Candidiasis

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Additional Notes

  • Fungal species frequently resistant to fluconazole: C. Glabrata and C. Krusei
  • Fungal cultures:
    • Diagnosis is limited by slow turn-around time of fungal cultures both blood and tissue. Positive cultures can take up to 7 days to result. Be sure to have final results before de-escalating.
    • Cultures of tissues or fluid recovered from infected sites during deep-seated candidiasis also exhibit poor sensitivity (often <50%)
    • Have to specifically order fungal cultures in addition to other cultures. The media other cultures are plated on will not necessarily give true results.
  • β-D-glucan assay (Fungitell):
    • True-positive results are not specific for invasive candidiasis, but rather suggest the possibility of an invasive fungal infection. For this reason, among patient populations that are also at risk.
    • The major concern about β-D-glucan detection is the potential for poor specificity and false positivity.
    • Causes of false positivity:
      • Gram-positive and gram-negative bacteremia
      • Certain antibiotics such as intravenous amoxicillin-clavulanate
      • Hemodialysis
      • Fungal colonization
      • Receipt of albumin or immunoglobulin
      • Use of surgical gauze or other material containing glucan
      • Mucositis or other disruptions of gastrointestinal mucosa
    • The specificity of β-D glucan can be improved by requiring consecutive positive results rather than a single result, but false positivity remains a significant limitation.

 

Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.