Giới thiệu
- Infections caused by Candida sp are major contributors to morbidity and mortality causing a diverse spectrum of clinical diseases that ranges from superficial and mucosal infections to invasive disease associated with candidemia and metastatic organ involvement
- Most common pathogens of invasive candidiasis are Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis complex, and Candida krusei
- 70-80% of invasive candidiasis are due to C albicans and C glabrata
- In Asia, C albicans is the most common infecting pathogen, followed by C tropicalis
- An emerging multidrug-resistant C auris has been described recently
Definition
Candidemia
- The isolation of Candida sp from ≥1 blood culture (BC) specimen
- Deep seated candidiasis may occur with or without candidemia
Endophthalmitis
- Infections within the eye can be:
- Exogenous if affecting the anterior chamber of the eye that occur following trauma or surgical procedure
- Endogenous is when candida infection reaches the posterior chamber of the eye via hematogenous spread; it can be manifested as chorioretinitis with or without extension into the vitreous leading to vitritis
- 90% of cases of endogenous endophthalmitis are due to C albicans
Pulmonary
- Can occur in 2 forms:
- Can either be local or diffuse bronchopneumonia originating from endobronchial inoculation of the lungs
- Hematogenous seeding, finely nodular, diffuse infiltration
Yếu tố nguy cơ
Candidemia
- The following factors predispose to the condition:
- Abdominal surgery
- Neutropenia
- Broad-spectrum antibiotics
- Indwelling intravenous (IV) catheters
- Peripheral alimentation
- Cancer chemotherapy
- Immunosuppressive therapy in transplant patients
- Intensive care unit admission
- Colonization with Candida sp
- Renal failure
Central Nervous System (CNS)
- Most cases occur in the setting of trauma, neurosurgery, immunosuppression or acquired immunodeficiency syndrome (AIDS)
Chronic Disseminated (Hepatosplenic)
- Most infections occur in severely immunocompromised patients and manifest during their recovery from neutropenia
Endocarditis
- Candidal endocarditis is associated with the following factors:
- Underlying valvular heart disease
- Heroin addiction
- Cancer chemotherapy
- Implantation of prosthetic valves
- Prolonged use of IV catheters
- Preexisting bacterial endocarditis
Genitourinary Tract (GUT)
- Risk factors:
- Diabetes
- History of previous antibiotic use
- Indwelling urinary catheters
- Immunosuppressive therapy
- Male patients: Urethral candidiasis usually results from sexual contact with women with candida vaginitis
- Female patients: Urethral candidiasis infection may be acquired from the extension of candida vaginitis
Infection of the Vasculature
- Often occurs in association with IV catheters
Musculoskeletal
- Often involves the joints (eg knee, vertebral column) due to trauma, joint injections or other surgical intervention
Peritonitis
- Often a complication of peritoneal dialysis, gastrointestinal tract surgery and perforation of an abdominal viscus
- Prior antibiotic administration is a predisposing factor
Signs and Symptoms
Candidemia
- Clinical features include:
- Fever of unclear etiology
- Sepsis syndrome
- Signs of multiple organ involvement including the kidney, brain, myocardium and eye
- Macronodular skin lesions
- Endophthalmitis
- Suppurative manifestations ie micro- and macro-abscesses
Central Nervous System (CNS)
- Meningeal irritation (eg headache, stiff neck, irritability)
- In the comatose or non-communicative patient, observation of abnormalities is difficult
Chronic Disseminated (Hepatosplenic)
- Persistent fever, abdominal pain, hepatosplenomegaly, increased alkaline phosphatase levels, leukocytosis
Endocarditis
- Similar to bacterial endocarditis with the exception of the occurrence of large emboli to major vessels and include the following:
- Hepatosplenomegaly
- Hematuria, proteinuria, pyuria
- Splinter hemorrhages
- Osler’s nodes
- Janeway lesions
Endophthalmitis
- Retina has visible white lesions that may progress to vitritis with high risk of vision loss
Genitourinary Tract (GUT)
- Lower urinary tract infection (UTI) (cystitis) is usually asymptomatic but may present with dysuria, hematuria, frequency
Infection of the Vasculature
- In patients with peripheral septic thrombophlebitis, symptoms may be minimal with the extent of the disease being greater than is apparent on initial clinical assessment
- Patient may have fever, signs of sepsis and persistent candidemia
- Suppuration and thrombosis may be present
Musculoskeletal
- Arthritis and osteomyelitis (eg similar to disease of bacterial etiology, includes suppurative synovitis)
Pulmonary
- Fever and cough