RESUMEN
The fungus Wickerhamiella pararugosa (Candida pararugosa) has been detected in various human organs but has rarely caused bloodstream infections. This report presents a case of central venous catheter-related bloodstream infection (CRBSI) of W. pararugosa in an adult. A female patient in her 80s was admitted to our facility for intestinal obstruction caused by colorectal cancer. The patient's ability to consume food was hindered, necessitating the insertion of a central venous catheter (CVC) into the internal jugular vein. On day 3 after admission, the patient developed a fever, prompting blood and CVC tip cultures to be performed. On day 5, yeast-like fungi were discovered in the blood cultures, and fosfluconazole (fluconazole [FLCZ] pro-drug) treatment was initiated. On day 8, yeast-like fungi were identified in both the blood and CVC tip cultures, leading to a diagnosis of CRBSI. The fungus was identified as W. pararugosa through biochemical and genetic characterization. This finding justified the use of micafungin (MCFG) for combination therapy. On day 17, the minimum inhibitory concentrations (MIC) for FLCZ and MCFG were 4-8 and 0.06 µg/mL, respectively. Accordingly, the treatment was changed to monotherapy with MCFG. After a 21-day treatment regimen, the patient was discharged on day 31. We present a case of CRBSI caused by W. pararugosa in an adult with intestinal obstruction. The notable increase in the MIC of FLCZ necessitated monotherapy with MCFG, which resulted in successful recovery of the patient.
Asunto(s)
Antifúngicos , Obstrucción Intestinal , Humanos , Femenino , Obstrucción Intestinal/microbiología , Obstrucción Intestinal/etiología , Antifúngicos/uso terapéutico , Anciano de 80 o más Años , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/diagnóstico , Pruebas de Sensibilidad Microbiana , Fluconazol/uso terapéutico , Candida/aislamiento & purificación , Candida/efectos de los fármacos , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/microbiología , Micafungina/uso terapéutico , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/microbiología , Candidemia/tratamiento farmacológico , Candidemia/diagnóstico , Candidemia/microbiología , Candidemia/complicacionesRESUMEN
PURPOSE: To analyze intravitreal antifungal injections performed at a tertiary center to determine (1) risk factors increasing fungal endophthalmitis likelihood at the time of patient presentation, (2) prognostic factors at presentation, and (3) validity of American Academy of Ophthalmology (Academy) ophthalmologic Candida septicemia (candidemia) screening guidelines. DESIGN: Single-center, retrospective clinical case-control study. METHODS: Clinical course, visual outcome, and final diagnosis were analyzed for 75 patients (81 eyes) receiving intravitreal antifungal injections between 2014 and 2021. Features were compared between fungal endophthalmitis and clinically similar diseases (masquerades). RESULTS: Fungal endophthalmitis was more likely than masquerade based on injection in emergency department or inpatient setting (P = .0002) vs outpatient, greater visual acuity (P = .049), artificial indwelling line present (P = .0004), sepsis within past 6 months (P = .0002), prior/current hepatitis C diagnosis (P = .044), total parenteral nutrition (P = .0028), complicated diabetes mellitus (P = .035), actively treated cancer (P = .021), immunosuppressive medication within past year (P = .035), immunocompromising condition number (P = .031), and delayed pain (P = .0094) and vision loss (P = .020) onset. Visual acuity at presentation correlated with visual outcome (R2 = 0.3524, P = 8.5 × 10-7). No patients with fungal endophthalmitis were asymptomatic or identified by screening. CONCLUSIONS: Many conditions can mimic fungal endophthalmitis, but certain risk factors should raise its suspicion. Regardless of diagnosis, presenting vision correlates with final vision. Lastly, no patients with fungal endophthalmitis were asymptomatic or identified by screening, further supporting current Academy candidemia screening guidelines.
