ppt emphysematous pyelonephritis due to fungal cause.pptx

Emphyesematous pyelonephritis due to fungal cause

1. Theme : E-Poster Presentation Topic : Emphysematous pyelonephritis by Candida “TOPICALIS”: A rare

2. INTRODUCTION A rare, severe necrotizing infection characterized by the presence of gas within renal parenchyma, collecting system, and perirenal tissue. 90% mortality and higher morbidity rates ,Women outnumbered men (41:7), and 96% patients had diabetes, most common causative pathogen is Escherichia coli (70%); other less, Unlike others candidal emphysematous pyelonephritis has an indistinctive presentation and diagnosed late, thus delaying prompt treatment.

3. 48-year-old Type 2 diabetic Lady presenting with fever with chills, rigor and right flank pain with Right renal angle tenderness. USG KUB and NCCT KUB shows enlarged right kidney with moderate hydronephrosis and large air pockets , establishing the diagnosis Right sided Acute Emphysematous Pyelonephritis TYPE IIIa on CT-based classification used by Huang and Tseng. USG-guided Right sided percutaneous nephrostomy and DJ stent was performed with 14-Fr pigtail catheter and pus was sent for culture and Conservative treatment was continued in order to preserve the kidney. In the view of persistant symptoms RENOGRAM (99M Tc DTPA) was done which shows reduced parenchymal function of right kidney { GFR;Lt.54.3, Rt.11.4 ,Total 65.8 ml/min ,SPLIT RENAL FUNCTION Left-82.6%, Right -17.4 %}. The patient underwent nephrectomy as she deteriorates despite parenteral broad-spectrum antibiotics and antifungal management. Following nephrectomy, she made a good clinical recovery. CASE REPORT

4. NCCT KUB . fig-1Right Sided Emphysematous Pyelonephritis (Coronal Cut),Preoperative Image with DJ stent insitu (Right KIDNEY) with air pockets inside the right kidney.Fig.2 (Axial Cut) HISTOPATHOLOGY REPORT ;- Report on 25/01/24) Nacroinflamatpry Areas In Kidney Show Extensive Yeast Like Forms And Fungal Hyphae Often As Colonies Suggestive Morphologicaly Of Candida Infection. (Fig.No.3,4,) CULTURE/SENSTIVITY OF DRAIN SITE ; date 01/02/24);-GROWTH OF CANDIDA SPP(NON-ALBICANS) CANDIDA TROPICALIS A Beta-D- glucan is 102 pg / mL .

5. DISCUSION EPN caused by Candida spp.is rare, and few cases have been reported with the outcome of successful treatment as well as mortality . MD Kamaliah et al .[1] reported a case of a diabetic patient with extensive unilateral emphysematous pyelonephritis caused by C.albicans . The patient underwent nephrectomy as she deteriorates despite parenteral broad-spectrum antibiotics and antifungal management. Following nephrectomy, she made a good clinical recovery. The mortality of invasive candidiasis may be 40-60% Zand F et al. [ 2 ]. BDG assay helps to detect invassive fungal infection at an early stage before being detected by other methods and guide for the empirical antifungal treatment   Bansal et al . have reported 90% positivity among confirmed candidemia cases from ICU settings[3]  

6. CONCLUSION Rare microorganisms like Candida should be suspected if the patient does not respond to initial antibiotics. EPN is commonly seen in diabetic patients and CT scan is the most effective tool for an early diagnosis. Treatment modalities should be changed accordingly to culture reports and clinical condition of the patient. Nephrectomy can be a life saving and still preferred if the initial medical management and percutaneous drainage fail.

7. REFRENCES. 1.Kamaliah M, Bhajan M, Abu Dzarr G. Case report emphysematous pyelonephritis caused by candida infection. ResearchGate . 2005. [Cited 2 Mar 2020.] 2.Zand F, Moghaddami M, Davarpanah MA, Masjedi M, Nikandish R, Amanati A, et al. 2016;9(3):371–81. [Google Scholar]   3.Bansal N, Gopalakrishnan R, Sethuraman N. Experience with β-d- glucan assay in the management of critically ill patients with high risk of invasive candidiasis: an observational study.  Indian J Crit Care Med.  2018;22(05):364–368