Candidiasis

Question 1

Candida species account for ________ % of invasive fungal infections

Answer 1

70–90

Question 2

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

Answer 2

ICU

Question 3

Candidemia

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

Answer 3

40 and 60

Question 4

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

Answer 4

albicans

Glabrata

Tropicalis

Parapsilosis

Krusei

Question 5

Recently emerging multidrug resistant Candida spp – C. ______

Answer 5

auris

Question 6

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

Answer 6

200; 5-7

Question 7

Genus Candida

Early diagnosis is (easy or difficult ?)

Most infections are (Endo or Exo?) genous

Answer 7

Difficult

Endo

Question 8

Genus Candida is Part of normal flora of skin and GIT

T/F

Answer 8

T

Question 9

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

Answer 9

Non-specific

Question 10

Genus Candida

• Invasive diagnostic procedures is risky

• Lack of sensitive, minimally invasive assays

T/F

Answer 10

T

T

Question 11

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

Question 12

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

Question 13

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.

Answer 13

8–10 ; fourth

2–3; 6th–8th

5.2

Question 14

Candida spp

Spectrum of Disease

__________ disease and ________ funguria

________ Fungal disease

Answer 14

Mucocutaneous; Asymptomatic

Invasive

Question 15

Candida spp
•
Candidiasis

Spectrum of Disease

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

Answer 15

Candidemia; Endopthalmitis

Disseminated Hematological

Single deep organ

Question 16

Candida spp

Spectrum of Disease

Single deep organ infection
» _______itis
» ___________itis
»__________ infection

Answer 16

Mening

Endocard

IntraAbdominal

Question 17

Pathogenesis of candida

First , candida ___________

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

Answer 17

Colonizes the gut

Peritonitis or candidemia

Question 18

Candidemia:

In intravascular catheters:

There is formation of __________

Candida is ______________

Answer 18

Biofilm

Released from biofilm

Question 19

Candidemia:

In kidneys:

Leads to _______ which can lead to _________

Answer 19

Candiduria

Ascending pyelonephritis

Question 20

Candidemia:

In spleen:

Causes __________

Answer 20

Infectious Spleen abscess

Question 21

Candidemia can also affect the liver

T/F

Answer 21

T

Question 22

Candidemia:

In eye:

Causes _______

Answer 22

Endopthalmitis

Question 23

Candidemia:

In lungs:

Causes _______

Answer 23

Infectious pulmonary abscess

Question 24

Candidemia can affect the bones

T/F

Answer 24

T

Question 25

Predicting Candidaemia Ostrosky-Zeichner et al. proposed a prediction rule very high NPV (______)

Answer 25

0.97

Question 26

Predicting Candidaemia Parameters include: use of ____________ total _________ dialysis, ______ or ______ agents major ______ or _______ the presence of a _____________

Answer 26

systemic antibiotic therapy parenteral nutrition steroids or immunosuppressive surgery; pancreatitis central venous catheter.

Question 27

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

Answer 27

Easy

Question 28

The Candida score Integrates four risk factors total ____________ _________ ________ Candida colonization __________ and also has a high NPV (_____) to rule out _______ candidiasis.

Answer 28

parenteral nutrition surgery multifocal severe sepsis 0.98; invasive

Question 29

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

Answer 29

F T T F

Question 30

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

Answer 30

50–70

Question 31

Laboratory diagnosis Blood cultures are rarely positive in patients with _______ candidiasis

Answer 31

deep-seated

Question 32

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

Answer 32

T

Question 33

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

Answer 33

Blood Cultures

Question 34

Blood Cultures in the Diagnosis of IC - (Sensitive or Insensitive?) - (Slow or Rapid?) - Highly (variable or constant?) performance across different blood culture systems systems

Answer 34

Insensitive Slow Variable

Question 35

Laboratory identification Gram (positive or negative?) __________ test – positive for C.albicans

Answer 35

Positive Germ tube

Question 36

Laboratory identification Germ tube test – positive for C._______ _______spores, _______hyphae

Answer 36

albicans Chlamydo pseudo

Question 37

Laboratory identification API, Auxocolor etc _______Agar Candida – presumptive identification

Answer 37

Chrom

Question 38

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

Answer 38

50 Higher ; 70-80 frequent use of antifungals fulconazole non-C.albican

Question 39

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

Answer 39

mannan and β-d-glucan (BDG)

Question 40

Treatment Therapy is based on multiple factors T/F

Answer 40

T

Question 41

Treatment ___________ is first line drug of choice for C.albicans

Answer 41

Fluconazole

Question 42

Drug therapy Types ________ _______ _________ _______

Answer 42

Prophylactic Empiric Preemptive Definitive

Question 43

Drug therapy Prophylactic in patients at _______________

Answer 43

high risk of fungal infection

Question 44

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

Answer 44

clinical signs of fungal infection risk factors

Question 45

Drug therapy Preemptive triggered by __________________ without _______________

Answer 45

microbiological or biomarker evidence of fungus actual infection

Question 46

Drug therapy Definitive after _______________________ and ________________

Answer 46

positive microbiological confirmation of strain and sensitivity of fungus

Question 47

Candida: Emerging Resistance Issues C. krusei – ________ resistant C. glabrata ________ and _________ C. parapsilosis _______ and ______

Answer 47

Fluconazole Azoles and Echinocandins Azoles and Echinocandins

Question 48

Candida ________ Is Fluconazole resistant

Answer 48

Krusei

Question 49

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

Answer 49

fluconazole echinocandins

Question 50

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

Answer 50

echinocandins

Question 51

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

Answer 51

Biomarkers

Question 52

______ 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.

Answer 52

BDG Colonization Index or the Candida score 80

Question 53

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

Answer 53

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