Candida: Difference between revisions
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Candida
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* First-line: |
* First-line: |
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** '''Remove lines!''' |
** '''Remove lines!''' |
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** GGT positive: fluconazole for 2 weeks after first negative blood culture |
** GGT positive: [[Is treated by::fluconazole]] for 2 weeks after first negative blood culture |
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** GGT negative: move to second-line therapies |
** GGT negative: move to second-line therapies |
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* Second-line: micafungin, then amphotericin B (last choice) |
* Second-line: [[Is treated by::micafungin]], then [[Is treated by::amphotericin B]] (last choice) |
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* Endophthalmitis: extend course to 4 weeks |
* Endophthalmitis: extend course to 4 weeks |
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* Failure of therapy: double-check for endophthalmitis |
* Failure of therapy: double-check for endophthalmitis |
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Revision as of 17:32, 19 November 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