Asunto(s)
Candidemia , Endoftalmitis , Infecciones Fúngicas del Ojo , Humanos , Antifúngicos/uso terapéutico , Hongos , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Estudios Retrospectivos , Estudios de Casos y Controles , Vitrectomía/efectos adversos , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Inyecciones IntravítreasRESUMEN
BACKGROUND: Infectious diseases and ophthalmology professional societies have disagreed regarding ocular screening in patients with candidemia. We aimed to summarize the current evidence on the prevalence of ocular candidiasis (OC) and Candida endophthalmitis (CE) according to the standardized definitions. METHODS: A literature search was conducted from the inception date through 16 October 2022 using PubMed, Embase, and SCOPUS. Pooled prevalence of ocular complications was derived from generalized linear mixed models (PROSPERO CRD42022326610). RESULTS: A total of 70 and 35 studies were included in the meta-analysis for OC and concordant CE (chorioretinitis with vitreous involvement), respectively. This study represented 8599 patients with candidemia who underwent ophthalmologic examination. Pooled prevalences (95% CI) of OC, overall CE, concordant CE, and discordant CE were 10.7% (8.4-13.5%), 3.1% (2.1-4.5%), 1.8% (1.3-2.6%), and 7.4% (4.5-12%) of patients screened, respectively. Studies from Asian countries had significantly higher concordant CE prevalence (95% CI) of patients screened (3.6%; 2.9-4.6%) compared with studies from European countries (1.4%; .4-5%) and American countries (1.4%; .9-2.2%) (P <.01). Presence of total parenteral nutrition and Candida albicans was associated with CE, with pooled odds ratios (95% CI) of 6.92 (3.58-13.36) and 3.02 (1.67-5.46), respectively. CONCLUSIONS: Prevalence of concordant CE overall and among Asian countries was 2 and 4 times higher than the prevalence previously reported by the American Academy of Ophthalmology (AAO) of <0.9%, respectively. There is an urgent need to study optimal screening protocols and to establish joint recommendations by the Infectious Diseases Society of America and AAO.
Asunto(s)
Candidemia , Candidiasis , Endoftalmitis , Infecciones Fúngicas del Ojo , Humanos , Candidemia/complicaciones , Prevalencia , Candidiasis/diagnóstico , Candida albicans , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/etiología , Endoftalmitis/epidemiología , Endoftalmitis/diagnósticoRESUMEN
A ocorrência das infecções do trato urinário (ITU) causadas por leveduras do gênero Candida estão aumentando consideravelmente nas últimas décadas, sendo a Candida albicans a mais comumente diagnosticada como causadora deste tipo de infecções. Contudo, outras espécies, como exemplo da Candida tropicalis, estão emergindo como preocupantes causadores da doença. Neste sentido, o objetivo do presente trabalho é revisar os aspectos relacionados com as ITU causadas por leveduras do gênero Candida. Foi realizada uma pesquisa na base de dados PubMed, buscando artigos sobre a epidemiologia, patogenia e tratamento das ITU causadas por leveduras do gênero Candida. As espécies de Candida são os fungos patogênicos oportunistas mais relevantes causadores de infecções nosocomiais e podem causar infecção no trato urinário, tanto inferior (ureteres, bexiga e uretra) quanto superior (rins), principalmente em pacientes imunocomprometidos. Existem alguns fatores predisponentes, como gênero feminino, idade avançada, diabetes mellitus, hospitalização prolongada, imunossupressão, gravidez, hipertensão, neutropenia, cálculos renais, infecções nosocomiais, terapia antibiótica e procedimentos, como a cateterização, que atuam como facilitadores das ITU por Candida spp. A doença pode ocorrer de forma assintomática, porém, pode evoluir para casos mais graves com comprometimento sistêmico em situações de candidemia que pode causar a morte do paciente, principalmente se tratando de indivíduos imunocomprometidos. Sendo assim, devido ao risco existente, a doença não pode ser negligenciada e um diagnóstico preciso e um tratamento adequado devem ser estabelecidos.
The occurrence of urinary tract infections (UTI) caused by yeasts of the genus Candida has increased considerably in recent decades, with Candida albicans being the most commonly diagnosed as causing this type of infections. However, other species, such as Candida tropicalis, are emerging as worrisome causes of the disease. In this sense, the objective of the present paper is to review the aspects related to the UTI caused by yeasts of the genus Candida. A search was carried out in the PubMed database, searching for articles on the epidemiology, pathogenesis and treatment of UTI caused by yeasts of the genus Candida. Candida species are the most relevant opportunistic pathogenic fungi that cause nosocomial infections and can cause both lower (ureters, bladder and urethra) and upper (kidneys) urinary tract infections, especially in immunocompromised patients. There are some predisposing factors, such as female gender, advanced age, diabetes mellitus, prolonged hospitalization, immunosuppression, pregnancy, hypertension, neutropenia, kidney stones, nosocomial infections, antibiotic therapy and procedures, such as catheterization, that act as facilitators of UTI by Candida spp. The disease can occur asymptomatically, however, it can progress to more severe cases with systemic involvement in situations of candidemia that can cause the death of the patient, especially in immunocompromised individuals. Therefore, due to the existing risk, the disease cannot be neglected and an accurate diagnosis and adequate treatment must be established.
