Candida: Difference between revisions
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Candida
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* See also [https://doi.org/10.1086/504492 Pharmacology of Systemic Antifungal Agents, CID 2006] |
* See also [[Antifungal spectrum of activity]] and [https://doi.org/10.1086/504492 Pharmacology of Systemic Antifungal Agents, CID 2006] |
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== Treatment == |
== Treatment == |
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Revision as of 19:36, 15 August 2019
- Most common medically-important genus of yeast
Microbiology
- Budding yeast
Organisms
- C. albicans
- C. dubliniensis
- C. glabrata: Fluconazole-resistant
- C. tropicalis
- C. parapsilosis
- C. krusei
- C. auris
Clinical Presentation
- Most common: mouth, vagina, skin
- In immunocompromised, ICU, IVDU, or TPN patients: Esophagus, blood, CNS, endophthalmitis
- Less common: joint
- IVDU: endocarditis
Investigations
- Urine culture if concern for cystitis
- Blood culture
- Never ignore candidemia!
- Requires an ophthalmology consult to rule out endophthalmitis (1-3% of cases)
- Echocardiogram if IVDU or prosthetic valve
- Germ tube test (GTT)
- If positive, indicates C. albicans or C. dubliniensis
- Identifies fluconazole-sensitive Candidae
Species and Resistance
| Species | Resistance pattern |
|---|---|
| C. albicans | Generally fluconazole-susceptible |
| C. dubliniensis | Generally fluconazole-susceptible |
| C. parapsilosis | Generally fluconazole-susceptible |
| C. glabrata | Often fluconazole resistant, or dose-dependent |
| C. tropicalis | Generally fluconazole-susceptible |
| C. krusei | Inherent fluconazole resistance |
| C. lusitaniae | Often amphotericin resistant but fluconazole-susceptible |
Treatment
- First-line:
- Remove lines!
- GGT positive: fluconazole for 2 weeks after first negative blood culture
- GGT negative: move to second-line therapies
- Second-line: micafungin, then amphotericin B (last choice)
- Endophthalmitis: extend course to 4 weeks
- Failure of therapy: double-check for endophthalmitis
