Invasive candidiasis: from mycobiome to infection, therapy, and prevention

Area of Science:

• Medical Mycology
• Critical Care Medicine
• Human Microbiome Research

Background:

• Candida species are common human commensals.
• Invasive candidiasis incidence is rising, particularly in critically ill patients.
• Understanding the transition from colonization to invasive disease is crucial.

Purpose of the Study:

• To examine the relationship between Candida spp. in the human mycobiome, host defenses, and invasive disease pathophysiology.
• To identify risk factors and diagnostic approaches for invasive candidiasis in intensive care unit (ICU) patients.
• To recommend optimal treatment strategies for invasive candidiasis in critically ill individuals.

Main Methods:

• Review of current hypotheses on immune responses to Candida.
• Analysis of risk factors associated with invasive candidiasis in ICU settings.
• Evaluation of diagnostic and therapeutic strategies, including predictive scores, biomarkers, and antifungal agents.

Main Results:

• Critically ill patients in ICUs face the highest risk due to factors like disease severity, immunosuppression, and broad-spectrum antibiotic use.
• Predictive scores and biomarkers are key for early screening and diagnosis.
• Echinocandins are the recommended first-line treatment for invasive candidiasis in this population.

Conclusions:

• Prompt diagnosis and treatment, alongside source control, are essential for managing invasive candidiasis in severe cases.
• Restoring a healthy microbiota is an important aspect of patient recovery.
• Future strategies may involve immune-genomics and detailed clinical background analysis for personalized treatment.