Candedmia Flashcards
Candidiasis
J
primary or secondary mycotic disease caused by a
member of the genus Candida.
U
clinical manifestations may be acute,
subacute or chronic.
H
Involvement may be localized to the mouth, throat, skin,
vagina, fingers, nails, bronchii, lungs or the gastrointestinal tract, or become
systemic following candidemia.
K
Occurrence
Y
Part of naturally occurring microbial flora -skin, body orifices,
gastrointestinal tract.
H
Mostly endogenous in origin
Epidemiology
J
The third most common pathogen isolated from blood in critically ill
patients.
K
being the most common causative species.
H
The major causative species are:
J
Candida albicans (> 50%)
K
parapsilosis
I
dubliniensis
J
tropicalis
J
krusei
K
glabrata
U
auris
J
emerging fungus that presents a serious global
health threat.
J
Often multidrug-resistant yeast that can cause a wide spectrum of
infections.
J
Issues related to detection methods
U
Propensity to cause outbreaks in healthcare setting
U
HOW TO IDENTIFYING PATIENTS AT RISK OF CANDIDEMIA ?
H
ICU and Surgical patients
K
Immunocompromised patients
Central venous catheter
P
Hematological malignancy
I
TPN
*
Solid organ transplantation
I
Broad spectrum antibiotics
L
Hematopoietic stem cell transplantation
N
Acute Renal failure
O
Chemotherapy
L
Recent surgery
O
Steroids
K
GI perforation and leaks
O
Prolonged Neutropenia
H
Colonization by Candida spp.
J
High APACHE score
B
Risk factor
Candida glabrata
I
Candida parapsilosis
RF
F
Candida tropicalis
RF
F
Candida krusei
RF
O
Candida auris
RF
J
Elderly
G
Malignancy & solid organ Tx
G
Antifungal exposure
G
TPN & CVC
T
Nosocomial outbreak (biofilms) >children
G
Hematological malignancies and neutropenia
G
GI surgery
H
Fluconazole exposure
T
Immunosuppression
T
Exposure to antifungal therapy
G
Broad spectrum antibiotics
G
Nosocomial outbreak (biofilms)
T
Vascular surgery
T
Diagnoses of candidemia
D
Blood culture
D
Immunological Assays
D
Nucleic acid amplification-based tests
D
T2Candida
(
glucan
F
Mannan
F
real-time PCR assays
D
three to five hours
D
detection of bloodstream infection caused by 5 candida species.
E
The assay breaks yeast cells apart, releasing DNA; copies the target DNA; and
detects the amplified DNA using magnetic resonance technology.
D
Empirical treatment
E
Preemptive treatment
D
Definitive
F
Prophylaxis
F
defined as antibacterial treatment of patients who have
persistent or recurrent fever.
F
was defined as treatment of patients who have clinical, imaging, or
galactomannan-antigen-assay evidence suggesting fungal disease
R
treatment plan for a disease or disorder that has been chosen as the best
one for a patient after all other choices have been considered of which there is supportive
diagnostic and clinical results .
F
treatment given or action taken to prevent disease.
F
Candida score
S
Severe sepsis
B
Multifocal Candida
F
Surgery
D
2 point
V
1 point
F
candida score’ of > 3 was classed as a positive ‘candida score’ which should identify patients who would benefit from early antifungal treatment
F
Classes of Antifungals
F
Polyenes
E
Azoles
C
Echinocandins
R
Amphotericin B
F
Abelcet
G
Ambisome
F
Caspofungin
F
Micafungin
F
Anidulafungin
G
bind with sterols in the fungal cell membrane, principally ergosterol. This causes the cell’s contents to leak out and the cell dies. Animal cells contain cholesterol instead of ergosterol and so they are much less susceptible.
F
Inhibit the enzyme cytochrome P450 14α-demethylase. This enzyme converts
lanosterol to ergosterol and is required in fungal cell membrane synthesis.
I
inhibit the synthesis of glucan in the cell wall,
probably via the enzyme 1,3-β glucan synthase:
Y
Guidelines for treatment IDSA
J
Neutropenic
D
Non Neutropenic
D
Lipid formulation Amphotericin B
F
Voriconazole
U
mould
D
Second choice
D
Step down
D
Third choice
D
Loading dose 70 mg then 50 mg
V
Loading dose 800 mg then 400 mg
C
0.5-0.7 mg/kg/daily
V
3-5 mg/kg
C
Loading dose 400 followed by 200-300
D
