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 Signs and Symptoms

Introduction

  • Infections caused by Candida sp are major contributors to morbidity and mortality causing a diverse spectrum of clinical diseases that ranges from superficial and mucosal infections to invasive disease associated with candidemia and metastatic organ involvement
  • Most common pathogens of invasive candidiasis are Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei
    • 70-80% of invasive candidiasis are due to C albicans and C glabrata
  • An emerging multidrug-resistant C auris has been described recently

Definition

Candidemia

  • It is the isolation of Candida sp from ≥1 blood culture (BC) specimen with hematogenous spread of the yeast to ≥1 organs
  • Positive for Candida sp in a single central-line or peripheral BC

Endophthalmitis

  • Infections within the eye can be:
    • Exogenous if affecting the anterior chamber of the eye that occur following trauma or surgical procedure
    • Endogenous is when Candida infection reaches the posterior chamber of the eye via hematogenous spread; it can be manifested as chorioretinitis with or without extension into the vitreous leading to vitritis
  • 90% of cases of endogenous endophthalmitis are due to C albicans

Pulmonary

  • Can occur in 2 forms:
    • Can either be local or diffuse bronchopneumonia originating from endobronchial inoculation of the lungs
    • Hematogenous seeding, finely nodular, diffuse infiltration

Risk Factors

Candidemia

  • The following factors predispose to the condition:
    • Abdominal surgery
    • Neutropenia
    • Broad-spectrum antibiotics
    • Indwelling IV catheters
    • Peripheral alimentation
    • Cancer chemotherapy
    • Immunosuppressive therapy in transplant patients
    • Colonization with Candida sp
    • Renal failure

Central Nervous System (CNS)

  • Most cases occur in the setting of trauma, neurosurgery, immunosuppression or acquired immunodeficiency syndrome (AIDS)

Chronic Disseminated (Hepatosplenic)

  • Most infections occur in severely immunocompromised patients and manifest during their recovery from neutropenia

Endocarditis

  • Candidal endocarditis is associated with the following factors:
    • Underlying valvular heart disease
    • Heroin addiction
    • Cancer chemotherapy
    • Implantation of prosthetic valves
    • Prolonged use of IV catheters
    • Preexisting bacterial endocarditis

Genitourinary Tract (GUT)

  • Risk factors:
    • Diabetes
    • History of previous antibiotic use
    • Indwelling urinary catheters
    • Immunosuppressive therapy
  • Male patients: Urethral candidiasis usually results from sexual contact with women with Candida vaginitis
  • Female patients: Urethral candidiasis infection may be acquired from the extension of Candida vaginitis

Infection of the Vasculature

  • Often occurs in association with IV catheters

Musculoskeletal

  • Often involves the joints (eg knee, vertebral column) due to trauma, joint injections or other surgical intervention

Peritonitis

  • Often a complication of peritoneal dialysis, gastrointestinal tract surgery and perforation of an abdominal viscus
  • Prior antibiotic administration is a predisposing factor

Signs and Symptoms

Candidemia

  • Clinical features include:
    • Fever of unclear etiology
    • Sepsis syndrome
    • Signs of multiple organ involvement including the kidney, brain, myocardium and eye
    • Macronodular skin lesions
    • Endophthalmitis
    • Suppurative manifestations ie micro- and macro-abscesses

Central Nervous System (CNS)

  • Meningeal irritation (eg headache, stiff neck, irritability)
  • In the comatose or non-communicative patient, observation of abnormalities is difficult

Chronic Disseminated (Hepatosplenic)

  • Persistent fever, abdominal pain, hepatosplenomegaly, increased alkaline phosphatase levels, leukocytosis

Endocarditis

  • Similar to bacterial endocarditis with the exception of the occurrence of large emboli to major vessels and include the following:
    • Hepatosplenomegaly
    • Hematuria, proteinuria, pyuria
    • Splinter hemorrhages
    • Osler’s nodes
    • Janeway lesions

Endophthalmitis

  • Retina has visible white lesions that may progress to vitritis with high risk of vision loss

Genitourinary Tract (GUT)

  • Lower urinary tract infection (UTI) (cystitis) is usually asymptomatic but may present with dysuria, hematuria, frequency

Infection of the Vasculature

  • In patients with peripheral septic thrombophlebitis, symptoms may be minimal with the extent of the disease being greater than is apparent on initial clinical assessment
  • Patient may have fever, signs of sepsis and persistent candidemia
  • Suppuration and thrombosis may be present

Musculoskeletal

  • Arthritis and osteomyelitis (eg similar to disease of bacterial etiology, includes suppurative synovitis)

Pulmonary

  • Fever and cough
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