La aparición de infecciones del tracto urinario (ITU) causadas por levaduras del género Candida ha aumentado considerablemente en las últimas décadas. Candida albicans es la infección por levaduras más comúnmente diagnosticada. Sin embargo, otras especies, como la Candida tropicalis, están surgiendo como causa preocupante de la enfermedad. En este sentido, el objetivo del presente trabajo es revisar los aspectos relacionados con la ITU causada por levaduras del género Candida. Se realizó una búsqueda en la base de datos PubMed, buscando artículos sobre la epidemiología, la patogénesis y el tratamiento de la ITU causada por levaduras del género Candida. Las especies de Candida son los hongos patógenos oportunistas más relevantes que causan infecciones nosocomiales y pueden provocar infecciones del tracto urinario inferior (uréteres, vejiga y uretra) y superior (riñones), especialmente en pacientes inmunodeprimidos. Existen algunos factores predisponentes, como el sexo femenino, la edad avanzada, la diabetes mellitus, la hospitalización prolongada, la inmunosupresión, el embarazo, la hipertensión, la neutropenia, los cálculos renales, las infecciones nosocomiales, la terapia con antibióticos y los procedimientos como el cateterismo, que actúan como facilitadores de la ITU por Candida spp. La enfermedad puede presentarse de forma asintomática, pero puede evolucionar a casos más graves con afectación sistémica en situaciones de candidemia que pueden causar la muerte del paciente, especialmente en individuos inmunodeprimidos. Por lo tanto, debido al riesgo existente, no se puede descuidar la enfermedad y se debe establecer un diagnóstico preciso y un tratamiento adecuado.
Asunto(s)
Infecciones Urinarias/complicaciones , Candida albicans/patogenicidad , Candida tropicalis/patogenicidad , Pielonefritis/complicaciones , Sistema Urinario/lesiones , Infección Hospitalaria/complicaciones , Epidemiología/estadística & datos numéricos , Huésped Inmunocomprometido/fisiología , Biopelículas , Cistitis/complicaciones , Candidemia/complicaciones , HospitalizaciónRESUMEN
Ocular candidiasis (OC) complicates approximately 10% of candidemia and carries potentially severe morbidity. There are conflicting recommendations about the need for routine funduscopic examinations of candidemic patients. Indirect funduscopy is accurate and safe in diagnosing OC, and positive findings change recommended treatment. However, conclusive evidence that treatment changes improve outcomes is lacking. Bringing perspectives as infectious diseases physicians and ophthalmologists, we review controversies about OC and endorse routine screening during candidemia. We acknowledge difficulties in obtaining inpatient ophthalmologic consults and recommend studies to evaluate digital fundus photography and teleophthalmology as an alternative to funduscopic examinations by ophthalmologists in asymptomatic patients.
Asunto(s)
Candidemia , Candidiasis , Endoftalmitis , Infecciones Fúngicas del Ojo , Oftalmología , Telemedicina , Candidemia/complicaciones , Candidemia/diagnóstico , Candidemia/tratamiento farmacológico , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Endoftalmitis/diagnóstico , Infecciones Fúngicas del Ojo/complicaciones , Infecciones Fúngicas del Ojo/diagnóstico , HumanosRESUMEN
BACKGROUND: Critically ill COVID-19 patients have a high risk for the development of candidemia due to being exposed to both well-defined classical risk factors and COVID-19-specific risk factors in ICU. OBJECTIVES: In this study, we investigated the incidence of candidemia in critically COVID-19 patients, and the independent risk factors for candidemia. PATIENTS/METHODS: COVID-19 patients hospitalised in ICU during 1-year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID-19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded. RESULTS: Of 1229 COVID-19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8-12.2, p < .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4-5.2, p < .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08-3-37, p < .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1-0.9, p < .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14-0.52, p < .0001) were significantly associated with candidemia. CONCLUSIONS: Our study filled the knowledge gap in the literature about the impact of COVID-19-associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID-19 patients should be confirmed by further studies.
