Candida Albicans Tracheobronchitis: Complication of a Viral Laryngotracheobronchitis: A Case Report

Background: Laryngotracheobronchitis/Croup is most often a viral infection, commonly caused by parainfluenza viruses. The diagnosis is usually based upon the characteristic acute onset of barking cough, hoarseness, and stridor. Although rare, complications can occur, and ventilatory support may be needed.

Case Report: Ten years old female with Koolen de Vries Syndrome and recurrent laryngitis/bronchospasm episodes history, was admitted in ER for sudden loud barking cough and stridor.

At admission she was hypoxemic, cyanotic and presented with biphasic stridor. The gasometry showed respiratory acidosis. No improvement was observed after nebulized adrenaline and ev metilprednisolone administration. Epiglottitis diagnosis was considered, and ceftriaxone was administered.

Given the lack of improvement after all me measure taken she was intubated and transferred to a PICU. Pararinfluenza 1 and adenovirus were detected on the nasopharyngeal aspirates.

On the 4th day of admission to the PICU, an attempt was made to extubate with bronchofiberscope support, but she was reintubated for keeping stridor. On the 10th day of admission, another attempt was made to extubate and nacreous lesions in the trachea, suggesting candidiasis, were found. Ev micafungin was started and dexamethasone dose was gradually reduced. The bacteriological study confirmed the presence of candica albicans.

After an eighteen day stay in the PICU, and twelve days in the pediatric ward, she showed progressive clinical improvement.

Discussion: Parainfluenza virus, as well as other viruses, may cause airway mucosal damage which predisposes the trachea to the seeding of secondary infections. Fungal infections of the trachea are rare and usually are relegated to immunocompromised hosts. In this case, most likely, airway mucosal damage caused by parainfluenza virus, the need of intubation and the combined use of steroid and antibiotics may have played important roles. The bronchofiberscope support and cultures from aspirates were crucial for establishing the diagnosis and allowing appropriate treatment.