The Bug Story: Melioidosis with Candidaemia

Candida infections, particularly Non-Albicans Candida (NAC) infections, are increasing in nosocomial settings. Catheter-related bloodstream infections (CRBSI) are fast becoming a significant risk to hospitalised patients. Of these, Candida parapsilosis is frequently isolated fromblood cultures. In the context of increasing antimicrobial resistance, these infections have gained additional importance. A 22-year-old woman with young-onset, uncontrolled diabetes presented with cough, fever, and dyspnoea for 1.5 months. Initial blood tests revealed anaemia, leukocytosis and significantly elevated HbA1C and CRP levels. Chest X-ray findings confirmed left lobar pneumonia, leading to the initiation of third-generation cephalosporins. She developed rapidly progressive hypoxia requiring intubation. Given her uncontrolled diabetes and pneumonia, a provisional diagnosis of Melioidosis, Staphylococcus and Tuberculosis was considered, and she was initiated on Meropenem. Following confirmation of Melioidosis, additional Trimethoprim/ Sulfamethoxazole was prescribed. Despite improvements in X-ray and ventilation, the patient continued to experience persistent fever spikes. Repeat blood cultures from both central and peripheral lines grew Candida species. Fluconazole was started while awaiting culture sensitivity reports. However, the patient did not respond to line removal and Fluconazole treatment. Her condition worsened, leading to severe hypotension and cardiac arrest within hours. Despite resuscitation efforts, she could not be revived and died. The blood culture sensitivity report revealed Candida parapsilosis with fluconazole resistance. This case highlights the importance of monitoring critically ill patients for Candidaemia (CRBSI), especially in those with central and peripheral lines. Prompt identification, removal of infected lines, along with appropriate antifungal therapy, may prevent further morbidity and mortality in these patients.