Asunto(s)
COVID-19 , Candidemia , Corticoesteroides/efectos adversos , Antifúngicos/uso terapéutico , COVID-19/complicaciones , COVID-19/epidemiología , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Candidemia/epidemiología , Enfermedad Crítica , Humanos , Incidencia , Unidades de Cuidados Intensivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Candidemia and Candida-associated catheter-related bloodstream infections (CRBSIs) are the significant cause of mortality and morbidity in patients with malignancy. METHODS: A retrospective analysis including all pediatric hematologic/oncologic malignancies patients with CRBSIs treated in Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital between the period of 2009 and 2020. RESULTS: During the study period, 53 children with CRBSIs associated with Candida species were included. The most common malignancy was acute lymphoblastic leukemia (45.3%) and acute myeloid leukemia (15.1%). A total of 56 Candida isolates were present including non-albicans Candida species (80.4%) and Candida albicans (19.6%). The most common isolated Candida species was Candida parapsilosis (42.9%) and followed by C. albicans (19.6%). The ratio of azole prophylaxis was significantly higher in patients with the non-albicans Candida group (P=0.031). Candida-related endocarditis (vegetation) was present in 2 (3.8%) patients, and the overall rate of hepatosplenic candidiasis was 3.8%. Seven days Candida attributable mortality was 7.5% (4 patients) and 30 days Candida attributable mortality was 11.3% (6 patients). The Candida species responsible for the Candida-related deaths were as following: Candida tropicalis (n=3), C. parapsilosis (n=2), and C. lusitanae (n=1). CONCLUSION: In pediatric cancer patients with Candida-associated CRBSIs, evaluation of the patient for organ involvement including liver and spleen ultrasonography and cardiac involvement with echocardiography are essential regardless of the patients' clinical picture.
Asunto(s)
Candidemia , Candidiasis , Hematología , Neoplasias , Antifúngicos/uso terapéutico , Candida , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Candidemia/epidemiología , Candidiasis/complicaciones , Candidiasis/etiología , Catéteres , Niño , Humanos , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Patients with severe coronavirus disease-2019 (COVID-19) are susceptible to superimposed infections. OBJECTIVES: To describe COVID-19 patients who presented with complications due to Candida bloodstream co-infection (candidemia) and their outcome in a single center in northern Israel (Emek Medical Center) during the second outbreak of COVID-19 in Israel (15 June 2020 to 20 September 2020). METHODS: A retrospective study of COVID-19 patients presenting with candidemia was conducted, including clinical and laboratory data. The incidence of candidemia among hospitalized COVID-19 patients was compared to a historical cohort of non-COVID-19 controls. RESULTS: Three COVID-19 patients complicated with candidemia were documented. All three patients died shortly after the detection of candidemia. Three different Candida sp. were isolated from the blood cultures: C. albicans, C. parapsilosis, and C. glabrata. The incidence of candidemia among COVID-19 patients was 0.679 episodes per 1000 hospital days. CONCLUSIONS: Our small sample suggests a much higher incidence of candidemia among COVID-19 patients compared to a historical cohort of non-COVID-19 controls. All clinicians treating COVID-19 patients in GICU should be aware of this complication.
Asunto(s)
COVID-19 , Candida/aislamiento & purificación , Candidemia , Caspofungina/administración & dosificación , Coinfección , Infección Hospitalaria , Anciano , Antifúngicos/administración & dosificación , COVID-19/complicaciones , COVID-19/fisiopatología , COVID-19/terapia , Candidemia/complicaciones , Candidemia/diagnóstico , Candidemia/tratamiento farmacológico , Cateterismo Venoso Central/métodos , Coinfección/diagnóstico , Coinfección/microbiología , Coinfección/terapia , Cuidados Críticos/métodos , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Infección Hospitalaria/terapia , Resultado Fatal , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Respiración Artificial/métodos , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID-19 patients. METHODS: From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID-19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. RESULTS: Five critically ill COVID-19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad-spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30-day mortality was 80%. The five T asahii strains from the COVID-19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross-transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. CONCLUSIONS: Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID-19 patients to prevent infections by hard-to-treat fungi like T asahii.
