RESUMEN
We report the case of a 61-year-old female with Crohn's disease dependent on total parenteral nutrition who developed a central venous catheter bloodstream infection and septic arthritis, complicated further by osteomyelitis and persistent Candida glabrata fungemia. Fluconazole treatment led to persistent infection, and micafungin therapy failed with development of FKS-associated resistance. Infection responded after initiation of amphotericin B plus voriconazole. Echinocandin resistance is increasingly recognized, suggesting a role for alternative antifungal therapies.
Asunto(s)
Anfotericina B/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Candida glabrata/efectos de los fármacos , Farmacorresistencia Fúngica/efectos de los fármacos , Equinocandinas/uso terapéutico , Osteomielitis/tratamiento farmacológico , Voriconazol/uso terapéutico , Antifúngicos/uso terapéutico , Artritis Infecciosa/microbiología , Candida glabrata/metabolismo , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Proteínas Fúngicas/metabolismo , Humanos , Persona de Mediana Edad , Osteomielitis/microbiología , Terapia Recuperativa/métodosRESUMEN
Invasive candidiasis is a collective term that refers to a group of infectious syndromes caused by a variety of species of Candida, 5 of which cause most cases. Candidemia is the most commonly recognized syndrome associated with invasive candidiasis. Certain conditions may influence the likelihood for one species versus another in a specific clinical scenario, and this can have important implications for selection of antifungal therapy and the duration of treatment. Molecular diagnostic technology plays an ever-increasing role as an adjunct to traditional culture-based diagnostics, offering significant potential toward improvement in patient care.