Fungemia - Revision history

Aidan at 13:43, 21 October 2025

2025-10-21T13:43:35Z

← Older revision		Revision as of 13:43, 21 October 2025
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	*Blood count (increased WBCs, decreased platelets)		*Blood count (increased WBCs, decreased platelets)
	*Consider echo to rule out endocarditis		*Consider echo to rule out endocarditis
			**Risk factors for endocarditis include valvular heart disease, persistent fungemia; receipt of [[TPN]], presence of hematologic malignancy, and infection with [[Candida glabrata]] make it less likely[[CiteRef::foong2019ri]]
	==Management==		==Management==
	*'''Never treat as a contaminant!'''		*'''Never treat as a contaminant!'''

Aidan at 15:13, 4 April 2024

2024-04-04T15:13:20Z

← Older revision		Revision as of 15:13, 4 April 2024
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	==Background==		==Background==
			*Bloodstream infection with a species of fungi; for the purposes of this page, focussing on yeast alone, and [[Candida]] in particular

	*Bloodstream infection with a species of [[Candida]]

	===Microbiology===		===Microbiology===

	*[[Candida albicans]] (46%)		*[[Candida albicans]] (46%)
	*[[Candida glabrata]] (26%)		*[[Candida glabrata]] (26%)
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	*[[Candida auris]] (rare): growing concern for multidrug resistance		*[[Candida auris]] (rare): growing concern for multidrug resistance
	*Numbers based on https://doi.org/10.1086/599039		*Numbers based on https://doi.org/10.1086/599039

	===Risk Factors===		===Risk Factors===

	*Hospital-onset		*Hospital-onset
	**Multiple or long-term IV lines, central lines, etc.		**Multiple or long-term IV lines, central lines, etc.
	**Long-term and broad-spectrum antibiotic use, especially in ICU		**Long-term and broad-spectrum antibiotic use, especially in ICU
			**Immunocompromise, including solid-organ and hematologic transplantation, hematologic malignancy, chemotherapy, and other immunosuppression
	**Immunosuppression
	**[[Total parenteral nutrition]]		**[[Total parenteral nutrition]]
	**[[Acute kidney injury]], especially requiring [[dialysis]]		**[[Acute kidney injury]], especially requiring [[dialysis]]
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	**HIV, malignancy, neutropenia, and diabetes similar to hospital-onset		**HIV, malignancy, neutropenia, and diabetes similar to hospital-onset
	**Less immunosuppressive therapy, recent surgery, or central venous catheters than hospital-onset, but still risk factors		**Less immunosuppressive therapy, recent surgery, or central venous catheters than hospital-onset, but still risk factors

	==Clinical Manifestations==		==Clinical Manifestations==

	*Positive blood culture for a [[Candida]]		*Positive blood culture for a [[Candida]]
	*Fever		*Fever
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	*[[Fungal endocarditis]] found in 8%		*[[Fungal endocarditis]] found in 8%
	*In patients with community-onset candidemia and candiduria, many have fungal endocarditis		*In patients with community-onset candidemia and candiduria, many have fungal endocarditis

	===Prognosis===		===Prognosis===

	*Mortality of about 25%[[CiteRef::sofair2006ep]]		*Mortality of about 25%[[CiteRef::sofair2006ep]]

	==Investigations==		==Investigations==

	*Blood cultures		*Blood cultures
	*Blood count (increased WBCs, decreased platelets)		*Blood count (increased WBCs, decreased platelets)
	*Consider echo to rule out endocarditis		*Consider echo to rule out endocarditis

	==Management==		==Management==

	*'''Never treat as a contaminant!'''		*'''Never treat as a contaminant!'''
	*'''Recommended ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures		*'''Recommended ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures
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	**Ocular infection: until resolution of ocular findings, often 4 to 6 weeks		**Ocular infection: until resolution of ocular findings, often 4 to 6 weeks
	**Endocarditis: at least 6 weeks; see [[fungal endocarditis]]		**Endocarditis: at least 6 weeks; see [[fungal endocarditis]]

	=== Ocular Candidiasis ===		=== Ocular Candidiasis ===

	* General preference for azoles (fluconazole and voriconazole), given high intraocular concentrations		* General preference for azoles (fluconazole and voriconazole), given high intraocular concentrations
	* Echinocandins may be adequate for chorioretinitis, but almost certainly inadequate for endophthalmitis		* Echinocandins may be adequate for chorioretinitis, but almost certainly inadequate for endophthalmitis
	* May need intravitreal injections (voriconazole or amphotericin B) or vitrectomy		* May need intravitreal injections (voriconazole or amphotericin B) or vitrectomy
	* Duration 4 to 6 weeks, but ideally until resolution of lesions on serial fundoscopy (if available)		* Duration 4 to 6 weeks, but ideally until resolution of lesions on serial fundoscopy (if available)

