Invasive candidiasis - Revision history

Neil.m.young: Text replacement - "* " to "*"

2016-10-27T15:37:11Z

Text replacement - "* " to "*"

← Older revision		Revision as of 15:37, 27 October 2016
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	==Background==		==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		*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)		*Associated with candidemia with further hematogenous spread to visceral organs (heart, kidney, liver, spleen, eye, brain, skin, joints etc)

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

	==Differential Diagnosis==		==Differential Diagnosis==

	==Evaluation==		==Evaluation==
	* positive blood culture		*positive blood culture
	* positive culture of blood, tissue, urine from normally sterile sites		*positive culture of blood, tissue, urine from normally sterile sites
	* biopsy of skin lesions for gram staining		*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		*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>==		==Management<ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>==
	* Vascular catheter removal		*Vascular catheter removal
	* 1st line: IV Echinocandins		*1st line: IV Echinocandins
	**[[Caspofungin]] 70mg IV day 1, 50mg IV Qdaily x 14 days following the last positive blood culture		**[[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		**[[Anidulafungin]] 200mg IV day 1, 100mg IV Qdaily x 14 days following the last positive blood culture
	**[[Micafungin]] 100mg IV Qdaily x 15 days		**[[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		**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:		*2nd line:
	**[[Fluconazole]] 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture		**[[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)		**[[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:		*Alternative:
	**[[Amphotericin B]] is acceptable but carries a higher toxicity and side-effect profile		**[[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		**1mg/kg/day IV x 14 days following first negative blood culture

Rossdonaldson1: /* ManagementKullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456. */

2016-09-19T03:57:05Z

ManagementKullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.

← Older revision		Revision as of 03:57, 19 September 2016
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	**[[Anidulafungin]] 200mg IV day 1, 100mg 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		**[[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		** 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:		* 2nd line:
	**[[Fluconazole]] 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture		**[[Fluconazole]] 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture

Rossdonaldson1: /* ManagementKullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456. */

2016-09-19T03:56:30Z

ManagementKullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.

← Older revision		Revision as of 03:56, 19 September 2016
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	==Management<ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>==		==Management<ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>==
	* ~~vascular~~ catheter removal		* Vascular catheter removal
	* 1st line: IV Echinocandins ([[Caspofungin]]~~, [[Anidulafungin]], [[Micafungin]])~~		* 1st line: IV Echinocandins
	**Caspofungin 70mg IV day 1, 50mg IV Qdaily x 14 days following the last positive blood culture		**[[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		**[[Anidulafungin]] 200mg IV day 1, 100mg IV Qdaily x 14 days following the last positive blood culture
	**Micafungin 100mg IV Qdaily x 15 days		**[[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		* 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]]~~, [[Voriconazole]]~~		* 2nd line:
	**Fluconazole 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture		**[[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)		**[[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		* 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		**1mg/kg/day IV x 14 days following first negative blood culture

	==Disposition==		==Disposition==
	*Admission		*Admission

ClaireLewis at 23:13, 10 September 2016

2016-09-10T23:13:11Z

← Older revision		Revision as of 23:13, 10 September 2016
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	==References==		==References==
	<references/>		<references/>

			[[Category:ID]]

Bklee at 23:18, 9 September 2016

2016-09-09T23:18:03Z

← Older revision		Revision as of 23:18, 9 September 2016
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	* vascular catheter removal		* vascular catheter removal
	* 1st line: IV Echinocandins ([[Caspofungin]], [[Anidulafungin]], [[Micafungin]])		* 1st line: IV Echinocandins ([[Caspofungin]], [[Anidulafungin]], [[Micafungin]])
			**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		* 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]], [[Voriconazole]]		* 2nd line: [[Fluconazole]], [[Voriconazole]]
			**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		* 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==		==Disposition==
	*Admission		*Admission

Rossdonaldson1: Created page with "==Background== * Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley cat..."

2016-09-04T13:27:13Z

Created page with "==Background== * Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley cat..."

New page

==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]], [[Anidulafungin]], [[Micafungin]])
* 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]], [[Voriconazole]]
* Alternative: [[Amphotericin B]] is acceptable but carries a higher toxicity and side-effect profile

==Disposition==
*Admission

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

==External Links==

==References==
<references/>