Cytographic changes in the haematological analysers in cases of sepsis by Candida Parapsilosis

What is it about?

Candida parapsilosis is an emerging major human pathogen that frequently causes sepsis in immuno-compromised patients. Since peripheral blood neutrophils prevent the invasion of the fungal pathogen by engulfing one or more C. parapsilosis cell and are easily counted by haematological analyzers, unusual changes in neutrophil cytograms could provide useful hints in identifying unexpected Candida infections. We describe two cases of Candida parapsilosis sepsis in which fungal diagnosis was early suspected observing unusual morphological changes in the three-dimensional DIFF cytogram on Mindray BC-6800 haematological analyzer, and was later confirmed by microscopic review of peripheral blood smear and culture. The BC-6800 DIFF cytogram showed the neutrophils population as divided into two clusters, formed by cells with normal and, reduced complexity, both exhibiting an increased size. The “ghost” area was modified in its extension and morphology. A microscopic review showed numerous granulocytes engulfed with one or more Candida cell as well as neuthrophils damaged by autolysis and deconstruction of nuclear chromatin. Numerous Candida bodies were observed outside neuthrophils. Blood culture tested positive for Candida parapsilosis. The morphological changes in 3D-DIFF cytograms on Mindray BC-6800 analyzer and the microscopic features of peripheral blood allowed us to discover and provide the clinicians with a diagnosis of Candida sepsis long before the blood culture positivity. This resulted in a significant diagnostic anticipation as well as in a timely beginning of the antifungal therapy.

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