	[[Category:Yeasts]]		[[Category:Yeasts]]
	[[Category:Endovascular infections]]		[[Category:Endovascular infections]]

Aidan: Aidan moved page Candidemia to Fungemia

2024-04-04T15:10:44Z

Aidan moved page Candidemia to Fungemia

← Older revision		Revision as of 15:10, 4 April 2024
(No difference)

Aidan at 01:50, 4 October 2022

2022-10-04T01:50:19Z

← Older revision		Revision as of 01:50, 4 October 2022
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	==Background==		==Background==

	*~~Systemic~~ infection with a [[Candida]]		*Bloodstream infection with a species of [[Candida]]

	===Microbiology===		===Microbiology===
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	*Fever		*Fever
	*Triad of bowel perforation, increase white cell count, and decreased platelets		*Triad of bowel perforation, increase white cell count, and decreased platelets
	*Ocular infections in 16%, which as primarily [[chorioretinitis]], although [[endophthalmitis]] is possible[[CiteRef::lashof2011oc]]		*Ocular infections in 16% (2-20%), which as primarily [[chorioretinitis]], although [[endophthalmitis]] is possible[[CiteRef::lashof2011oc]]
			**Less common with prompt diagnosis and treatment
			**Chorioretinitis shows focal, yellowish-white infiltrative lesions in the choroid and retina, without vitreal involvement, and most patients do not have visual symptoms
			**Endophthalmitis has vitreal involvement, with fluff balls surrounded by cloudy vitreous, and can result in retinal necrosis and detachment, and is associated with long-term vision loss
	*[[Fungal endocarditis]] found in 8%		*[[Fungal endocarditis]] found in 8%
	*In patients with community-onset candidemia and candiduria, many have fungal endocarditis		*In patients with community-onset candidemia and candiduria, many have fungal endocarditis
Line 50:		Line 53:

	*'''Never treat as a contaminant!'''		*'''Never treat as a contaminant!'''
	*'''~~Requires~~ ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures		*'''Recommended ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures
	*Repeat 1 to 2 blood cultures every 24 to 48 hours until negative (1 culture q24h in ESCMID guidelines)		*Repeat 1 to 2 blood cultures every 24 to 48 hours until negative (1 culture q24h in ESCMID guidelines)
	*Antifungal therapy		*Antifungal therapy
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	**Ocular infection: until resolution of ocular findings, often 4 to 6 weeks		**Ocular infection: until resolution of ocular findings, often 4 to 6 weeks
	**Endocarditis: at least 6 weeks; see [[fungal endocarditis]]		**Endocarditis: at least 6 weeks; see [[fungal endocarditis]]

			=== Ocular Candidiasis ===

			* General preference for azoles (fluconazole and voriconazole), given high intraocular concentrations
			* Echinocandins may be adequate for chorioretinitis, but almost certainly inadequate for endophthalmitis
			* May need intravitreal injections (voriconazole or amphotericin B) or vitrectomy
			* Duration 4 to 6 weeks, but ideally until resolution of lesions on serial fundoscopy (if available)

	[[Category:Yeasts]]		[[Category:Yeasts]]

Aidan: Text replacement - " species]]" to "]]"

2022-02-09T08:35:27Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 08:35, 9 February 2022
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	==Background==		==Background==

	*Systemic infection with a [[Candida ~~species~~]]		*Systemic infection with a [[Candida]]

	===Microbiology===		===Microbiology===
Line 30:		Line 30:
	==Clinical Manifestations==		==Clinical Manifestations==

	*Positive blood culture for a [[Candida ~~species~~]]		*Positive blood culture for a [[Candida]]
	*Fever		*Fever
	*Triad of bowel perforation, increase white cell count, and decreased platelets		*Triad of bowel perforation, increase white cell count, and decreased platelets

