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[Systemic mycotic infections: epidemiology and diagnostic criteria]
1Laboratoire de bactériologie, Centre hospitalier universitaire vaudois, Lausanne.
Abstract:
Among the systemic mycotic infections, disseminated candidiasis is the most frequent and is constantly on the increase. Candidiasis occurs in patients with particular risks, i.e., in oncologic neutropenic patients and in surgical patients after intraabdominal surgery. Independent predictive factors are multiple prior antibiotic therapy, the presence of intravascular devices and previous colonization by Candida, as well as the rupture of skin or cutaneous anatomical barriers. C. albicans is still the predominant species. Diagnosis of disseminated candidiasis is difficult and sometimes delayed. It relies essentially on a high index of suspicion, on blood cultures and the analysis of other samples (biopsies) by a combination of microbiological and anatomopathological procedures. The detection of Candida antigens, antibodies or metabolites still suffers from suboptimal sensitivity and specificity. Molecular diagnosis by amplification (PCR) is promising. The reservoir of Candida is mainly the human digestive tract, and a colonization stage usually precedes an established infection. Transmission of Candida by human carriage or through the environment could play an important role, particularly in intensive care units.
Insights
Disseminated candidiasis, a growing systemic fungal infection, frequently affects high-risk patients. Early diagnosis and understanding transmission routes are crucial for managing this challenging condition.
Area of Science:
- Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Disseminated candidiasis is a frequent and increasing systemic mycosis.
- High-risk patient groups include neutropenic oncology patients and post-abdominal surgery patients.
- Predictive factors include prior antibiotics, intravascular devices, prior Candida colonization, and skin barrier disruption.
Purpose of the Study:
- To review the epidemiology, diagnosis, and transmission of disseminated candidiasis.
- To highlight diagnostic challenges and emerging molecular methods.
- To emphasize the role of colonization and transmission in intensive care units.
Main Methods:
- Review of current literature on disseminated candidiasis.
- Analysis of diagnostic approaches, including microbiological and anatomopathological methods.
- Discussion of emerging diagnostic technologies like PCR.
Main Results:
- Candida albicans remains the predominant species.
- Diagnosis is often delayed and relies on clinical suspicion and conventional methods.
- Current antigen/antibody detection methods have suboptimal sensitivity and specificity.
- Molecular diagnostics (PCR) show promise for improved detection.
Conclusions:
- Disseminated candidiasis requires a high index of suspicion for timely diagnosis.
- The human digestive tract is the primary reservoir, with colonization preceding infection.
- Understanding transmission, especially in ICUs, is vital for infection control.