View source for WBR847

{{WBRQuestion
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 1
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Infectious Disease
|Prompt=A 25 year old male patient, previously healthy, is brought to the emergency department after a motor vehicle collision. The patient suffered extensive abdominal trauma and requires splenectomy and pancreatectomy. During post-operative care in the intensive care unit (ICU), the patient is started on intravenous hyperalimentation fluids. On day 10 of hyperalimentation, he develops fever and endophthalmitis. Blood cultures are taken immediately and empirical antimicrobial therapy is initiated. Which of the following organisms is most likely to grow in this patient's condition?
|Explanation=The patient is most likely having Candida albicans infection, which is strongly associated with intravenous (IV) hyperalimentation. IV hyperalimentation is used to provide sufficient calories for patients who undergo extensive surgery, such as the patient described in the vignette. Approximately 15-20% of patients with IV hyperalimentation develop systemic candidiasis after several days of hyperalimentation. It is important to note that Candida is difficult to grow in culture media and more than 50% of cultures do not yield positive results. Because Candida may spread hematogenously to the eyes, endophthalmitis is not an uncommon event. 

Educational Objective: 
Systemic candidiasis with Candida albicans is associated with IV hyperalimentation.

Reference: 
Montgomerie JZ, Edwards Jr. JE. Association of infection due to Candida albicans with intravenous hyperalimentation. J Infectious Diseases. 1978
|AnswerA=Pseudohyphae and budding yeast
|AnswerAExp=Candida albicans are pseudohyphae and budding yeast.
|AnswerB=Irregular, broad, non-septate hyphae that branch at right angles
|AnswerBExp=Rhizopus species are irregular, broad, non-septate hyphae that branch at right angles
|AnswerC=Aerobic, oxidase-positive, gram-negative rods that produce pyocyanin
|AnswerCExp=Pseudomonas aeroginosa is an aerobic, oxidase-positive, gram-negative rod that produces pyocyanin
|AnswerD=Catalase-positive gram-positive cocci in clusters
|AnswerDExp=Staphylococcus aureus is a catalase-positive gram-positive coccus in clusters.
|AnswerE=Gram-negative bacilli that form mucoid colonies
|AnswerEExp=Klebsiella species are gam-negative bacilli that form mucoid colonies.
|RightAnswer=A
|WBRKeyword=candida, albicans, hyperalimentation, intensive, care, unit, pseudohyphae, budding, yeast, yeasts, fungi, fungal, infection
|Approved=No
}}