African Journal of Medical Case Reports Vol. 2 (1), pp. 012-014, January, 2014. Available online at www.internationalscholarsjournals.org © International Scholars Journals Review Candiduria by Candida tropicalis evolves to fatal candidemia Vidigal, Pedrina Gonçalves 1 , Santos, Simone Aparecida 2 , Maria Aparecida Fernandez 2 , Patrícia de Souza Bonfim 1 , Hilton Vizi Martinez 3 and Terezinha Inez Estivalet Svidzinski 1 * 1 Department of Clinical Analysis, Universidade Estadual de Maringá, Brazil. 2 Department of Cell Biology, Universidade Estadual de Maringá, Brazil. 3 Hospital Universitário de Maringá, Universidade Estadual de Maringá, Brazil. Accepted 16 November, 2013 Candida species are opportunistic pathogens that belong to the normal human microbiota. In the past decades, the incidence of nosocomial fungal diseases has increased, and Candida spp. is still one of the main causal agents. Urinary tract is usually involved with disseminated infections, but interpretation of yeast findings, from representative specimens of this anatomical site, remains controversial. We report a candiduria case in a 64-year-old male patient from intensive care unit (ICU) who developed candiduria due to Candida tropicalis, which complicated to fatal candidemia despite antifungal treatment. Key words: Candida tropicalis, candiduria, candidemia. INTRODUCTION In recent years, Candida spp. has emerged as an important nosocomial pathogen (Colombo and Guimarães, 2007; Klotz et al., 2007; Pfaller and Diekema, 2007; Galvan and Mariscal, 2006). Candiduria is a frequently documented condition in ICU, but it remains a common dilemma, faced by clinicians, whether determining if a patient is suffering from a fungal infection or if the fungal presence is only due to normal colonization. In hospitalized patients, the urinary tract (UT) is one of the most propitious anatomical sites for the development of infections, once it is normally colonized by such microorganisms (Schaberg et al., 1991; Guler et al., 2006). However, the lack of a proper and safer protocol to characterize candiduria as a UT infection is usually a serious problem (Kauffman, 2005). On the other hand, candiduria has been considered an early marker of disseminated fungal infection in critically ill patients. According to Ang et al. (1993), ascending infections may uncommonly result in Candida *Corresponding author. E-mail: terezinha@email.com. Tel: +55 44 3011-4809. Fax: +55 44 3011-4860. pyelonephritis, which is responsible for up to 3 to 10% of candidaemia secondary episodes. Nonetheless, the criteria for yeast quantification continue to be contro- versial, once they are not properly standardized and specimens from this site could be easily contaminated. In this report, we describe a case of candiduria caused by Candida tropicalis, which resulted in a fatal candidaemia. Case summary A 64 year-old male patient was admitted in February 2008, in the Emergency room of the Maringá University Hospital, Maringá, Brazil, due to acute obstructive abdomen and enterorrhagia. This patient was submitted to an abdomen surgery due to obstruction of the small intestine with a necrotic area of 1 cm. After the surgery, the patient was transferred to intensive care unit (ICU). Prior the hospitalization, his current medical history included diabetes mellitus and hypertension. At admission, empirical treatment with antibiotics (metronidazole, gentamicin and ceftriaxone) was adopted in the first day of hospitalization due to patient’s febrile condition.