1 / 39

Candidiasis

Candidiasis. Candida sp. albican non-albican : C. glabrata, C . krusei, C . parapsilosis, C . tropicalis, C . parapsilosis. Candida infection. LOCAL MUCOUS MEMBRANE INFECTIONS INVASIVE FOCAL INFECTIONS CANDIDEMIA AND DISSEMINATED CANDIDIASIS. Candida sp.

virgil
Download Presentation

Candidiasis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Candidiasis Downloded from www.pharmacy123.blogfa.com

  2. Candida sp. • albican • non-albican: C. glabrata, C. krusei, C. parapsilosis, C. tropicalis,C. parapsilosis Downloded from www.pharmacy123.blogfa.com

  3. Candida infection • LOCAL MUCOUS MEMBRANE INFECTIONS • INVASIVE FOCAL INFECTIONS • CANDIDEMIA AND DISSEMINATED CANDIDIASIS Downloded from www.pharmacy123.blogfa.com

  4. Candidasp. • Normal flora in the gastrointestinal and genitourinary tracts of humans. Downloded from www.pharmacy123.blogfa.com

  5. Candida infection • Immune response is an important determinant of the type of infection. • Benign infections: local overgrowth on mucous membranes • More extensive persistent mucous membrane infections: deficiencies in cell-mediated immunity. • Invasive focal infections: after hematogenous spread or when anatomic abnormalities or devices Downloded from www.pharmacy123.blogfa.com

  6. LOCAL MUCOUS MEMBRANE INFECTIONS • Oropharyngeal candidiasis • Esophagitis • Vulvovaginitis • Chronic mucocutaneous candidiasis Downloded from www.pharmacy123.blogfa.com

  7. Oropharyngeal candidiasis • A common local infection. • Host: infants, older adults who wear dentures, patients treated with antibiotics, chemotherapy, or radiation therapy to the head and neck, and cellular immune deficiency states. • Symptoms: cottony feeling, loss of taste, pain on eating and swallowing, asymptomatic Downloded from www.pharmacy123.blogfa.com

  8. Oropharyngeal candidiasis • Signs: Downloded from www.pharmacy123.blogfa.com

  9. Oropharyngeal candidiasis • Diagnosis: Gram stain or KOH preparation on the scrapings. Budding yeasts with or without pseudohyphae. • Rx: • Clotrimazole troche (10 mg troche dissolved five times per day) • Nystatin suspension (400,000 to 600,000 units four times per day) • Nystatin troche (200,000 to 400,000 units four to five times per day), • For 7 to 14 days Downloded from www.pharmacy123.blogfa.com

  10. Esophagitis • AIDS-defining illness • Clinical: odynophagia or pain on swallowing • Dx: endoscopy • Confirmatory biopsy shows the presence of yeasts and pseudohyphae invading mucosal cells, and culture reveals Candida. Downloded from www.pharmacy123.blogfa.com

  11. Esophagitis • Rx: • Fluconazole 200 mg once daily then 100 mg for 14 d • Amphotericin B 0.3-0.7 mkd iv for 14 d Downloded from www.pharmacy123.blogfa.com

  12. Vulvovaginitis • Risk: associated with increased estrogen levels, antibiotics, corticosteroids, diabetes mellitus, HIV infection, intrauterine devices, and diaphragm use • Symptoms: itching and discharge. Dyspareunia, dysuria, and vaginal irritation. • Signs: vulvar erythema and swelling and vaginal erythema and discharge, which is classically white and curd-like but may be watery Downloded from www.pharmacy123.blogfa.com

  13. Vulvovaginitis • Dx: Wet mount or KOH preparation of vaginal secretions • Rx: • clotrimazole 100 mg vg suppo. for 7 d • fluconazole 150 mg oral single dose Downloded from www.pharmacy123.blogfa.com

  14. Chronic mucocutaneous candidiasis • A rare syndrome • Onset in childhood • Some have autosomal recessive polyglandular autoimmune syndrome type I, referred to as the autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome • manifested by chronic mucocutaneous candidiasis and endocrine disorders, such as hypoparathyroidism, adrenal insufficiency, and primary hypogonadism Downloded from www.pharmacy123.blogfa.com

