A case of urinary tract infection due to Candida albicans and responding to fluconazole is presente

Agba Matthias, Dr. Ikenna

Agbonlahor Dennis, Dr. E

Nwobu Gilbert, Dr. O

Tatfeng Youtchou, Dr. Mirabeau

English

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Candida albicans in Urinary Tract or in Seminal Sac

Cognitive Sciences ePrint Archive

1Published Quarter ly
Mangalore, S outh I ndia
I S S N 0972-5997
Volume 2;  I s sue 4;  October -December
Cas e R epor t
Candida albicans  in  U r inar y T r act  or  in  S eminal S ac
T at f eng YM, Agba M, Department of Medical Microbiology, Faculty of Pathological
S ciences , College of Medicine
Nw obu GO,  Department of Medical Laboratory S ciences , Faculty of Pathological
S ciences , College of Medicine
Agbonlahor  DE ,  Department of Microbiology, Faculty of Natural S ciences
Ambr os e Al l i  U niver s i t y, P .M.B . 1 4  E kpoma, E do S t at e, Niger ia
E -mai l :  yout chou@ yahoo.com
Cit at ion:  T atfeng Y.M., Agba M.I .,  Nwobu G.O, Agbonlahor  D.E.Candida albicans  in
Ur inary T ract or  in S eminal S ac.Online J Health All ied S cs .2003; 4: 5
U R L :  http: //www.oj has .org/is sue8/2003-4-5.htm
Open Acces s  Ar ch ive:  http: //cogpr ints .ecs .soton.ac.uk/view/subj ects /OJHAS .html
I nt r oduct ion
T he ur inary tract cons is ts  of the kidneys , the
bladder  and accessory s tructures . Ur inary tract
infections  (UT I s ) occur  more frequently in
females  than males  because the female urethra
is  shor t (about 1.5 inches , compared 8 inches  in
the male) and is  adj acent to the genital and
intes tinal tract.[1]
UT I s  are pr imar ily of two types :  cys titis , which is
infection of the bladder  and pyelonephr itis  which
is  infection of the renal parenchyma. Urethr itis
which occur s  often is  generally discussed as  a
sexually transmitted disease, although the acute
urethral syndrome is  not placed in the sexually
transmitted category, s tr ictly speaking. Among
the bacter ia mos t frequently isolated in UT I s  are
Escher ichia coli, K lebs iella sp, S taphylococcus
saprophyticus , Proteus  mirabilis , Pseudomonas
aeruginosa etc. Mos t infections  involving the
kidneys  are acquired by the ascending route.
However , yeas t (usually Candida albicans ),
Mycobacter ium tuberculos is , S almonella sp, or
S taphylococcus  aureus  in the ur ine often
indicates  pyelonephr itis  acquired via
hematogensous  spread.[2]
R epor t
A 27 year s  old medical s tudent from Ambrose
Alli Univer s ity repor ted to the Univer s ity Health
center  in January 2003 with a his tory of painful
mictur ition.  Ur inary tract infection was
suspected and consequently Pefloxacin was
prescr ibed. On completion of the course, no
meaningful improvement was  observed. I n July
2003, dur ing a practical clas s  where proces s ing
of ur ine specimens  was  discus sed, the s tudent
informed the scientis t of his  condition who
picked interes t in the s tudent's  case. On
interviewing the s tudent, it was  gathered that
the painful ur ination was  sporadic and
sometimes  accompanied with a s limy discharge.
T he s tudent also complained of frequent wet
dreams  s ince the beginning of the disorder . He
also complained of pain dur ing and after
ur ination around the pubic area.
A s ter ile, screw capped, wide mouthed,
container  was  given to the s tudent and was
ins tructed to collect a mid-s tream ear ly morning
ur ine the next day. After  proces s ing the sample
us ing s tandard bacter iological techniques  as
descr ibed by Mackie and McCar tney,[3] one to
two pus  cells  per  high power  field were counted
and no growth on both Cys tine Lactose
Electrolyte Deficiency Agar  (CLED) and B lood
Agar  (BA) was  obtained after  over  night
incubation of the specimen.
Another  s ter ile ur ine sample and blood was
collected. S yphilis  antibodies  screening (VDRL)