Asunto(s)
Corticoesteroides/administración & dosificación , Antifúngicos/administración & dosificación , Basidiomycota/aislamiento & purificación , COVID-19/complicaciones , Sobreinfección/complicaciones , Tricosporonosis/complicaciones , Corticoesteroides/farmacología , Anciano , Antifúngicos/farmacología , Basidiomycota/clasificación , Basidiomycota/efectos de los fármacos , Basidiomycota/genética , Brasil/epidemiología , COVID-19/epidemiología , Candidemia/complicaciones , Femenino , Fungemia/complicaciones , Haplotipos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Filogenia , Factores de Riesgo , Sobreinfección/epidemiología , Tricosporonosis/epidemiologíaRESUMEN
INTRODUCTION: Critically ill COVID-19 patients are at high risk for nosocomial bacterial and fungal infections due to several predisposing factors such as intensive care unit stay, mechanical ventilation, and broad-spectrum antibiotics. Data regarding multidrug resistant (MDR) Candida species in COVID-19 patients is scarce, and nonexistent regarding Candida duobushaemulonii superinfections. CASE DESCRIPTION: A 34-year-old male presented to our institution with acute respiratory distress syndrome (ARDS) due to COVID-19 infection and developed Candida duobushaemulonii fungemia after multiple courses of antibiotics and prolonged mechanical ventilation. He died after recurrent pneumothorax led to respiratory failure and cardiac arrest. DISCUSSION: Bacterial and fungal infections are common complications of viral pneumonia in critically ill patients. Data regarding these infections in COVID-19 patients has been poorly studied with only a few cases reporting secondary infection, mostly without identifying specific pathogens. Prolonged hospital stays, invasive interventions (central venous catheter, mechanical ventilation), and the use of broad-spectrum antibiotics in COVID-19 infections could carry a high risk of bacterial and/or fungal superinfections. CONCLUSION: Strategies to improve outcome in COVID-19 ICU patients should include early recognition of candidemia and appropriate antifungal therapy.
Asunto(s)
COVID-19/complicaciones , Candidemia/tratamiento farmacológico , Sobreinfección/tratamiento farmacológico , Adulto , Antifúngicos/uso terapéutico , Candida , Candidemia/complicaciones , Resultado Fatal , Humanos , Masculino , Respiración Artificial , Síndrome de Dificultad Respiratoria , Saccharomycetales , Sobreinfección/complicacionesRESUMEN
BACKGROUND: Recently, several scores to quantify compliance with the guidelines in candidaemia management (EQUAL, GEMICOMED, Valerio) have been developed. Evidence supporting the association of these scores to the prognosis is scarce. We aim to evaluate the performance of these candidaemia guideline adherence scores to predict candidaemia outcome. METHODS: We recorded retrospectively data from candidaemia episodes (January 2017-December 2018). We analysed adherence to guidelines for candidaemia management according to EQUAL, GEMICOMED and Valerio scores, and we correlated those to outcome. RESULTS: Fifty-four first episodes of candidaemia were retrieved. Five patients who died in the first 48 hours after blood cultures were not included. Thirty-day mortality in evaluable patients was 18.4%. Median adherence to guidelines according to EQUAL score was 17 (interquartile range [IQR]: 15-19), and according to GEMICOMED was 86% (IQR: 72.5%-100%). According to Valerio score, adequacy of antifungal prescription was 8.5/10 (SD: 1.9). A cut-off of ≥17 for EQUAL or compliance >70% for GEMICOMED was associated with inferior 30-day mortality (7.1% vs 33.3%, P = .028 and 7.9% vs 54.5%, P = .002, respectively). Infectious diseases (ID) evaluated cases obtained a better EQUAL score (>17; 82.1% vs 42.9%, P = .006), had inferior 30-day mortality (9.4% vs 35.3%, P = .049) and a better antifungal prescription adequacy (Valerio score 9.0 vs 7.5, P = .011). CONCLUSION: Adherence to guidelines for candidaemia management evaluated by means of EQUAL and GEMICOMED score was associated with a decreased 30-day mortality. Adequacy of antifungal prescription can be ameliorated. ID consultation improved guideline adherence and was associated with decreased 30-day mortality.
