Survival of candida septicaemia treated with amphotericin B

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Abstract
Candida albicans septicaemia occurred in an alcoholic woman who had severe hepatic dysfunction, and was further debilitated by multiple cardiac arrests, prolonged artificial ventilation, bronchopneumonia and Ps. aeruginosa septicaemia. She received broad spectrum antibiotics and corticosteroids, and needed prolonged intravenous cannulation. In vitro, a specific defect was demonstrated in her cell-mediated immune response to candida antigens. Examination of her serum showed normal immunoglobulins, and an adequate agglutination titre to these antigens. Amphotericin B (800 mg intravenously over 19 days) was administered, and she survived. Hypokalaemia, anaemia, and peripheral neuropathy complicated therapy, and thrombophlebitis of a cannulated peripheral vein necessitated a vena caval catheter. There was no significant deterioration of renal function. Toxic effects of other drugs were encountered—deafness following kanamycin, an encephalopathy when blood levels of carbenicillin were boosted by probenecid, and cardiac arrest when diazepam and phenobarbitone were administered to control an epileptic fit and delirium tremens. Prolonged intravenous cannulation was complicated by staphylococcal septicaemia. A year later she died of peritonitis. Chronic pancreatitis was complicated by ascites, which became infected by E. coli. No residual C. albicans infection was found at necropsy.