Fungemia: Difference between revisions

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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

Revision as of 15:27, 11 February 2021

Background

Microbiology

Risk Factors

  • Hospital-onset
  • Community-onset1
    • 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

  • Positive blood culture for a Candida species
  • Fever
  • Triad of bowel perforation, increase white cell count, and decreased platelets
  • Ocular infections in 16%, which as primarily chorioretinitis, although endophthalmitis is possible2
  • Fungal endocarditis found in 8%
  • In patients with community-onset candidemia and candiduria, many have fungal endocarditis

Prognosis

  • Mortality of about 25%1

Investigations

  • Blood cultures
  • 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
  • Repeat 1 to 2 blood cultures every 24 to 48 hours until negative (1 culture q24h in ESCMID guidelines)
  • Antifungal therapy
  • 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

References

  1. a b  Andre N. Sofair, G. Marshall Lyon, Sharon Huie‐White, Errol Reiss, Lee H. Harrison, Laurie Thomson Sanza, Beth A. Arthington‐Skaggs, Scott K. Fridkin. Epidemiology of Community‐Onset Candidemia in Connecticut and Maryland. Clinical Infectious Diseases. 2006;43(1):32-39. doi:10.1086/504807.
  2. ^ lashof2011oc