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What are the risk factors for developing Candida infections?
- Colonization
- Exposure to broad-spectrum antibiotics
- Central venous catheter
- Parenteral nutrition
- CI or cardiac surgery
- Long hospitalization
- ICU stay
- Thermal injury
- Premature birth
- Immunosuppression (Neutropenia, HIV, corticosteroids, DM)
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What are the 5 most common Candida species that cause human infection?
- C. albicans:
- Most common species
- Susceptible to everything
- C. glabrata:
- Low virulence, but difficult to treat
- Higher mortality
- Susceptible to AMB and echinocandins
- Some rst to azoles
- C. tropicalis :
- Pronounced involvement of the entire GI tract
- Susceptible to everything
- C. parapsilosis:
- Exogenous infection
- Susceptible to everything (but a little questionable with echcinocandins)
- C. krusei:
- Higher mortality
- Susceptible to AMB, echinocandins, voriconazole
- Rst to fluconazole
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What is the treatment for Candidemia in a patient who is not severely ill and glabrata or krusei are not suspected?
- Fluconazole DOC (make sure to use adequate dosing)
- Echinocandin
- 14d after last positive blood culture and resolution of symptoms
-
What is the treatment for Candidemia in a patient who is severely ill or glabrata or krusei is suspected?
- Use an echinocandin
- Possibly Fluconazole
- 14d after last positive blood culture and resolution of symptoms
-
What is the treatment for invasive Candidiasis in a patient who is not severely ill and glabrata or krusei are not suspected?
- Fluconazole
- Echinocandin
- Treat until all lesions have resolved - months
- Treat through immunosuppression
-
What is the treatment for invasive Candidiasis in a patient who is not severely ill and glabrata or krusei is suspected?
- Echinocandin
- Possibly Fluconazole
- Treat until all lesions have resolved - months
- Treat through immunosuppression
-
What is the treatment for invasive candidiasis in a patient who is severely ill?
- LAMB
- Echinocandin
- Voriconazole
- Treat until all lesions have resolved - months
- Treat through immunosuppression
-
What are the risk factors for acquiring Aspergillus?
- Prolonged neutropenia
- Advanced HIV infection
- Inherited immunodeficiency
- Transplant
-
What is the most common method of acquiring Aspergillus?
inhalation of conidia
-
What is the treatment for Aspergillosis?
- Voriconazole DOC
- AMB
- Echinocandins (not monotherapy)
- Posaconazole
- Itraconazole
- Duration of tx: 6-12 wks
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