  15. Chronic mucocutaneous candidiasis • Clinical: severe, recurrent thrush, onychomycosis, vaginitis, and chronic skin lesions (hyperkeratotic, crusted appearance on the face, scalp, and hands) • Rx: oral fluconazole,itraconazole Downloded from www.pharmacy123.blogfa.com

  16. RISK FACTORS FOR INVASIVE INFECTION • immunosuppressed patients • Hematologic malignancies • Recipients of solid organ or hematopoietic stem cell transplants • Those given chemotherapeutic agents for a variety of different diseases • intensive carepatients • Trauma and Burn patients, • Neonatal units • Central venous catheters • Total parenteral nutrition • Broad-spectrum antibiotics • High APACHE II scores • Renal failure requiring hemodialysis • Abdominal surgical procedures • Gastrointestinal tract perforations and anastomotic leaks Downloded from www.pharmacy123.blogfa.com

  17. INVASIVE FOCAL INFECTIONS • Urinary tract infection • Endophthalmitis • Osteoarticular infections • Meningitis • Endocarditis • Hepatosplenic or chronic disseminated candidiasis • Peritonitis and intraabdominal infections • Pneumonia • Mediastinitis • Pericarditis Downloded from www.pharmacy123.blogfa.com

  18. Urinary tract infection • BLADDER INFECTION AND COLONIZATION • KIDNEY INFECTION Downloded from www.pharmacy123.blogfa.com

  19. BLADDER INFECTION AND COLONIZATION • Risk factors: urinary tract drainage devices; prior antibiotic therapy; diabetes; urinary tract pathology and malignancy. • Most patients with candiduria are asymptomatic. • It is difficult to differentiate between colonization and bladder infection. • Infected patients may have dysuria, frequency, and suprapubic discomfort, no symptoms. • Pyuria with a chronic indwelling bladder catheter that it cannot be used to indicate infection. Downloded from www.pharmacy123.blogfa.com

  20. BLADDER INFECTION AND COLONIZATION • Ascending involvement of the kidneys is uncommon but can occur in urinary tract obstruction or renal transplantation. • Candiuria can be seen in systemic infection, it is accompanied by many other signs and symptoms of disseminated infection. Downloded from www.pharmacy123.blogfa.com

  21. BLADDER INFECTION AND COLONIZATION Recommendations: IDSA • Asymptomatic candiduria rarely requires antifungal therapy, if kidney transplantation, neutropenia, low birth-weight neonates, or urinary tract manipulation. • Asymptomatic candiduria may respond to risk factor reduction by removal of bladder catheters or urologic stents, and discontinuation of antibiotics ]. If it is not possible, placement of new devices or intermittent bladder catheterization may be beneficial. • Symptomatic candiduria should always be treated. • Rx: • Fluconazole 200 mg/day 7- 14 days, • Azole-resistant yeast can be treated with intravenous amphotericin B 0.3-0.7 mg/kg per day for 1-7 days Downloded from www.pharmacy123.blogfa.com

  22. KIDNEY INFECTION • Most commonly occurs in patients with disseminated • Acute infection • Bilateral, consisting of multiple microabscesses in the cortex and medulla • Chronic infection • Involve the renal pelvis and medulla with sparing of the cortex, which reflects ascending infection. • The kidney is usually the only organ involved and the infection tends to be unilateral Downloded from www.pharmacy123.blogfa.com

  23. KIDNEY INFECTION • Rx: • Amphotericin B (0.5 to 1.0 mg/kg/day) • Fluconazole (400 mg/day adjusted for renal function). • At least 2 weeks • removal and replacement of all intravenous catheters Downloded from www.pharmacy123.blogfa.com

  24. Endocarditis • Risk: prosthetic heart valves, IVDU, indwelling central venous catheters and prolonged fungemia. • Dx: Duke criteria • Rx: • Amphotericin B 0.7-1 MKD at least 6 weeks. with fluconazole being substituted for amphotericin B as follow-up therapy. • Resection of the valve and any associated abscesses Downloded from www.pharmacy123.blogfa.com

  25. CANDIDEMIA AND DISSEMINATED CANDIDIASIS • Candidiemia: presence of Candida sp. in the blood • Disseminated candidiasis: several viscera are infected Downloded from www.pharmacy123.blogfa.com

