Candidiasis

Candidiasis

2/9/10

PY Mindmaps- contentious issue

- difficult to diagnose

- organisms: albicans, topicalis, krusie, glabrate, lusitanae, parasilopsis- invasive if found in:

(1) blood(2) found in a sterile site(3) cultured from two non-continguous sites

(4) identified species is a non-commensal

(5) cultured from tissue or burn wound biopsyHISTORY

- unexplained fever

- sepsis syndrome

- deterioration in the presence of the immunocompromised

- candida cultured from: vascular catheterisation, colonisation of bladder, respiratory tract, wounds, intraperitoneal cavity

Risk Factors

- colonisation by a Candida species

- broad spectrum antibiotic cover

- Hickman lines

- haemodialysis

- recent abdominal surgery

- GI tract perforation

- CVL

- TPN

EXAMINATION

- candida oral, genital, retina

- endoscopy

INVESTIGATIONS

- BAL

- blood culture positive for candida (treat)

- cultured from a sterile site (ie. aspiration of an abscess (hepatic)) -> treat- serological testing has a low specificity

MANAGEMENT

Resuscitation

Treat the cause remove line, foreign bodies

Drain abscesses

Improve immunocompetence reduce steroid, immunosuppressants, increase nutrition

Reduce colonisation load oral anti-fungal, bladder washout

Broad spectrum anti-fungal (IV):

- amphortericin B 0.5-1mg/kg Q24 hrly nephro and hepatotoxic, blood dyscrasias

- caspafungin 70mg LD -> 50mg Q24 hrly GI upset, myalgias, increased LFTs

- voriconazole 6mg/kg Q12hrly for 24 hrs (LD) -> 4mg/kg Q12hrly transient visual disturbance, GI upset, fever, rash

- itraconazole 200mg Q12 hrly for 4 doses -> 200mg Q24 hrly

- fluconazole for proven albicans 10mg/kg IV daily

COMPLICATIONS

- liver abscess- splenic abscess- endocarditis

- retinopathy

Prophylaxis with Fluconazole

Arguments For

- reduces invasive fungal infections

- reduces total mortality across a broad range of clinical settings in non-neutropenic critically ill patients on systematic review

Arguments Against

- resistance formation

- drug interaction with fluconazole

- hepatotoxicity

- certain species are resistant to fluconazole (glabrate, krusei, aspergillus)Jeremy Fernando (2011)