Candidemia

Candidemia General Information

This disease is considered to be the isolation of Candida from blood specimens (one or more). Candidemia is a disease that can be characterized by the presence of yeasts or fungi (Candida) in the blood stream. This is why it is also known as fungemia, invasive candidiasis or candedemia. This disease is very common among oncology patients, immunocompromised or immunosuppressed patients that suffer of severe neutropenia, babies with a low weight at birth or patients with intravenous catheters. A higher risk of developing Candidemia is also present in the case of immunocompetent patients who take infliximab. The most known pathogen is Candida albicans that is responsible with more than 60% of cases. Candida albicans is a genus of yeasts and a member of gut flora in animals that leads to the appearance of many infections in some animals and in humans, known as thrush or candidiasis. Candidemia is the fourth most common infection of the blood stream in hospitalized persons in the USA. Studies found that 10 persons of 100,000 per year get infected with the disorder. The very common cause of this disease is the infection from a vascular catheter. Once the catheter is removed, an amelioration of the patient’s health state can be noticed because the primary infection is at the place of the fibrin clot that appears around the catheter or even of the catheter itself. But the infection is gone only after a treatment. There are some cases where the disease resolved well without therapy. In the last decades it has become a very important nosocomial infection. The morbidity and mortality rates are big and this is why all patients suffering of this illness must follow a treatment.

Candidemia Symptoms

The signs symptoms of Candidemia are not very specific. The most common symptoms are considered to be fever and chills, which do not improve after therapy with antibiotics. If the infection spreads to the internal organs such as kidneys, liver, bones, muscles, joints, spleen, or eyes, there are other specific signs and symptoms that can develop, and usually they vary depending on the site of the infection. If the infection resists to the treatment, the patient’s organs can fail and lead to the individual’s death. Other signs and symptoms can include severe itching, burning, and soreness, irritation of the vagina and vulva, in female patient cases, and a whitish or whitish-gray discharge, often with a curd-like appearance. In male patient cases, symptoms can include red patchy sores in the head of the penis area or on the foreskin, with severe itching and a burning sensation. If patients have no signs and symptoms at all a more chronic stage of the symptoms can develop later. When Candidemia affects the skin, the symptoms appear as a red flat rash with sharp scalloped edges. In some cases, there are smaller patches of similar appearing rash in the surrounding area, called satellite lesions. These rashes can cause itching or pain. If Candidemia gets into the patient’s bloodstream, he or she can become sick with or without fever symptoms. If the infection gets to the brain, the patient can have small changes in mental function or behavior. Oral infection of the disease is known as thrush with symptoms such as thick, white lacy patches on top of a red base can develop on the tongue, palate, or elsewhere in the mouth.

Candidemia Treatment

Usually, Candidemia is diagnosed after samples of infected tissue are examined under the microscope or by culture of tissues or blood. But diagnosing this disease can be really complicated because the routine cultures of blood have very poor sensitivity. It is highly important that Candidemia is correctly diagnosed because no matter how the infection occurred it spreads throughout the body. As soon as the diagnosis is established, the health care provider must proceed with the adequate treatment depending on the stage of the disease. Because the mortality rate is around 30%, any treatment is recommended to be prompt and adequate for better results and a bigger efficiency. The proper therapy is based on two fundamental elements. One of them is the exact source of Candidemia that should be first identified and treated if the doctors can. If a non-neutropenic patient gets Candidemia, then the likely source of the infection is an intravascular catheter that should be immediately removed.

Localized infections and the urinary tract are possible sources that are quite common. In these cases, the first step is to treat the local conditions at these places, such as draining an abscess or eliminating urinary obstruction. Another fundamental element is the antifungal agent that it is useful to be employed. Antifungal drugs are medicines used in therapies against fungal infections and are usually purchased over the counter or obtained by a prescription of a doctor. These drugs can be found in antidandruff shampoos and some more common examples are: selenium sulfide, pyrithione zinc and ketoconazole. The patients in a critical situation are treated only with two of these antifungal agents, fluconazole and amphotericin B. Only these two are readily available in the parentral formulas. Studies showed that these agents can be generally comparable after scientists tested the relative utility of them, mostly in the case of non-neutropenic patients with C. albicans fungemia. Flucanazole (INN) is a triazole (azole) drug prescribed against systemic and superficial fungal infections and it is used to prevent them. It is sold under the trade names Pfizer (Trican) and Diflucan. Also, fluconazole is used against other microorganisms, for example: trichophyton, Cryptococcus neoformans, blastomyces dermatitidis, microsporum, coccidioides immitis, histoplasma capsulatum, and epidermophyton. Usually, fluconazole increases the drug concentration that is metabolized by the humane enzymes and lowers the metabolism. It also inhibits cytochrome P450 system of the human organism, especially two isozymes, CYP3A4 and CYP2C9. This drug is given either intravenously or orally, taken by mouth and it is also very suitable as an alternative therapy. Amphotericin B represents a polyene drug with antifungal action that is often given intravenously (IV, in the vein) especially in the cases of systemic fungal infections. This drug is very effective and it is considered to be a reliable therapy because it is not that toxic.. Nowadays, more recent forms of therapy are the intravenous combinations of itraconazole that are intensively tested as a therapy against Candidemia, but nothing is known for sure so that there no data is available on how it can be used. Its exact role is not yet established because its microbiological anti-Candida spectrum is not that extended. It is believed that this drug could give the option of another way for therapies.