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A 25-year-old male was admitted to the Accident and Emergency department with a history of a deliberate ingestion of 150–200 ml of 20% Gramaxone (paraquat) solution. Patient’s written informed consent was obtained on admission. Initial qualitative testing of vomitus and urine were strongly positive for paraquat. Activated charcoal therapy was commenced and initial arterial blood gas analysis showed pH 7.30, PaO2 12 kPa, PaCO2 5.0 kPa and base excess −3.9. Paraquat levels were 1.4 µg/ml at 4.5-h post-ingestion and 0.3 µg/ml at 16 h. These levels confirmed that a potentially lethal dose of paraquat had been consumed.1 The patient’s renal function began to deteriorate and he was transferred to the intensive care unit and commenced on continuous renal replacement therapy. The following intravenous treatment regimes were initiated: ascorbic acid 1 g every 6 h; n -acetylycysteine 1200 mg daily; methylprednisolone 1 g daily for 3 days and dexamethasone 8 mg every 8 h.2,3 On day 2 of admission to intensive care, intravenous cyclophosphamide 1 g daily for 2 days and α-tocopherol (vitamin E) were added.2,3 Unfortunately, despite these interventions, the patient’s condition …

Dear Editor, We read with interest the article by Delisle and colleagues [1] concerning the clinical significance of Candida colonization of the respiratory tract in critically ill patients with ventilator-associated pneumonia. We recently performed a retrospective analysis of patients admitted to a large mixed intensive care unit in Northern Ireland over a 1year period. The aim was to investigate whether there is an association between the presence of Candida species in respiratory tract secretions of critically ill adults and intensive care unit (ICU) mortality, irrespective of the confirmed presence of ventilator-associated pneumonia. Data were analyzed to compare mortality in patients whose respiratory secretions had cultured Candida species (both with and without coexisting bacteria) compared to those in whom cultures were negative for Candida species but positive for bacterial pathogens. In total, 287 patients were analyzed. Of these, 208 (72%) had respiratory tract secretions that cultured only bacterial pathogens (“nonCandida group”), whereas the “Candida-group” consisted of 79 (28%) patients. Mortality during the ICU episode was 18.8% (39/208 patients) in the “non-Candida group” and 21.5% (17/79 patients) in the “Candida-group” (P = .597). χ2 Testing was used to evaluate statistical significance of observed differences.