invasive%20candidiasis
INVASIVE CANDIDIASIS
Treatment Guideline Chart

Infections caused by Candida sp that is associated w/ candidemia & metastatic organ involvement.

Most common pathogens of invasive candidiasis are Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei

Early initiation of antifungal therapy w/ adequate source control is essential in the management of invasive candidiasis.

Invasive%20candidiasis Diagnosis

Diagnosis

  • Lab exams are used to help identify the different Candida sp and susceptibility to antifungals

Laboratory Tests

Candidemia

  • Definitive diagnosis can be made only by histopathologic demonstration of the organism invading tissue or by the isolation of Candida sp from normally sterile body sites eg blood
  • However, BCs are negative in many patients with disseminated infection
  • A presumptive clinical diagnosis based on the presence of typical signs and symptoms in a high-risk patient is often the basis for initiating antifungal therapy
  • New techniques such as peptide nucleic acid fluorescence in situ hybridization (PAN-FISH) and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) allow faster identification of Candida sp in blood
  • Nonculture methods such as beta-D-glucan assay, T2Candida and polymerase chain reaction (PCR) tests may also be considered

Central Nervous System (CNS)

  • Cerebrospinal fluid (CSF) findings: Pleocytosis, hypoglycorrhachia, elevated protein levels, wet mount and Gram stain positive for Candida sp

Chronic Disseminated (Hepatosplenic)

  • Definitive: Biopsy with culture and histopathologic exam or aspiration of ≥1 abscesses in an attempt to identify the infecting organism

Endocarditis

  • BCs may be negative in many patients
  • The presence of endophthalmitis and major embolic episodes should raise suspicion of candidal endocarditis

Genitourinary Tract (GUT)

  • Renal involvement is indicated by granular casts with hyphal elements on urinalysis
  • Urine fungal culture
  • Cystoscopic visualization with biopsy, either biopsy-proven fungus ball or tissue invasion, is necessary to determine presence of disease invasion

Infection of the Vasculature

  • Cultures of blood and involved veins

Musculoskeletal

  • BCs are usually negative
  • Osteomyelitis may be diagnosed by percutaneous needle aspiration or open biopsy of the involved area

Peritonitis

  • Culture of peritoneal fluid

Pulmonary

  • Definitive diagnosis: Biopsy with demonstration of tissue invasion
  • Positive sputum cultures usually represent colonization rather than active infection and therefore should not prompt treatment

Imaging

Central Nervous System (CNS)

  • Computed tomography (CT) scan may show abscesses

Chronic Disseminated (Hepatosplenic)

  • CT scan/magnetic resonance imaging (MRI) scan/ultrasonography reveal multiple hepatosplenic filling defects and/or abscesses
  • CT scan is the most specific diagnostic tool
    • The lesions are hypodense and many times have ring enhancement

Endocarditis

  • Echocardiography is used to detect vegetations

Musculoskeletal

  • X-ray: Nonspecific

Pulmonary

  • X-ray and CT scan are nonspecific

Physical Examination

Endophthalmitis

  • Dilated retinal examination
  • Fundoscopy shows large and off-white cotton ball-like lesions with indistinct borders; cellular aggregates can be seen in vitreous; hemorrhages, Roth spots, hypopyon, anterior chamber inflammation, iritis
  • Vitrectomy is helpful diagnostically and therapeutically
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