Candida is a common yeast or fungi that is frequently found on the skin, digestive, urinary, and reproductive systems in humans. Invasive Candida infections and/or Candida overgrowth is common in many humans, especially if they are newborn/ elderly, immunocompromised, consuming lots of refined sugars, or taking antibiotics or steroid drugs such as birth control pills. Candida can occasionally cause fungus balls in the urinary system which can cause severe problems such as urinary blockage, high fevers, and septic infection. Four recent case reports of Candida fungus balls are briefly described below (1-4).
The first case involved a premature infant born at 27 weeks and weighing 770 grams and experiencing renal failure with a Candida fungal ball in both renal collecting systems (1). The infant received peritoneal dialysis, Caspofungin, and Amphotericin B antifungal treatment, and bilateral collecting tube surgery. Candida albicans and Enterobacter cloacae were found in the blood cultures. The patient gradually improved after a month’s treatment and the patient is now 6 years old and doing well (1).
The final 3 case involved older adults. A 69 year old man developed pyelonephritis and urinary retention (4). Candida albicans was found in both the fungus balls and urine. Treatment with intravenous tazobactam/ piperacillin, and oral anti-fungal fluconazole resulted in resolution of symptoms (4). Another case involved a 74 year old diabetic woman who developed high fever and urinary retention from a Candida glabrata renal fungus ball (3). She later died despite treatment with Caspofungin(3). The final case involved an 80 year old man with sepsis, kidney failure, and confusion (2). A renal fungus ball grew heavy amount of Candida albicans. Surgical removal of the Candida albicans fungal ball and treatment with intravenous fluconazole resulted in resolution of symptoms (2).
Clinicians should have a high index of suspicion for Candida fungus balls among patients with unexpected renal failure.
Research and References:
1. Brüning F, Hegele A, Klaus G, Maier RF, Hofmann R. Management of an Extremely Low Birth Weight Infant with Bilateral Renal Obstruction Caused by Candida albicans Fungus Balls. Case reports in urology. 2019;2019:3684734.
2. Abuelnaga M, Khoshzaban S, Reda Badr M, Chaudry A. Successful Endoscopic Management of a Renal Fungal Ball using Flexible Ureterorenoscopy. Case reports in urology. 2019;2019:9241928.
3. Barcelos V, Ferreira AC. Renal Fungal Balls – The Importance of Radiological Findings. Revista da Sociedade Brasileira de Medicina Tropical. 2020;53:e20190558.
4. Hiyama Y, Takahashi S, Masumori N. Management of fungus balls as a result of Candida albicans. Int J Urol. 2018;25(6):635-6.