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Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
How is a clinically significant infection with Candida identified and how should it be treated?All isolates from blood should be considered important.Patients at risk with Candida isolated from two sites and clinical signs of infection should be presumed to have a clinically significant infection.Antifungal treatment should be based on the resistance profile of the organism, isolated and guided by local microbiological advice.Removal of existing intravascular catheters may reduce the duration of candidaemia.Fundoscopy should be performed as up to 15% of patients may have endophthalmitis associated with the candidaemia.Treatment should be continued for at least 14 days following the last negative blood culture.
Called to ITU to Examine a Fundus
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
The most common referral probably remains a fundal review following positive blood or line cultures for candidaemia or suspected candidaemia. Endogenous endophthalmitis is always a concern following candida growth on blood cultures and a fundal review is recommended by the microbiologist. However, endogenous endophthalmitis only makes up around 2%–8% of the endophthalmitis cases we see. It is always worth checking the patient hasn't had recent ophthalmic surgery or intravitreal injection to exclude exogenous endophthalmitis. Studies have suggested an increase in incidence of systemic candidaemia in recent years, likely related to an increase in the number of ITU beds, complicated surgery and prolonged ITU stays. Patients at risk of systemic candidaemia include those following major abdominal surgery, patients who have prolonged central line placement with broad spectrum antibiotic usage and to a lesser degree transplant patients and those undergoing haemofiltration/haemodialysis. Diabetes mellitus and immunosuppression with corticosteroids and chemotherapy are also significant risk factors.
Tropical Colorectal Surgery
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Meheshinder Singh, Kemal I. Deen
Candidemia results when the pathogen gains access to the bloodstream. Colonisation of indwelling vascular catheters is an increasingly important source of sepsis. Penetration and absorption through the gastrointestinal mucosal barrier from an overgrowth of yeasts in the bowel lumen is probably the most common mode of candidial infection, particularly in immunocompromised hosts.
Prevention of acquired invasive fungal infection with decontamination regimen in mechanically ventilated ICU patients: a pre/post observational study
Published in Infectious Diseases, 2023
Nicolas Massart, Florian Reizine, Clarisse Dupin, François Legay, Eleonore Legris, Anne Cady, Guillaume Rieul, Nicolas Barbarot, Eric Magahlaes, Pierre Fillatre
Patients were classified as having possible, putative, probable or proven aspergillosis according to the AspICU, IAPA and CAPA criteria when indicated [10–12]. Fungal culture was performed in respiratory samples in Sabouraud-Chloramphenicol media and species identification was by MALDI-ToF mass spectrometry. Molecular detection was also performed on respiratory samples after DNA extraction with a qPCR assay targeting the mitochondrial gene and the 28S rDNA region. Galactomannan was measured in serum with an index cut-off of 0.5 and in BAL with an index cut-off of 1.0. Chest computed tomographies were analysed by a senior radiologist and was considered compatible with acquired pulmonary aspergillosis when lesions were not present at admission but developed during ICU stay. Candidemia was diagnosed by at least one blood culture positive for a Candida species.
From intestinal colonization to systemic infections: Candida albicans translocation and dissemination
Published in Gut Microbes, 2022
Jakob L. Sprague, Lydia Kasper, Bernhard Hube
As previously mentioned, many predisposing factors increase the risk of translocation of C. albicans from the GI tract to the bloodstream. Trauma, intestinal surgery, chemotherapy, and immunosuppression can all lead to candidemia.1,2 Many host factors are critical for preventing fungal translocation from the gut, including a balanced gut microbiome, intact intestinal barrier and cellular immunity, particularly neutrophils.15,45 The contribution of surgery and physical disruption of the intestinal barrier will be discussed in section 4.2, but here we will focus on C. albicans-mediated translocation and the strategies the fungus uses to overcome the intestinal epithelium. The interaction of C. albicans with the host at mucosal barriers has been recently reviewed with detailed descriptions of the different players (gut microbiota, intestinal epithelial cells, and gut mucosal immunity) as well as the fungal factors involved and models that can be used to study such processes.19 Here, we focus on the major translocation routes observed or proposed for C. albicans (transcellular, via microfold cells, and paracellular), compare the knowledge on fungal translocation to known mechanisms used by bacteria, and highlight the current knowledge gaps concerning fungal translocation.
Existing and emerging therapies for the treatment of invasive candidiasis and candidemia
Published in Expert Opinion on Emerging Drugs, 2022
David De Bels, Evelyne Maillart, Françoise Van Bambeke, Sebastien Redant, Patrick M. Honoré
The gold standard for the diagnosis of invasive candidiasis and candidemia consists in culture from blood or other sterile fluids or in histopathological demonstration of tissular invasion. Yet, it remains difficult, with a large proportion of false negative results. The sensitivity of blood cultures is estimated around 50% for invasive candidiasis but to only 42% for cultures from infected tissues [17]. Microbiological data also need to be interpreted in the light of the characteristics of the disease. Primary candidemia often comes from the gastrointestinal tract, from which the fungi translocate to the blood, or from intravenous catheters. Deep-seated candidiasis can also result from a non-hematogenous introduction of Candida into sterile sites, most commonly the abdominal cavity [11]. On this basis, diagnostic tests must identify three situations, namely candidemia without deep-seated candidiasis, deep-seated candidiasis in the absence of candidemia and, lastly, candidemia associated with deep-seated candidiasis [17]. Culture-based methods being not sensitive enough and taking time, culture-independent diagnostic methods have been developed including detection of 1,3-β-D-glucan [18], mannan antigen and anti-mannan antibodies [19], or C. albicans germ tube antibody [20], (multiplex) PCR [21], and T2 Magnetic Resonance assay (T2MR) detecting 5 Candida species [22]. Non-culture diagnostics for candidiasis may help to improve patients’ care, but are currently far from being available in all hospitals [23].