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[Visceral candidiasis]
R Herbrecht1, A Zamfir, V Letscher-Bru
1Département d'hématologie et d'oncologie Hôpital de Hautepierre 67098 Strasbourg. raoul.herbrecht@chru-strasbourg.fr
Abstract:
Invasive candidiasis is a frequent infection in compromised patient. Several risk factors have been identified and include neutropenia, broad-spectrum antibiotherapy, colonisation with a Candida spp. and presence of central venous catheter. Candidemia is the most common clinical aspect. Diagnosis is based on positive culture of blood, skin biopsy or fine needle aspiration of a deep-seated lesion. Serology is not helpful in severely immunocompromised patients. Prophylaxis is based on strict hygiene and, in neutropenic patients, oral fluconazole. Treatment of an invasive candidiasis depends on the localisation of the infection, of its acute or chronic evolution, on the species involved and on underlying condition. Amphotericin B deoxycholate or in lipid formulation and fluconazole are the antifungal drugs of choice. Removal of a central venous catheter should always be discussed in candidemia.
Insights
Invasive candidiasis, a common infection in immunocompromised patients, is often diagnosed via blood cultures. Treatment involves antifungals like fluconazole and Amphotericin B, with catheter removal crucial for candidemia.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Invasive candidiasis is a significant opportunistic infection, particularly affecting immunocompromised individuals.
- Key risk factors include neutropenia, broad-spectrum antibiotic use, Candida colonization, and central venous catheters.
- Candidemia represents the most frequent clinical manifestation of invasive candidiasis.
Purpose of the Study:
- To outline the diagnostic approaches for invasive candidiasis.
- To discuss current prophylaxis and treatment strategies for invasive candidiasis.
- To highlight the importance of risk factor management and timely intervention.
Main Methods:
- Diagnosis relies on positive cultures from blood, skin biopsy, or deep-seated lesion aspiration.
- Serological tests are generally not reliable in severely immunocompromised patients.
- Treatment selection is guided by infection site, severity, fungal species, and patient's condition.
Main Results:
- Antifungal drugs of choice include Amphotericin B (deoxycholate or lipid formulations) and fluconazole.
- Strict hygiene and oral fluconazole are recommended for prophylaxis in neutropenic patients.
- Removal of central venous catheters is a critical consideration in managing candidemia.
Conclusions:
- Prompt diagnosis and appropriate antifungal therapy are essential for managing invasive candidiasis.
- Risk factor modification, including catheter removal, plays a vital role in patient outcomes.
- Tailored treatment based on clinical context and causative species improves therapeutic efficacy.