Aidan: /* Clinical Manifestations */

2021-02-11T15:27:15Z

Clinical Manifestations

← Older revision		Revision as of 15:27, 11 February 2021
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	*Fever		*Fever
	*Triad of bowel perforation, increase white cell count, and decreased platelets		*Triad of bowel perforation, increase white cell count, and decreased platelets
	*Ocular infections in 16%, which as primarily [[chorioretinitis]], although [[endophthalmitis]] is possible		*Ocular infections in 16%, which as primarily [[chorioretinitis]], although [[endophthalmitis]] is possible[[CiteRef::lashof2011oc]]
	*[[Fungal endocarditis]] found in 8%		*[[Fungal endocarditis]] found in 8%
	*In patients with community-onset candidemia and candiduria, many have fungal endocarditis		*In patients with community-onset candidemia and candiduria, many have fungal endocarditis

Aidan: /* Clinical Manifestations */

2021-02-11T15:24:59Z

Clinical Manifestations

← Older revision		Revision as of 15:24, 11 February 2021
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	*Fever		*Fever
	*Triad of bowel perforation, increase white cell count, and decreased platelets		*Triad of bowel perforation, increase white cell count, and decreased platelets
	*~~Can~~ be ~~complicated~~ by [[endophthalmitis]]		*Ocular infections in 16%, which as primarily [[chorioretinitis]], although [[endophthalmitis]] is possible
			*[[Fungal endocarditis]] found in 8%
	*In patients with community-onset candidemia and candiduria, many have fungal endocarditis		*In patients with community-onset candidemia and candiduria, many have fungal endocarditis

Line 50:		Line 51:
	*'''Never treat as a contaminant!'''		*'''Never treat as a contaminant!'''
	*'''Requires ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures		*'''Requires ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures
			*Repeat 1 to 2 blood cultures every 24 to 48 hours until negative (1 culture q24h in ESCMID guidelines)
	*Antifungal therapy		*Antifungal therapy
	**First-line (stable patients): [[fluconazole]] if no risk factors for a resistant species		**First-line (stable patients): [[fluconazole]] if no risk factors for a resistant species
	**Alternative (resistance or septic): [[micafungin]] or another [[echinocandin]]		**Alternative (resistance or septic): [[micafungin]] or another [[echinocandin]]
	**Alternative (last-line): [[amphotericin B]]		**Alternative (last-line): [[amphotericin B]]
			*Duration
			**No organ involvement: 14 days from first negative
			**Ocular infection: until resolution of ocular findings, often 4 to 6 weeks
			**Endocarditis: at least 6 weeks; see [[fungal endocarditis]]

	[[Category:Yeasts]]		[[Category:Yeasts]]

Aidan: /* Clinical Manifestations */

2021-02-11T15:13:23Z

Clinical Manifestations

← Older revision		Revision as of 15:13, 11 February 2021
Line 34:		Line 34:
	*Triad of bowel perforation, increase white cell count, and decreased platelets		*Triad of bowel perforation, increase white cell count, and decreased platelets
	*Can be complicated by [[endophthalmitis]]		*Can be complicated by [[endophthalmitis]]
			*In patients with community-onset candidemia and candiduria, many have fungal endocarditis

	=== Prognosis ===		===Prognosis===

	* Mortality of about 25%[[CiteRef::sofair2006ep]]		*Mortality of about 25%[[CiteRef::sofair2006ep]]

	==Investigations==		==Investigations==

Aidan at 11:59, 11 February 2021

2021-02-11T11:59:21Z

← Older revision		Revision as of 11:59, 11 February 2021
Line 1:		Line 1:
	== Background ==		==Background==

	*Systemic infection with a [[Candida species]]		*Systemic infection with a [[Candida species]]
Line 15:		Line 15:
	===Risk Factors===		===Risk Factors===

			*Hospital-onset
	*Immune-compromised
		⚫	**Multiple or long-term IV lines, central lines, etc.
	*Long-term and broad-spectrum antibiotic use, especially in ICU		**Long-term and broad-spectrum antibiotic use, especially in ICU
⚫	*Multiple or long-term IV lines, central lines, etc.
			**Immunosuppression
	*[[Total parenteral nutrition]]		**[[Total parenteral nutrition]]
	*[[Acute kidney injury]], especially requiring [[dialysis]]		**[[Acute kidney injury]], especially requiring [[dialysis]]
	*Abdominal surgery		**Abdominal surgery
	*[[Gastrointestinal perforation]]		**[[Gastrointestinal perforation]]
			*Community-onset[[CiteRef::sofair2006ep]]
			**Hospitalization within the past month
			**HIV, malignancy, neutropenia, and diabetes similar to hospital-onset
			**Less immunosuppressive therapy, recent surgery, or central venous catheters than hospital-onset, but still risk factors

