Candida-Invasive candidiasis

Most common cause of opportunistic yeast infections in humans.

Most common cause of invasive fungal infections and the fourth most common cause of nosocomial bloodstream infections in the U.S.

Species commonly a normal flora and an opportunistic pathogen.

Candidemia fourth most common blood stream infection.

Risk factors divided into host related (immunocompromised) and healthcare related factors (surgery, antibiotics, intravascular catheters).

In patients with hematologic malignancies beneficial bacteria in the GI tract are often destroyed by antibiotics and these bacteria normally inhibit the growth of yeasts.

Risk factors for sepsis include parenteral nutrition, acute renal insufficiency, chemotherapy administration, breakdown of anatomic barriers, transplantation, malignancies and colonization of Candida.

Prolonged neutropenia, especially in hematologic malignancies greatly increased risk for candida sepsis.

5-15% of patients are colonized at the time of hospital admission.

50-85% of critically ill patients are colonized after a prolonged stay in an ICU, and mucosal or invasive disease that may develop in 5-30% of such patients.

Infections may range from mucocutaneous to invasive disease, with involvement of any organ.

Colonization of the mucosal membranes precedes invasive disease.

Invasive candidiasis defined as blood stream infection, esophagitis or deep tissue site involvement.

Invasive candidiasis most common manifestation is candidemia accounting for 50-70% of cases.

Incidence of invasive candidiasis is increasing.

Invasive candidiasis accounts for 8-10% of all cases of nosocomial bloodstream infections in the U.S.

Candida species are the most common fungal infections in patients with cancer and bone marrow transplant recipients.

Hepatosplenic candidiasis is a complication following: acute leukemia intravascular catheters, administration of broad-spectrum antibiotics, and prolonged neutropenia.

Hepatosplenic candidiasis usually presents with a high spiking fevers in the setting of prolonged neutropenia.

MRI imaging is more specific in diagnosing hepatosplenic candidiasis than is CT scans.

Definitive diagnosis of hepatosplenic candidiasis requires tissue biopsy showing granulomas with yeast.

Tissue cultures are commonly negative with hepatosplenic candidiasis.

Autopsy studies on bone marrow transplant patients reveal Candida infections 10-40% of the time.

Ocular involvement can produce choroiditis, retinitis and endophthalmitis.

Ocular candidiasis presents most commonly as chorioretinitis, but may manifest associated iritis, choroidal neovascularization, and retinal detachment.

Mortality rate higher in patients with endophthalmitis and candidiasis compared to patients with candidemia alone.

Peptide nucleic acid fluorescent in-situ hybridization (PNA-FISH) assay can identify Candida species directly from cultures.

Trend towards decreasing incidence of Candida sepsis since use of prophylactic fluconazole.

Increased incidence due to use of central venous catheters, parenteral nutrition, broad spectrum antibiotic use among hospitalized patients.

Annual mortality rate associated with candidiasis is 0.2 to 0.7 per 100,000 population.

All cause mortality in adults with invasive candidiasis estimated at 47%.

There has a been a shift from Candida albicans to Candida Sp as the dominant causative agents.

Risk factors associated with candidemia include recent major surgery, intravenous drug abuse, use of systemic antibiotics, use of indwelling intravenous catheters, prolonged neutropenia, immunosuppressive state and post-organ transplantation.

For invasive disease recommended agents include caspofungin, fluconazole, amphotericin B, misgauging, anidulafungin voriconazole and posaconazole with no clear benefit of any agent.

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