Candida: Difference between revisions

Revision as of 08:12, 26 August 2020

Background

Most common medically-important genus of yeast

Microbiology

Budding yeast
Human pathogens include:
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

Most common: infections of the mouth, vagina, skin
In immunocompromised, ICU, IVDU, or TPN patients: esophageal candidiasis, candidemia, CNS infection, endophthalmitis
Less common: septic arthritis
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 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
- See also management of candidemia

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

See also Antifungal spectrum of activity and Pharmacology of Systemic Antifungal Agents, CID 2006

@@ Line 1: / Line 1: @@
+== 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]]
+**[[Candida tropicalis]]
+**[[Candida parapsilosis]]
+**[[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==
-* ''[[C. albicans]]''
-* ''[[C. dubliniensis]]''
-* ''[[C. glabrata]]'': Fluconazole-resistant
-* ''[[C. tropicalis]]''
-* ''[[C. parapsilosis]]''
-* ''[[C. krusei]]''
-* ''[[C. auris]]''
+*Most common: infections of the mouth, vagina, skin
-== Clinical Manifestations ==
+*In immunocompromised, ICU, IVDU, or TPN patients: [[esophageal candidiasis]], [[candidemia]], CNS infection, [[endophthalmitis]]
+*Less common: [[septic arthritis]]
+*IVDU: [[endocarditis]]
+==Investigations==
-* Most common: mouth, vagina, skin
-* In immunocompromised, ICU, IVDU, or TPN patients: Esophagus, blood, CNS, endophthalmitis
-* Less common: joint
-* IVDU: endocarditis
+*Urine culture if concern for cystitis
-== Investigations ==
+*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==
-* 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"
-! 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}}