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.

Candidiasis Management

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
Editor's Recommendations
Most Read Articles
Elaine Soliven, 4 days ago

Switching from efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) to the new bictegravir/ emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) regimen maintained high rates of virological suppression in adults who are living with HIV*, according to a study presented at AIDS 2020.

3 days ago
Among individuals with abdominal obesity, drinking beverages with artificial sweeteners (ASBs) or no sugar (USBs) instead of sugar-sweetened beverages (SSBs) helps lose body weight, a study has found. However, USBs have a more favourable effect on sweet taste preference compared with ASBs.
Stephen Padilla, 5 days ago
Pre-exposure prophylaxis (PrEP) containing either long-acting injectable cabotegravir (CAB) or tenofovir/emtricitabine (TDF/FTC) is safe and effective for transgender women (TGW) and cisgender men who have sex with men (MSM), but CAB results in a much lower HIV incidence compared to TDF/FTC, results of the HIV Prevention Trials Network (HPTN) 083 have shown.
Jairia Dela Cruz, 4 days ago
Monthly prophylaxis with the fixed-dose combination of naphthoquine-azithromycin (NQAZ) is well tolerated and confers significant protection against infection with Plasmodium parasites among individuals residing in malaria-endemic areas in Southeast Asia, as shown in the results of a phase III trial.