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Candidemia , Adhesión a Directriz , Anciano , Antifúngicos/uso terapéutico , Candida/efectos de los fármacos , Candida/patogenicidad , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Enfermedades Transmisibles/complicaciones , Enfermedades Transmisibles/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Pronóstico , Calidad de la Atención de Salud , Derivación y Consulta , Estudios Retrospectivos , España/epidemiologíaRESUMEN
RATIONALE: Bacterial and fungal infections in Coronavirus Disease-19 (COVID-19) patients have been inadequately investigated and reported thus far. The safety profile of tocilizumab (TCZ) administration in candidemia patient still debatable. PATIENT CONCERNS: A 54 year-old woman presenting with weakness on the left side of her body was diagnosed with COVID-19. After 7âdays of admission, her condition worsened and developed respiratory distress and was having respiratory distress despite standard treatment. DIAGNOSES: Acute respiratory distress syndrome (ARDS) in COVID 19 was diagnoses based on real time-PCR swab, deterioration of PaO2/FiO2 and increased of acute phase reactants. INTERVENTIONS: Anti Interleukin-6 (IL-6) was considered to tackle her inflammatory condition. Prior to TCZ administration, blood culture was performed and the result came with Candida tropicalis in the absence of bacterial growth. OUTCOMES: No major complications associated with intravenous antifungal or TCZ occurred. After 40âdays of hospitalization, the patient's clinical condition improved and was finally discharged. LESSONS: This case underscores the safety profile of giving TCZ in candidemia as a secondary infection in severe COVID-19 patient.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Antifúngicos/uso terapéutico , Tratamiento Farmacológico de COVID-19 , COVID-19/complicaciones , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Interleucina-6/antagonistas & inhibidores , Anticuerpos Monoclonales Humanizados/efectos adversos , Candida tropicalis , Coinfección , Femenino , Humanos , Micafungina/uso terapéutico , Persona de Mediana Edad , SARS-CoV-2RESUMEN
We analyzed 19 cases of breakthrough candidemia from a referral pediatric cancer center in Brazil. All patients had neutropenia and were under antifungal prophylactic regimens, mostly micafungin (68%). Most of the patients were treated with amphotericin B formulations and 30-day mortality was 21%. Candida parapsilosis was the main etiologic agent (63%), and horizontal transmission was not evidenced by microsatellite analysis.
Asunto(s)
Antifúngicos/uso terapéutico , Candidemia/complicaciones , Neoplasias/complicaciones , Brasil , Candida/clasificación , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Niño , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: Endogenous fungal endophthalmitis (EFE) is a critical complication of candidemia. We conducted a study to investigate the prevalence and risk factors for EFE. METHODS: Adult candidemia patients≥19years who underwent an ophthalmological examination at a tertiary care hospital in the Republic of Korea from 2006 to 2018 were enrolled. RESULTS: There was a total of 152 adult candidemia patients analyzed. EFE was found in 29 patients (19.1%). Patients were categorized into two groups (Non-endophthalmitis [NE] and endophthalmitis [E]). Between the two groups, there was no significant difference in terms of age, sex, and underlying comorbidities. However, there were more Candida albicans candidemia, abnormal alanine aminotransferase (ALT) at the time of candidemia diagnosis, receipt of antifungal treatment≥48hours after onset of candidemia symptoms and blood culture sample (AOCS), and candidemia clearance≥5days after initiation of antifungal treatment (AIAT) in the E group. A predictive model for the E was created, which had an area of 0.811 under the receiver operating characteristics curve. In a multivariate logistic regression analysis, C. albicans candidemia, ALT at the time of candidemia diagnosis, receipt of antifungal treatment≥48hours AOCS, and candidemia clearance≥5days AIAT were significantly associated with EFE. CONCLUSION: EFE occurred in 19% of adult patients with candidemia. Adult candidemia patients with C. albicans candidemia, abnormal ALT, receipt of antifungal treatment≥48hours AOCS, and candidemia clearance≥5days AIAT need to be closely monitored for the possibility of EFE.
Asunto(s)
Candidemia/epidemiología , Infecciones Fúngicas del Ojo/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Anciano , Antifúngicos/uso terapéutico , Candidemia/complicaciones , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , República de Corea , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Introducción: las infecciones por cándida en el ámbito intrahospitalario han ido en ascenso en las últimas décadas en especial en las unidades de cuidado intensivo (UCI), dado el uso cada vez más frecuente de antibióticos de amplio espectro y de procedimientos invasivos tanto diagnósticos como terapéuticos. Hoy se consideran las especies de cándida como la cuarta causa de infección del torrente sanguíneo en los Estados Unidos de Norteamérica, con alto riesgo de complicaciones que incluyen endocarditis, trombosis y embolismo séptico al sistema nervioso central (SNC) entre otros. En relación con la endocarditis por especies de cándida, se ha considerado de mal pronóstico por el alto riesgo de afectación al SNC, por lo que se ha recomendado el manejo quirúrgico como piedra angular de su tratamiento. Presentación del caso: se describe el caso clínico de un paciente con endocarditis y con candidemia por Candida parapsilosis a quien se le realizó manejo médico.
