Candida: Difference between revisions
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Candida
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== Species and Resistance == |
== Species and Resistance == |
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{| class="wikitable" |
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! Species |
! Species !! Resistance pattern |
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! Resistance pattern |
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| ''C. albicans'' |
| ''C. albicans'' || Generally fluconazole-susceptible |
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| Generally fluconazole-susceptible |
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| ''C. dubliniensis'' |
| ''C. dubliniensis'' || Generally fluconazole-susceptible |
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| Generally fluconazole-susceptible |
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| ''C. parapsilosis'' |
| ''C. parapsilosis'' || Generally fluconazole-susceptible |
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| Generally fluconazole-susceptible |
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| ''C. glabrata'' |
| ''C. glabrata'' || Often '''fluconazole resistant''', or dose-dependent |
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| Often '''fluconazole resistant''', or dose-dependent |
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| ''C. tropicalis'' |
| ''C. tropicalis'' || Generally fluconazole-susceptible |
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| Generally fluconazole-susceptible |
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| ''C. krusei'' |
| ''C. krusei'' || Inherent '''fluconazole resistance''' |
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| Inherent '''fluconazole resistance''' |
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| ''C. lusitaniae'' |
| ''C. lusitaniae'' || Often '''amphotericin resistant''' but fluconazole-susceptible |
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| Often '''amphotericin resistant''' but fluconazole-susceptible |
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Revision as of 13:45, 23 September 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
