Type your tag names separated by a space and hit enter

Candidiasis, Invasive

Candidiasis, Invasive is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

Medicine Central

-- The first section of this topic is shown below --

Basics

Description

Candida albicans and related species cause a variety of infections. Noninvasive candidal infections are common and can take many forms including esophagitis, vaginitis, onychomycosis, oral candidiasis (thrush).

  • Invasive candidiasis occurs in the setting of an immunocompromised host and can be life-threatening.
  • Candidemia is the most common form of invasive candidiasis.
  • Other forms of invasive candidiasis include endocarditis, peritonitis, meningitis, osteomyelitis, arthritis, endophthalmitis.

Epidemiology

  • All ages are susceptible to hematogenously disseminated candidiasis; premature neonates and immunocompromised patients are at highest risk.
  • Predominant sex: male = female (hematogenously disseminated candidiasis)
  • Fourth most common bloodstream infection
  • Accounts for ~10% of nosocomial bloodstream infections

Incidence
  • Incidence has increased in the past 2 decades.
  • 6 to 13/100,000 cases per year in the United States

Prevalence
7 cases per 1000 patients globally

Etiology and Pathophysiology

  • Candida naturally grows on the skin and in the GI tract.
  • Invasive fungal infection is caused by candidal species in the setting of decreased polymorphonuclear host defenses.
  • C. albicans is the most frequent pathogen (45–49% of isolates).
  • Five species cause >90% of candidal disease: C. albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei.
  • Human-to-human transmission is possible.

Risk Factors

  • Indwelling intravascular access devices
  • Parenteral nutrition
  • Mechanical ventilation; ICU stay (>7 days)
  • Broad-spectrum antibiotic therapy
  • Recent chemotherapy or radiation
  • Immunocompromised: HIV, neutropenia, chronic corticosteroid use, bone marrow or solid organ transplant
  • Burns involving >30% of body surface
  • Malignancy, diabetes mellitus, acute renal failure, end-stage renal disease, renal replacement therapy; cardiothoracic or abdominal surgery
  • Premature birth
  • Fungal colonization
  • Infection ± sepsis; APACHE II score >20
  • Pancreatitis

General Prevention

  • Adult ICU: Consider treating patients at high risk for invasive candidiasis with fluconazole.
  • Consider postoperative prophylaxis in solid organ transplant recipients at high risk for candidiasis using fluconazole or liposomal amphotericin B (L-AmB).
  • Treat patients with chemotherapy-induced neutropenia or stem cell transplant at risk for neutropenia with echinocandins or azoles.

Commonly Associated Conditions

  • Neutropenia (common)
  • Hematologic malignancy or receiving immunosuppressive medications (common)
  • Stem cell or organ transplant recipient (common)
  • HIV (common)
  • Trauma or burn patient receiving care in the ICU (less common)
  • ICU patient with renal failure, TPN, or central venous catheter, or receiving broad-spectrum antibiotics (less common)

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

Stephens, Mark B., et al., editors. "Candidiasis, Invasive." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816060/all/Candidiasis__Invasive.
Candidiasis, Invasive. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816060/all/Candidiasis__Invasive. Accessed April 21, 2019.
Candidiasis, Invasive. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816060/all/Candidiasis__Invasive
Candidiasis, Invasive [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816060/all/Candidiasis__Invasive.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Candidiasis, Invasive ID - 816060 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816060/all/Candidiasis__Invasive PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -