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House Microbiology > Candidiasis > Flashcards

Candidiasis Flashcards

1
Q

Candida species account for ________ % of invasive fungal infections

A

70–90

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2
Q

Approximately 30–35 % of all episodes of candidemia (blood stream infections) occur in ______ patients

A

ICU

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3
Q

Candidemia

Highly lethal infection associated with mortality rates between ______ and _____ %

A

40 and 60

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4
Q

Overview
The five most common Candida species are Candida ______, Candida ______, Candida ______, Candida _______, and Candida ______

A

albicans

Glabrata

Tropicalis

Parapsilosis

Krusei

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5
Q

Recently emerging multidrug resistant Candida spp – C. ______

A

auris

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6
Q

Genus Candida contains over _____ species but ______ species accounts for most documented infections

A

200; 5-7

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7
Q

Genus Candida

Early diagnosis is (easy or difficult ?)

Most infections are (Endo or Exo?) genous

A

Difficult

Endo

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8
Q

Genus Candida is Part of normal flora of skin and GIT

T/F

A

T

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9
Q

Genus Candida Has (Specific or Non-specific?) clinical signs and symptoms

A

Non-specific

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10
Q

Genus Candida

• Invasive diagnostic procedures is risky

• Lack of sensitive, minimally invasive assays

T/F

A

T

T

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11
Q

Genus Candida contains over 200 species but 5-7 species accounts for most documented infections
Early diagnosis is difficult Most infections are endogenous
Part of normal flora of skin and GIT
• Non-specific clinical signs and symptoms
• Invasive diagnostic procedures risky
• Lack of sensitive, minimally invasive assays

A
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12
Q

Genus Candida contains over 200 species but 5-7 species accounts for most documented infections
Early diagnosis is difficult Most infections are endogenous
Part of normal flora of skin and GIT
• Non-specific clinical signs and symptoms
• Invasive diagnostic procedures risky
• Lack of sensitive, minimally invasive assays

A
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13
Q

Epidemiology

In the USA, Candida species are responsible for _____% of bloodstream infections (BSI) and are the ______ most common bloodstream pathogen.

In Europe, Candida species only account for ____ % of BSI and are ranked as the _______ most frequent pathogen

Nigeria -____% of critically ill patients were diagnosed.

A

8–10 ; fourth

2–3; 6th–8th

5.2

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14
Q

Candida spp

Spectrum of Disease

__________ disease and ________ funguria

________ Fungal disease

A

Mucocutaneous; Asymptomatic

Invasive

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15
Q

Candida spp
•
Candidiasis

Spectrum of Disease

Invasive Fungal disease
–__________ ± __________
–_____________ infection
–____________ infection

A

Candidemia; Endopthalmitis

Disseminated Hematological

Single deep organ

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16
Q

Candida spp

Spectrum of Disease

Single deep organ infection
» _______itis
» ___________itis
»__________ infection

A

Mening

Endocard

IntraAbdominal

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17
Q

Pathogenesis of candida

First , candida ___________

Then, it leafs to ______ or ———- caused by surgical anastomotic leakage or translocation

A

Colonizes the gut

Peritonitis or candidemia

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18
Q

Candidemia:

In intravascular catheters:

There is formation of __________

Candida is ______________

A

Biofilm

Released from biofilm

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19
Q

Candidemia:

In kidneys:

Leads to _______ which can lead to _________

A

Candiduria

Ascending pyelonephritis

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20
Q

Candidemia:

In spleen:

Causes __________

A

Infectious Spleen abscess

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21
Q

Candidemia can also affect the liver

T/F

A

T

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22
Q

Candidemia:

In eye:

Causes _______

A

Endopthalmitis

23
Q

Candidemia:

In lungs:

Causes _______

A

Infectious pulmonary abscess

24
Q

Candidemia can affect the bones

T/F

A

T

25
Q

Predicting Candidaemia

Ostrosky-Zeichner et al. proposed a prediction rule

very high NPV (______)

A

0.97

26
Q

Predicting Candidaemia

Parameters include:

use of ____________

total _________

dialysis, ______ or ______ agents

major ______ or _______

the presence of a _____________

A

systemic antibiotic therapy

parenteral nutrition

steroids or immunosuppressive

surgery; pancreatitis

central venous catheter.

