Invasive candidiasis NEJM

Question 1

Pathogenesis?

Answer 1

Question 2

Risk factors?

Answer 2

Question 3

Diagnosis

Answer 3

Culture is currently the only diagnostic approach
that allows subsequent susceptibility testing.
The sensitivity of blood cultures is far from
ideal, with a sensitivity of 21 to 71% reported in
autopsy studies.9
Whereas blood cultures may
establish a diagnosis during the period when candida
resides in the bloodstream, cultures of blood
obtained from patients with hematogenous, deepseated
infections often yield negative results because
candida has been cleared from the bloodstream
at the time the blood sample is collected.9
Blood cultures are further limited by slow turnaround
times and by the fact that a positive result
may be revealed only late in the course of
disease. Positive blood cultures should prompt
the immediate initiation of therapy and a search
for metastatic foci.18,31
Candida mannan antigens and antimannan
antibodies and β-d-glucan are the primary surrogate
markers for invasive candidiasis.18,21,22 The
reported performance of assays for these markers
varies somewhat according to case mix, the
frequency of sampling, and the choice of comparator.
Studies that include healthy controls or
less severely ill patients may overestimate specificity,
since there are many potential sources of
contamination of β-d-glucan testing that can
produce false positive results, and these are
found more frequently in patients at high risk
for invasive candidiasis (Table 2). The major diagnostic
benefit of β-d-glucan is its negative
predictive value for invasive candidiasis in environments
in which the prevalence is low to
moderate.

Question 4

Prophylaxis

Answer 4

Indicated in patients with risk factors

Question 5

Treatment?
3 classes

Answer 5