVES: To determine the clinical course of patients with chronic sputum and fungi on culture, including response to antifungal treatment. METHODS: All patients seen at a single long term acute care hospital (LTAC) between May 2009 and September 2010 with at least two months of daily sputum and fungus on more than one sputum culture were identified. LTAC, inpatient, and outpatient records through June 2011 were reviewed to assess clinical features and response to therapy or to cessation of therapy. RESULTS: Eleven patients were identified, having sputum duration of 5 months to 28 years, and respiratory cultures growing Candida species. Fungi included C albicans (8 patients), C glabrata (2), C krusei (2), C tropicalis (1), C parapsilosis (1), Aspergillus fumigatus (1), Aspergillus terreus (1), and Scedosporium (1), the latter 3 in conjunction with Candida species. All had abnormal chest CT scans, often with bronchiectasis and sometimes atelectasis or consolidation, and ten of 11 patients were on chronic steroids (inhaled and/or systemic). Antifungal therapy, mostly oral voriconazole and nebulized amphotericin, led to improved respiratory symptoms and sputum within 3 weeks in 10 of 10 treated patients. Lack of antifungal therapy or early cessation of treatment was associated with progressive or recurrent symptoms and death of one patient. CONCLUSIONS: This case series suggests that chronic candidal bronchitis is associated with significant morbidity and responds well to treatment. Such patients may benefit from extended antifungal therapy. Guidelines for the treatment of Candida in pulmonary secretions should be reevaluated.