candidiasis
CANDIDIASIS
Candida sp are the most common cause of fungal infections.
 It can cause infections that range from benign mucocutaneous illnesses to invasive process that may affect any organ.
 It is considered as normal flora in the gastrointestinal and genitourinary tracts, but when there is an imbalance in the ecological niche, they can invade and cause disease.
Most common risk factors include broad-spectrum antibiotic use, central venous catheter use, receipt of parenteral nutrition, receipt of renal placement therapy by patients in ICUs, neutropenia, implantable prosthetic device use and receipt of immunosuppressive agents.

Follow Up

Therapy Duration
Candidemia without neutropenia
  • For clinically stable patients who have isolates susceptible to Fluconazole and have negative repeat blood cultures on antifungal therapy, it is recommended to transition from an echinocandin to Fluconazole or Amphotericin B to Fluconazole usually within 5-7 days
  • Follow-up blood cultures should be done every day or every other day
  • In patients without obvious metastatic complication the duration of therapy is 2 weeks after documented clearance of Candida sp from the bloodstream and resolution of symptoms
Candidemia with neutropenia
  • In patients without obvious metastatic complication the duration of therapy is 2 weeks after documented clearance of Candida sp from the bloodstream and resolution of symptoms
Chronic Disseminated (Hepatosplenic)
  • Therapy is usually continued for several months until lesions resolve on repeat imaging
  • Premature discontinuation of antifungal therapy can lead to relapse
Endophthalmitis
  • Duration of therapy should be at least 4-6 weeks depending on the resolution of lesions determined by repeat ophthalmological exam

Monitor Patient's Clinical and Mycological Response

  • Observe resolution of signs, symptoms, and lesions that are present
  • Repeat fungal cultures as necessary

Candidemia and Acute Hematogenously Disseminated Candidiasis

  • The following should be considered when there is persistent candidemia despite appropriate therapy
    • Possibility of an infected intravascular device
    • Significant immunosuppression
    • Microbiological resistance
  • In this case, the following steps should be taken:
    • Start therapy with an agent from a different class of antifungals
    • Send isolate for identification to the species level and consider susceptibility testing
    • Remove any infected intravascular device
    • If present, ameliorate immunosuppression

Genitourinary Tract

  • In case of persistent candiduria in an immunocompromised patient, do ultrasonography or computed tomography (CT) of the kidney
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