Nosocomial Candida infections have increased in the last decades particularly in the intensive care units (ICU) due to the rise in broad-spectrum antibiotics usage and invasive diagnostic and therapeutic procedures usage. Today, Candida species are recognized as the fourth causative organisms of endovascular infection in the United States of America posing a high risk of endocarditis, thrombosis and septic embolization to the central nervous system (CNS). Endocarditis due to Candida species is associated with a poor prognosis because of the increased risk of CNS involvement for which surgical approach has been recommended as the cornerstone of therapy. We hereby report a patient with endocarditis and candidemia due to Candida parapsilosis, who received medical management.
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Humanos , Masculino , Anciano , Endocarditis/microbiología , Candidemia/complicaciones , Candida parapsilosis/aislamiento & purificación , Enfermedades de las Válvulas Cardíacas/microbiología , Endocarditis/terapia , Candidemia/terapia , Enfermedades de las Válvulas Cardíacas/terapiaRESUMEN
Background: In the past years, saprophytic bacteria and candida have been emerging as potential human pathogens causing life-threatening infections in patients with cancer. This study was designed to determine the bacteria and candida species, causing bloodstream infections in cancer patients and the assessment of their susceptibility to antibiotics and biosynthesised silver nanoparticles. Materials and Methods: Ninety-seven microbial pathogens recovered from blood samples of cancer patients were included in the present study. The microbial isolates were collected in a duration period extending from December 2016 to July 2018 at National Cancer Institute, Cairo, Egypt. The clinical samples were collected using microbiological methods and were cultivated on MacConkey agar, blood agar media and Sabouraud dextrose agar media. The microbial isolates were identified using both standard microbiological methods and VITEK 2 compact automated system. The antibiotic resistance pattern was determined by the VITEK 2 compact automatic system and disk diffusion method, according to the Clinical and Laboratory Standards Institute. The characterisation of nanoparticles was carried out using ultraviolet spectroscopy and electron microscope. The antimicrobial activity of bio (AgNPs) was evaluated. Results: A total of 97 microbial isolates recovered from collected blood samples from cancer patients were included in the study. Pathogenic bacteria and Candida were represented by 74 isolates (76.22%) and 23 isolates (23.69), respectively. Among the 74 bacterial isolates, Escherichia coli constituted (27.81%), Klebsiella pneumoniae (24.72%), Acinetobacter baummannii (11.33%), Pseudomonas aeruginosa (4.12%), Enterobacter spp. (3.09%) and) Staphylococcus aureus (2.06%). Cedecea davisae (1.03%), Burkholderia cepacia (1.03%) and Pantoea agglomerans (1.03%). Among the 23 Candida isolates, Candida tropicalis constituted (9.27%), Candida albicans (5.15%), Candida glabrata (5.15%) and Candida krusei (4.12%) from the total microbial isolates. The antibiotic susceptibility results revealed that amikacin and gentamycin were the most effective antibiotics against Gram-negative bacteria, while vancomycin and linezolid were most effective against S. aureus. Caspofungin was the most effective against candida species. The obtained stable biosynthesised silver nanoparticles ranged in size from 10 nm to 100 nm and were mostly spherical in shape. These biosilver nanoparticles showed the highest antimicrobial activity against most of the microbial isolates (bacteria and Candida). The in vitro cytotoxicity of biosynthesised AgNPs on HeLa cell lines revealed a dose-dependent potential. The IC50 value of AgNPs was found 6 and 5.6 µg/ml, respectively. Conclusion: The present study revealed a significant distribution of multidrug-resistant microbes, which may increase the burden of healthcare to prevent infections in cancer patients. Biosilver nanoparticles exhibit antimicrobial activity against multidrug-resistant microbes and could be considered as effective agents against these strains.
