Self-Study: Candida Infections of the Bladder and Kidneys

Question 1

pathophysiology of Candida infections of the genitourinary tract

Answer 1

• Lower UTI or hematogenous spread

- Fungi adhere to endothelium and then invade the interstitium

Question 2

epidemiology and risk factors for Candida infections of the genitourinary tract

Answer 2

• Hospitalized pts w/ catheter palcement
• Prior Abx Tx
• Diabetes
• UT Pathology
• Malignancy

Question 3

history and clinical characteristics of Candida infections of the genitourinary tract

Answer 3

• S/S: dys/Polyuria, Abdominal pain/tenderness, flank pain, Costovertebrak tenderness,
  1. Asceding: UTI + obstruction f/ fungus balls; Spares cortex of kidney;
  2. Candidemia f/ UT abnormalities, obstruction, or Urinary procedure
  3. Disseminated

Question 4

Treatment of Candida infections of the genitourinary tract

Answer 4

• Asymptomatic: Antifungals NOT recommended unless high risk (Ex Urinary procedure pts treated w/ fluconazole or amphotericin B)
• Fluconazole-sensitive: Fluconazole
• Fluconazole-resistant: Amhotericin B w/ Flucytosine in cases of pyelonephritis ***No Bladder irrigation

Question 5

Complications of Candida infections of the genitourinary tract

Answer 5

• Perinephric Abcess -> drainage + systemic antifungals

- Fungus balls/bezoars -> Systemic fungal Tx + Sx such as debulking by extraction; possible irrigation

Question 6

workup for patient with suspected Candida Infection of the Bladder and/or Kidneys

Answer 6

• Blood Culture Gold standard candidemia
• Focal lesions -> Biopsy and culture/staining of specimen
• Ultrasound/CT of Kidney in diabetics w/ suspected candiduria to look for hydronephrosis, fungus balls, or perinephric abscesses
• B-D-glucan + other immune assay are helpful, but not conclusive