  26. PATHOGENESIS • three major routes by which Candida gain access to the bloodstream: • Through the gastrointestinal tract mucosal barrier • Via an intravascular catheter • From a localized focus of infection, such as pyelonephritis Downloded from www.pharmacy123.blogfa.com

  27. CLINICAL MANIFESTATIONS • Vary from minimal fever to a full-blown sepsis syndrome • Clinical clues: • characteristic eye lesions (chorioretinitis, endophthalmitis), • skin lesions, • much less commonly, muscle abscesses. • signs of multiorgan system failure may present: kidneys, heart, liver, spleen, lungs, eyes, and brain Downloded from www.pharmacy123.blogfa.com

  28. CLINICAL MANIFESTATIONS • Skin lesions: • Suddenly as clusters of painless pustules on an erythematous base; occur on any area of the body. • The lesions vary from tiny pustules or nodular; several centimeters in diameter; and appear necrotic in the center. • In severely neutropenic patients, the lesions may be macular rather than pustular. • Dx: by a punch biopsy. Downloded from www.pharmacy123.blogfa.com

  29. CLINICAL MANIFESTATIONS • Skin lesions Downloded from www.pharmacy123.blogfa.com

  30. CLINICAL MANIFESTATIONS • Eye lesions: • Exogenous: following trauma or surgery on the eye • Endogenous: through hematogenous seeding of the retina and choroid as a complication of candidemia. • Primary presenting symptoms: pain and gradual decrease in visual acuity. • The classic findings of chorioretinal involvement: focal, glistening, white, infiltrative, often mound-like lesions on the retina, a vitreal haze is present; sometimes fluffy white balls or "snowballs" in the vitreous Downloded from www.pharmacy123.blogfa.com

  31. CLINICAL MANIFESTATIONS • Eye lesions Downloded from www.pharmacy123.blogfa.com

  32. CLINICAL MANIFESTATIONS • Muscle abcess • soreness in a discrete muscle group. • warm and swollen Downloded from www.pharmacy123.blogfa.com

  33. DIAGNOSIS • Gold standard: candidemia is a positive blood culture • Blood cultures: H/C +ve 50 % of patients who were found to have disseminated candidiasis at autopsy. • Ophthalmologic evaluation: Once H/C+ve, whether or not they have ocular symptoms • Culture and stain of biopsy material Downloded from www.pharmacy123.blogfa.com

  34. Treatment • CATHETER REMOVAL • ANTIFUNGAL AGENTS • Polyenes: Amphotericin B • Azoles: Fluconazole, Itraconazole and Voriconazole. • Echinocandins:Caspofungin Downloded from www.pharmacy123.blogfa.com

  35. DRUG RESISTANCE • C. albicans; resistance is extremely low • C. krusei; intrinsically resistant to fluconazole due to an altered cytochrome P-450 isoenzyme, sometimes demonstrates decreased susceptibility to amphotericin B • susceptible to voriconazole • increased doses of amphotericin B Downloded from www.pharmacy123.blogfa.com

  36. DRUG RESISTANCE • C. glabrata; many are also resistant to the azoles due to changes in drug efflux, Amphotericin B also has delayed killing kinetics against C. glabrata in vitro • using high doses of fluconazole, amphotericin B Downloded from www.pharmacy123.blogfa.com

  37. DRUG RESISTANCE • C. parapsilosis ; • very susceptible to most antifungal agents; • caspofungin minimal inhibitory concentrations are higher than for other Candida species Downloded from www.pharmacy123.blogfa.com

  38. DRUG RESISTANCE • C. lusitaniae • often resistant to amphotericin therapy; • usually susceptible to azoles and echinocandins Downloded from www.pharmacy123.blogfa.com

  39. Treatment • Fluconazole 400 mg or 800 mg of daily • Amphotericin B 0.7 mg/kg per day • Caspofungin is 50 mg/day after a loading dose of 70 mg • Voriconazole is 3 mg/kg twice daily after a loading dose of 6 mg/kg twice daily for one day. • C. glabrata and C. krusei, higher doses of amphotericin B (1 mg/kg daily of standard amphotericin B • Duration of therapy for candidemia : • A minimum of two weeks of therapy after blood cultures become negative Downloded from www.pharmacy123.blogfa.com

More Related