	==Clinical Manifestations==		==Clinical Manifestations==
Line 29:		Line 34:
	*Triad of bowel perforation, increase white cell count, and decreased platelets		*Triad of bowel perforation, increase white cell count, and decreased platelets
	*Can be complicated by [[endophthalmitis]]		*Can be complicated by [[endophthalmitis]]

			=== Prognosis ===

			* Mortality of about 25%[[CiteRef::sofair2006ep]]

	==Investigations==		==Investigations==

Aidan: /* Management */

2020-08-25T13:52:06Z

Management

← Older revision		Revision as of 13:52, 25 August 2020
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			== Background ==
⚫	* Systemic infection with a [[Candida species]]

		⚫	*Systemic infection with a [[Candida species]]
	== Etiology ==

			===Microbiology===
⚫	* ~~''C.~~ albicans'' (46%)
⚫	* ~~''C.~~ glabrata'' (26%)
⚫	* ~~''C.~~ parapsilosis'' (16%)
⚫	* ~~''C.~~ tropicalis'' (8%)
⚫	* ~~''C.~~ krusei'' (3%)
⚫	* ~~''C.~~ auris'' (rare): growing concern for multidrug resistance
⚫	* Numbers based on ~~[https://doi.org/10.1086/599039~~ https://doi.org/10.1086/599039]

		⚫	*[[Candida albicans]] (46%)
⚫	== Risk Factors ==
		⚫	*[[Candida glabrata]] (26%)
		⚫	*[[Candida parapsilosis]] (16%)
		⚫	*[[Candida tropicalis]] (8%)
		⚫	*[[Candida krusei]] (3%)
		⚫	*[[Candida auris]] (rare): growing concern for multidrug resistance
		⚫	*Numbers based on https://doi.org/10.1086/599039

		⚫	===Risk Factors===
⚫	* Immune-compromised
⚫	* Long-term and broad-spectrum antibiotic use, especially in ICU
⚫	* Multiple or long-term IV lines, central lines, etc.
⚫	* Total parenteral nutrition
⚫	* Acute kidney injury, especially requiring dialysis
⚫	* Abdominal surgery
⚫	* Gastrointestinal ~~perforations~~

		⚫	*Immune-compromised
⚫	== Clinical Manifestations ==
		⚫	*Long-term and broad-spectrum antibiotic use, especially in ICU
		⚫	*Multiple or long-term IV lines, central lines, etc.
		⚫	*[[Total parenteral nutrition]]
		⚫	*[[Acute kidney injury]], especially requiring [[dialysis]]
		⚫	*Abdominal surgery
		⚫	*[[Gastrointestinal perforation]]

		⚫	==Clinical Manifestations==
⚫	* Positive blood culture for Candida ~~spp.~~
⚫	* Fever
⚫	* Triad of bowel perforation, increase white cell count, and decreased platelets

		⚫	*Positive blood culture for a [[Candida species]]
⚫	== Investigations ==
		⚫	*Fever
		⚫	*Triad of bowel perforation, increase white cell count, and decreased platelets
			*Can be complicated by [[endophthalmitis]]

		⚫	==Investigations==
⚫	* Blood ~~culture~~
⚫	* Blood count (increased WBCs, decreased platelets)
⚫	* ~~Echo~~ to rule out endocarditis

		⚫	*Blood cultures
⚫	== Management ==
		⚫	*Blood count (increased WBCs, decreased platelets)
		⚫	*Consider echo to rule out endocarditis

		⚫	==Management==
⚫	* '''Never treat as a contaminant!'''

⚫	* '''Requires ophthalmology consult''' to rule out endophthalmitis, ideally around 1 week after positive cultures
		⚫	*'''Never treat as a contaminant!'''
⚫	* Antifungal therapy
		⚫	*'''Requires ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures
⚫	** First-line (stable patients): fluconazole if no risk factors for a resistant species
		⚫	*Antifungal therapy
⚫	** Alternative (resistance or septic): micafungin or another echinocandin
		⚫	**First-line (stable patients): [[fluconazole]] if no risk factors for a resistant species
⚫	** Alternative (last-line): amphotericin B
		⚫	**Alternative (resistance or septic): [[micafungin]] or another [[echinocandin]]
		⚫	**Alternative (last-line): [[amphotericin B]]

	[[Category:Yeasts]]		[[Category:Yeasts]]