View source for Invasive candidiasis

==Background==
* Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley catheter, recent abdominal surgery with anastamotic leak 
* Associated with candidemia with further hematogenous spread to visceral organs (heart, kidney, liver, spleen, eye, brain, skin, joints etc)

==Clinical Features==
* presence of biofilms on catheter
* fever and chills unresponsive to antibiotics 
* chorioretinitis
* muscle abscesses
* skin lesions with satellite pustules

==Differential Diagnosis==

==Evaluation==
* positive blood culture 
* positive culture of blood, tissue, urine from normally sterile sites 
* biopsy of skin lesions for gram staining 
* beta-D-glutan assay can be a diagnostic adjunct to blood cultures and identify systemic fungal infections weeks before positive blood cultures 

==Management<ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>==
* Vascular catheter removal
* 1st line: IV Echinocandins
**[[Caspofungin]] 70mg IV day 1, 50mg IV Qdaily x 14 days following the last positive blood culture
**[[Anidulafungin]] 200mg IV day 1, 100mg IV Qdaily x 14 days following the last positive blood culture
**[[Micafungin]] 100mg IV Qdaily x 15 days 
* Step down therapy: as early as 5 days, can step down to oral if blood stream is clear and patient can tolerate oral regime 
* 2nd line:
**[[Fluconazole]] 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture
**[[Voriconazole]] 400mg (6mg/kg) IV Q12 hours x 2 doses (loading dose), 200mg (3mg/kg) IV Q12 x 14 days following first negative blood culture (maintenance dose)
* Alternative: 
**[[Amphotericin B]] is acceptable but carries a higher toxicity and side-effect profile
**1mg/kg/day IV x 14 days following first negative blood culture

==Disposition==
*Admission

==See Also==
*[[Candidiasis]]

==External Links==

==References==
<references/>

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