Candida: Difference between revisions

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Candida
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== Background ==
⚫
* Most common medically-important genus of yeast


⚫
*Most common medically-important genus of yeast
⚫
== Microbiology ==


⚫
===Microbiology===
⚫
* Budding yeast


⚫
*Budding yeast
== Organisms ==
*Human pathogens include:
⚫
**[[Candida albicans]]
⚫
**[[Candida dubliniensis]]
**[[Candida glabrata]]
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**[[Candida tropicalis]]
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**[[Candida parapsilosis]]
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**[[Candida krusei]]
**[[Candida guilliermondii]]
⚫
**[[Candida auris]]
*Species that only rarely cause disease in humans include: [[Candida albidus]], [[Candida catenulate]], [[Candida chiropterorum]], [[Candida ciferrii]], [[Candida famata]], [[Candida haemulonii]], [[Candida humicola]], [[Candida inconspicua]], [[Candida kefyr]], [[Candida lambica]], [[Candida lipolytica]], [[Candida norvegensis]], [[Candida pelliculosa]], [[Candida pintolopesii]], [[Candida pulcherrima]], [[Candida rugosa]], [[Candida utilis]] and [[Candida zeylanoides]]


⚫
==Clinical Manifestations==
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* ''[[C. albicans]]''
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* ''[[C. dubliniensis]]''
* ''[[C. glabrata]]'': Fluconazole-resistant
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* ''[[C. tropicalis]]''
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* ''[[C. parapsilosis]]''
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* ''[[C. krusei]]''
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* ''[[C. auris]]''


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*Most common: infections of the mouth, vagina, skin
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== Clinical Manifestations ==
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*In immunocompromised, ICU, IVDU, or TPN patients: [[esophageal candidiasis]], [[candidemia]], CNS infection, [[endophthalmitis]]
*Less common: [[septic arthritis]]
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*IVDU: [[endocarditis]]


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==Investigations==
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* Most common: mouth, vagina, skin
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* In immunocompromised, ICU, IVDU, or TPN patients: Esophagus, blood, CNS, endophthalmitis
* Less common: joint
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* IVDU: endocarditis


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*Urine culture if concern for cystitis
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== Investigations ==
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*Blood culture
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**'''Never ignore candidemia!'''
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**Requires an '''ophthalmology''' consult to rule out endophthalmitis (1-3% of cases)
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**Echocardiogram if IVDU or prosthetic valve
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*Germ tube test (GTT)
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**If positive, indicates ''Candida albicans'' or ''Candida dubliniensis''
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**Identifies fluconazole-sensitive Candidae


==Management==
⚫
* 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


* Superficial infections involving skin or mucosa can be treated with either topical preparations or low-dose oral fluconazole
== Species and Resistance ==
* Invasive infections should be treated with an echinocandin until species and susceptibilities are available
** See also [[Candidemia#Management|management of candidemia]]


{| class="wikitable"
{| class="wikitable"
! Species !! Resistance pattern
!Species!!Resistance pattern
|-
|-
| ''C. albicans'' || Generally fluconazole-susceptible
|[[Candida albicans]]||Generally fluconazole-susceptible
|-
|-
| ''C. dubliniensis'' || Generally fluconazole-susceptible
|[[Candida dubliniensis]]||Generally fluconazole-susceptible
|-
|-
| ''C. parapsilosis'' || Generally fluconazole-susceptible
|[[Candida parapsilosis]]||Generally fluconazole-susceptible
|-
|-
| ''C. glabrata'' || Often '''fluconazole resistant''', or dose-dependent
|[[Candida glabrata]]||Often '''fluconazole resistant''', or dose-dependent
|-
|-
| ''C. tropicalis'' || Generally fluconazole-susceptible
|[[Candida tropicalis]]||Generally fluconazole-susceptible
|-
|-
| ''C. krusei'' || Inherent '''fluconazole resistance'''
|[[Candida krusei]]||Inherent '''fluconazole resistance'''
|-
|-
| ''C. lusitaniae'' || Often '''amphotericin resistant''' but fluconazole-susceptible
|[[Candida lusitaniae]]||Often '''amphotericin resistant''' but fluconazole-susceptible
|}
|}


* See also [[Antifungal spectrum of activity]] and [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]

== Treatment ==

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


{{DISPLAYTITLE:''Candida'' species}}
{{DISPLAYTITLE:''Candida'' species}}

Revision as of 12:12, 26 August 2020

Background

  • Most common medically-important genus of yeast

Microbiology

Clinical Manifestations

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 Candida albicans or Candida dubliniensis
    • Identifies fluconazole-sensitive Candidae

Management

  • Superficial infections involving skin or mucosa can be treated with either topical preparations or low-dose oral fluconazole
  • Invasive infections should be treated with an echinocandin until species and susceptibilities are available
Species Resistance pattern
Candida albicans Generally fluconazole-susceptible
Candida dubliniensis Generally fluconazole-susceptible
Candida parapsilosis Generally fluconazole-susceptible
Candida glabrata Often fluconazole resistant, or dose-dependent
Candida tropicalis Generally fluconazole-susceptible
Candida krusei Inherent fluconazole resistance
Candida lusitaniae Often amphotericin resistant but fluconazole-susceptible
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