27
Q

The Candida score, a/an (easy or difficult?) -to-use assessment system proposed by Leon et al

A

Easy

28
Q

The Candida score

Integrates four risk factors

total ____________

_________

________ Candida colonization

__________

and also has a high NPV (_____) to rule out _______ candidiasis.

A

parenteral nutrition

surgery

multifocal

severe sepsis

0.98; invasive

29
Q

Laboratory diagnosis

Early diagnosis is always easy.

Microscopic examination is rapid

Microscopic examination can be helpful

a negative result in microscopy excludes the infection.

T/F

A

F

T

T

F

30
Q

Laboratory diagnosis

Blood cultures are positive in only ________% of cases of Candida BSI.

A

50–70

31
Q

Laboratory diagnosis

Blood cultures are rarely positive in patients with _______ candidiasis

A

deep-seated

32
Q

It can take several days before Candida is identified at the species level and antifungal susceptibility data are available.

T/F

A

T

33
Q

___________ Is Presently the “Gold Standard” for diagnosis of IC

A

Blood Cultures

34
Q

Blood Cultures in the Diagnosis of IC

  • (Sensitive or Insensitive?)
  • (Slow or Rapid?)
  • Highly (variable or constant?) performance across different blood culture systems systems
A

Insensitive

Slow

Variable

35
Q

Laboratory identification

Gram (positive or negative?)

__________ test – positive for C.albicans

A

Positive

Germ tube

36
Q

Laboratory identification

Germ tube test – positive for C._______

_______spores, _______hyphae

A

albicans

Chlamydo

pseudo

37
Q

Laboratory identification

API, Auxocolor etc

_______Agar Candida – presumptive identification

A

Chrom

38
Q

C.albicans

This account for over _____% of clinical isolates.

Use to be (lower or higher?) (_____%) but _________ especially ______ has led to emergence of more _________ spps accounting for invasive infections.
However, resistance is emerging

A

50

Higher ; 70-80

frequent use of antifungals

fulconazole

non-C.albican

39
Q

Nonculture-based diagnostic tests (such as __________ and _________ ) by immunoassays, of DNA by PCR, and of antibodies by serology.

A

mannan and β-d-glucan (BDG)

40
Q

Treatment

Therapy is based on multiple factors

T/F

A

T

41
Q

Treatment

___________ is first line drug of choice for C.albicans

A

Fluconazole

42
Q

Drug therapy
Types

________
_______
_________
_______

A

Prophylactic
Empiric
Preemptive
Definitive

43
Q

Drug therapy

Prophylactic

in patients at _______________

A

high risk of fungal infection

44
Q

Drug therapy

Empiric

triggered by ________________, e.g., persistent fever in the presence of __________

A

clinical signs of fungal infection

risk factors

45
Q

Drug therapy

Preemptive

triggered by __________________ without _______________

A

microbiological or biomarker evidence of fungus

actual infection

46
Q

Drug therapy

Definitive

after _______________________ and ________________

A

positive microbiological confirmation of strain and sensitivity of fungus

47
Q

Candida: Emerging Resistance Issues
C. krusei
– ________ resistant

C. glabrata

________ and _________

C. parapsilosis
_______ and ______

A

Fluconazole

Azoles and Echinocandins

Azoles and Echinocandins

48
Q

Candida ________ Is Fluconazole resistant

A

Krusei

49
Q

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines no longer consider _________ the drug of choice for invasive candidiasis, and endorse the use of ———— as first-line empiric treatment

A

fluconazole

echinocandins

50
Q

The recent Infectious Diseases Society of America (IDSA) guidelines also recommend ________ for initial therapy of invasive candidiasis

A

echinocandins

51
Q

Monitoring response to therapy

_________ have been suggested to assist in decisions to start or stop antifungals.

A

Biomarkers

52
Q

______ was superior to the ___________ or the _________ for the prediction of intraabdominal candidiasis in high-risk surgical and ICU patients, with a cutoff value of _____ pg/ml.

A

BDG

Colonization Index or the Candida score

80

53
Q

Candida score and the Colonization Index is more accurate than the BDG for early prediction of invasive Candida infection in patients at risk for Candida sepsis

T/F

A

F

Similarly a prospective observational study demonstrated that BDG was more accurate than the Candida score and the Colonization Index for early prediction of invasive Candida infection in patients at risk for Candida sepsis

House Microbiology (93 decks)

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