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Bacteriemia/microbiología , Bacterias/efectos de los fármacos , Candida/efectos de los fármacos , Candidemia/microbiología , Nanopartículas del Metal/uso terapéutico , Neoplasias/complicaciones , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Resistencia a Múltiples Medicamentos , Femenino , Humanos , Masculino , PlataRESUMEN
Objective: To investigate the clinical feature, diagnosis, treatment and prognosis of childhood acute lymphoblastic leukemia (ALL) complicated with candida tropicalis bloodstream infection (CTBI), so as to improve the understanding of this disease. Methods: The general information, clinical manifestation, auxiliary examination, treatment and outcome of 14 childhood ALL who were diagnosed with tropical candidemia between January 2015 and December 2018 in 6 hospitals were analyzed retrospectively. Clinical data of non invasive fungal disease (IFD) ALL (28 cases) and other IFD children (9 cases) admitted in the same period were collected as control group. Logistic regression model was used to analyze the risk factor of CTBI. Results: Among 14 cases, there were 7 males and 7 females, with the age ranged from 17 months to 13 years. All the cases had fever, 9 cases had digestive system symptoms and stool fungal culture were positive in 3 of them; 7 cases had respiratory system symptoms and sputum fungal culture was positive in 1 of them; 2 cases had central nervous system symptoms and 10 cases progressed into septic shock. All 14 cases had neutropenia and the neutropenia duration was 1 to 53 days. Among 14 cases, the C-reactive protein was>50 mg/L in 8 cases, in which the proportion was significantly higher than that in other invasive fungal disease(IFD) (8/14 vs. 1/9, P<0.05), meanwhile the 1, 3-ß-D-glucan detection, galactomannan detection and pulmonary imaging were not remarkable in all 14 cases. The blood culture results of 14 cases were all candida tropicalis, among which 13 cases finished drug susceptibility tests, the isolates of all cases were sensitive to flucytosine and amphotericin B, and the isolates of 4 cases were sensitive to fluconazole, voriconazole and itraconazole. Among 14 cases, 1 case lost to follow-up after giving up treatment, 1 case died before antifungal therapy and the remaining 12 cases received antifungal therapy; 7 of the 14 cases died. Univariate analysis showed that between ALL with CTBI group (14 cases) and ALL without invasive fungal disease (IFD) group (28 cases), the differences in variables such as ALL not in remission (χ²=37.847, P<0.01), length of hospital stay>15 days (χ2=8.351, P=0.004), neutropenia (χ²=14.280, P<0.01), neutropenia duration>10 days (χ²=10.254, P=0.001), use of broad-spectrum antibiotics (χ²=13.888, P<0.01), skin and mucous membrane damage (χ²= 5.923, P=0.015) were statistically significant. Conclusions: In childhood ALL complicated with tropical candidemia, the drug resistance rate and mortality rate were high. For azole-resistant tropical candida, amphotericin B liposome or echinocandins(caspofungin) -fluorocytosine combined therapy was recommended to reduce treatment-related deaths.
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Candidemia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Adolescente , Antifúngicos/uso terapéutico , Candida , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
A wide range of neurological complications of coronavirus disease 2019 (COVID-19) is increasingly recognised. Although the majority of these remain ischaemic and haemorrhagic events, various disorders are being reported. In particular, several cases of diffuse acute leukoencephalopathy have been observed in critically ill patients with COVID-19 disease. We report the case of a 59-year-old man with multiple comorbidities and severe COVID-19 pneumonia who developed a diffuse leukoencephalopathy with microhaemorrhages and extensive associated white matter necrosis. Although this is the first documented case of extensive COVID-19-associated white matter necrosis, we highlight the relatively constant features of this injury similar to previously reported cases, including symmetrical involvement of the supratentorial white matter, sparing of the peripheral subcortical regions except in the precentral gyri, frequently associated microhaemorrhages, relative sparing of the deep gray matter structures and infratentorial structures, and lack of enhancement.
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Encéfalo/diagnóstico por imagen , COVID-19/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Leucoencefalopatías/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Bacteriemia/complicaciones , COVID-19/complicaciones , COVID-19/fisiopatología , Candidemia/complicaciones , Hemorragia Cerebral/etiología , Diabetes Mellitus , Humanos , Hipertensión/complicaciones , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Leucoencefalopatías/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis , Diálisis Renal , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Sustancia Blanca/patologíaRESUMEN
BACKGROUND: Delayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients. METHODS: A matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia. RESULTS: The 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p < 0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421-3.217, p < 0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719-0.890, p < 0.001), with a sensitivity and specificity of 72.9 and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group. CONCLUSIONS: DNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.
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Candidemia/diagnóstico , Neutrófilos/citología , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Candida/aislamiento & purificación , Candidemia/complicaciones , Candidemia/microbiología , Candidemia/mortalidad , Estudios de Casos y Controles , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Neutrófilos/metabolismo , Oportunidad Relativa , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Análisis de Supervivencia , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnósticoRESUMEN
BACKGROUND: Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. METHODS: A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). RESULTS: Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02). CONCLUSIONS: Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.