was  negative. T he microscopic examination of
the centr ifuged ur ine depos it revealed a yeas t
cell and overnight incubation of the ur ine sample
showed a colony which was suspected to be a
contaminant. All attempt made to explain the
presence of the yeas t cell in the ur ine specimen
2proved abor tive as  the s tudent denied indulging
in any form of sexual intercourse with a female
counterpar t s ince the onset of the discomfor t.
A third bottle was  again given to the s tudent
who this  time around produced a very turbid and
s limy ur ine the next day. After  proces s ing, it
was  found out that, although the pus  cells
counted in the centr ifuged depos it of the ur ine
sample were 2-3/HPF, a lot of s luggish
spermatozoa were seen along s ide many yeas t
cells . T he overnight culture of the specimen
yielded a moderate growth of organisms . T he
Gram S taining of the colonies  showed large
Gram pos itive organisms suspected to be yeas ts
cells . Germ T ube T es t (GT T ) was  then used to
identify the organism as  Candida albicans . B lood
was  subsequently collected for  HI V tes t which
was  negative. F luconazole was  prescr ibed to the
s tudent and a repeat tes t was  done two weeks
after . No yeas t cell was  seen in the depos it of
the centr ifuged ur ine specimen and an over
night culture of the repeat specimen revealed no
growth. At the time of wr iting this  repor t, 4
months  after , the s tudent has  not repor ted of
painful ur ination and turbid ur ine production.
Dis cus s ion
Even though Candida albicans  is  incr iminated in
the causation of UT I , the case of this  s tudent
raises  many ques tions . I f this  was  a case of
pyelonephr itis , cys titis  or  urethr itis , why couldn’t
we isolate the pathogen each time the specimen
was  collected? Why the incons is tent production
of turbid ur ine containing spermatozoa? T he
presence of spermatozoa in the ur ine with yeas t
cells  (Candida albicans ) could be an indication of
seminal sac infection.
Fur ther  more, the examination of the high
vagina swab of the patient’s  sex par tner
revealed a moderate growth of Candida albicans
which was treated with F luconazole.
R efer ences
1. Nes r ter  E.W., Rober ts  C.E., Pear sall
N.N., et al:  Microbiology:  A human
pespective, (1995) Mc Graw –  Hill 6 th
Edition
2. Ellen J.B , Lange R.P, S ydney M.F.
Diagnos tic microbiology:  Mosby, 9 th
edition (1994) page 384-385.
3. Mackie T .J. and MaCar tney J.E.
Practical Medical Microbiology Churchill
L ivings tone, Longman Group UK, 13 th
edition (1989) page 601-649
R eview er 's  Comment s :
T he exact cause of non-bacter ial chronic
pros tatitis /chronic pelvic pain syndrome is  a
matter  of controversy and organisms
presumable respons ible viz. Chlamydia, U.
urealyticum and rarely Candida are often
difficult to isolate. Even when isolated, the exact
cause and effect relationship is  difficult to
ascer tain. I n the present case s tudy, there is  no
doubt that the yeas t cells  or iginated from the
lower  ur inary tract. Unlike ves ical infections ,
organisms  respons ible for  seminal and pros tatic
infections  remain seques tered and may not
necessar ily be isolated in all samples  of ur ine.
Compar ing examination of EPS  (expres sed
pros tatic secretions ) with mid s tream specimen
of ur ine would probably have confirmed the
pros tatic or  seminal ves icular  or igin of the
organism. I n literature, documented cases  of
Candidias is  are rare. (I ndudhara et al. I solated
invas ive Candidal pros tatitis . Urol I nt.
1992; 48: 362-364). S atis factory clinical response
to Fluconazole in this  patient indicates  a
probable Candidal etiology, though clinical
follow-up along with repeated examination of
EPS  for  Candida over  a longer  term is  sugges ted
for  confirmation.


Candida albicans in Urinary Tract or in Seminal Sac

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