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Invasive candidiasis
Cornelia Lass-Flörl1, Souha S Kanj2, Nelesh P Govender3,4
1Institute of Hygiene and Medical Microbiology, ECMM Excellence Centres of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria. cornelia.lass-floerl@i-med.ac.at.
Abstract:
Invasive candidiasis is an important fungal disease caused by Candida albicans and, increasingly, non-albicans Candida pathogens. Invasive Candida infections originate most frequently from endogenous human reservoirs and are triggered by impaired host defences. Signs and symptoms of invasive candidiasis are non-specific; candidaemia is the most diagnosed manifestation, with disseminated candidiasis affecting single or multiple organs. Diagnosis poses many challenges, and conventional culture techniques are frequently supplemented by non-culture-based assays. The attributable mortality from candidaemia and disseminated infections is ~30%. Fluconazole resistance is a concern for Nakaseomyces glabratus, Candida parapsilosis, and Candida auris and less so in Candida tropicalis infection; acquired echinocandin resistance remains uncommon. The epidemiology of invasive candidiasis varies in different geographical areas and within various patient populations. Risk factors include intensive care unit stay, central venous catheter use, broad-spectrum antibiotics use, abdominal surgery and immune suppression. Early antifungal treatment and central venous catheter removal form the cornerstones to decrease mortality. The landscape of novel therapeutics is growing; however, the application of new drugs requires careful selection of eligible patients as the spectrum of activity is limited to a few fungal species. Unanswered questions and knowledge gaps define future research priorities and a personalized approach to diagnosis and treatment of invasive candidiasis is of paramount importance.
Insights
Invasive candidiasis, a serious fungal infection, presents diagnostic challenges and significant mortality (~30%). Early treatment and personalized approaches are crucial for managing these Candida infections.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Invasive candidiasis is a severe fungal infection caused by Candida species, often originating from endogenous reservoirs due to compromised host defenses.
- Candidaemia and disseminated infections are common, presenting with non-specific symptoms and posing diagnostic difficulties, frequently requiring advanced non-culture-based assays.
- Attributable mortality remains high at approximately 30%, highlighting the urgent need for effective management strategies.
Purpose of the Study:
- To review the epidemiology, diagnosis, treatment, and emerging challenges of invasive candidiasis.
- To highlight the growing concern of antifungal resistance in specific Candida species.
- To emphasize the importance of early diagnosis, prompt treatment, and personalized medicine in improving patient outcomes.
Main Methods:
- Literature review of invasive candidiasis, focusing on epidemiology, risk factors, diagnostic modalities, and therapeutic interventions.
- Analysis of current antifungal resistance patterns, including resistance to azoles and echinocandins.
- Discussion of novel therapeutic agents and future research directions.
Main Results:
- Invasive candidiasis epidemiology varies geographically and by patient population, with risk factors including ICU stay, central lines, and immunosuppression.
- Fluconazole resistance is increasing in species like Nakaseomyces glabratus and Candida auris, while echinocandin resistance remains rare.
- Early antifungal therapy and central venous catheter removal are key to reducing mortality.
Conclusions:
- Effective management of invasive candidiasis requires a multi-faceted approach, including early diagnosis, appropriate antifungal selection, and risk factor modification.
- The emergence of antifungal resistance necessitates ongoing surveillance and the development of new therapeutic agents.
- A personalized approach to diagnosis and treatment is paramount for addressing knowledge gaps and improving outcomes in invasive candidiasis.
