Candidiasis Flashcards
Candida species account for ________ % of invasive fungal infections
70–90
Approximately 30–35 % of all episodes of candidemia (blood stream infections) occur in ______ patients
ICU
Candidemia
Highly lethal infection associated with mortality rates between ______ and _____ %
40 and 60
Overview
The five most common Candida species are Candida ______, Candida ______, Candida ______, Candida _______, and Candida ______
albicans
Glabrata
Tropicalis
Parapsilosis
Krusei
Recently emerging multidrug resistant Candida spp – C. ______
auris
Genus Candida contains over _____ species but ______ species accounts for most documented infections
200; 5-7
Genus Candida
Early diagnosis is (easy or difficult ?)
Most infections are (Endo or Exo?) genous
Difficult
Endo
Genus Candida is Part of normal flora of skin and GIT
T/F
T
Genus Candida Has (Specific or Non-specific?) clinical signs and symptoms
Non-specific
Genus Candida
• Invasive diagnostic procedures is risky
• Lack of sensitive, minimally invasive assays
T/F
T
T
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
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
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.
8–10 ; fourth
2–3; 6th–8th
5.2
Candida spp
Spectrum of Disease
__________ disease and ________ funguria
________ Fungal disease
Mucocutaneous; Asymptomatic
Invasive
Candida spp
•
Candidiasis
Spectrum of Disease
Invasive Fungal disease
–__________ ± __________
–_____________ infection
–____________ infection
Candidemia; Endopthalmitis
Disseminated Hematological
Single deep organ
Candida spp
Spectrum of Disease
Single deep organ infection
» _______itis
» ___________itis
»__________ infection
Mening
Endocard
IntraAbdominal
Pathogenesis of candida
First , candida ___________
Then, it leafs to ______ or ———- caused by surgical anastomotic leakage or translocation
Colonizes the gut
Peritonitis or candidemia
Candidemia:
In intravascular catheters:
There is formation of __________
Candida is ______________
Biofilm
Released from biofilm
Candidemia:
In kidneys:
Leads to _______ which can lead to _________
Candiduria
Ascending pyelonephritis
Candidemia:
In spleen:
Causes __________
Infectious Spleen abscess
Candidemia can also affect the liver
T/F
T
Candidemia:
In eye:
Causes _______
Endopthalmitis
Candidemia:
In lungs:
Causes _______
Infectious pulmonary abscess
Candidemia can affect the bones
T/F
T
Predicting Candidaemia
Ostrosky-Zeichner et al. proposed a prediction rule
very high NPV (______)
0.97
Predicting Candidaemia
Parameters include:
use of ____________
total _________
dialysis, ______ or ______ agents
major ______ or _______
the presence of a _____________
systemic antibiotic therapy
parenteral nutrition
steroids or immunosuppressive
surgery; pancreatitis
central venous catheter.
The Candida score, a/an (easy or difficult?) -to-use assessment system proposed by Leon et al
Easy
The Candida score
Integrates four risk factors
total ____________
_________
________ Candida colonization
__________
and also has a high NPV (_____) to rule out _______ candidiasis.
parenteral nutrition
surgery
multifocal
severe sepsis
0.98; invasive
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
F
T
T
F
Laboratory diagnosis
Blood cultures are positive in only ________% of cases of Candida BSI.
50–70
Laboratory diagnosis
Blood cultures are rarely positive in patients with _______ candidiasis
deep-seated
It can take several days before Candida is identified at the species level and antifungal susceptibility data are available.
T/F
T
___________ Is Presently the “Gold Standard” for diagnosis of IC
Blood Cultures
Blood Cultures in the Diagnosis of IC
- (Sensitive or Insensitive?)
- (Slow or Rapid?)
- Highly (variable or constant?) performance across different blood culture systems systems
Insensitive
Slow
Variable
Laboratory identification
Gram (positive or negative?)
__________ test – positive for C.albicans
Positive
Germ tube
Laboratory identification
Germ tube test – positive for C._______
_______spores, _______hyphae
albicans
Chlamydo
pseudo
Laboratory identification
API, Auxocolor etc
_______Agar Candida – presumptive identification
Chrom
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
50
Higher ; 70-80
frequent use of antifungals
fulconazole
non-C.albican
Nonculture-based diagnostic tests (such as __________ and _________ ) by immunoassays, of DNA by PCR, and of antibodies by serology.
mannan and β-d-glucan (BDG)
Treatment
Therapy is based on multiple factors
T/F
T
Treatment
___________ is first line drug of choice for C.albicans
Fluconazole
Drug therapy
Types
________
_______
_________
_______
Prophylactic
Empiric
Preemptive
Definitive
Drug therapy
Prophylactic
in patients at _______________
high risk of fungal infection
Drug therapy
Empiric
triggered by ________________, e.g., persistent fever in the presence of __________
clinical signs of fungal infection
risk factors
Drug therapy
Preemptive
triggered by __________________ without _______________
microbiological or biomarker evidence of fungus
actual infection
Drug therapy
Definitive
after _______________________ and ________________
positive microbiological confirmation of strain and sensitivity of fungus
Candida: Emerging Resistance Issues
C. krusei
– ________ resistant
C. glabrata
________ and _________
C. parapsilosis
_______ and ______
Fluconazole
Azoles and Echinocandins
Azoles and Echinocandins
Candida ________ Is Fluconazole resistant
Krusei
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
fluconazole
echinocandins
The recent Infectious Diseases Society of America (IDSA) guidelines also recommend ________ for initial therapy of invasive candidiasis
echinocandins
Monitoring response to therapy
_________ have been suggested to assist in decisions to start or stop antifungals.
Biomarkers
______ 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.
BDG
Colonization Index or the Candida score
80
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
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
