0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
Candidiasis 271■Hepatosplenic: multiple abscesses in the liver and/or spleen seen
in immunocompromised patients, especially those with prolonged
neutropenia; presents with fever, nausea and vomiting
■Less common manifestations: endocarditis, pneumonia, meningitis,
arthritis, osteomyelitis, peritonitis and endophthalmitis
tests
■Diagnosis made by seeing organism on KOH preparation (skin,
mucous membranes, vaginal secretions) or by culture; endoscopy,
biopsy of liver or aspiration of subcutaneous nodule may be needed
to obtain appropriate material
■Abdominal CT in neutropenic patients with elevated alkaline phos-
phatase and fever usually shows multiple abscesses or “bull’s-eye”
lesions in liver and/or spleen
■Echocardiogram in patients with persistent candidemia without
focus (especially IV drug users)
differential diagnosis
■Other bacterial and fungal infections can produce similar clinical
manifestations and are differentiated by culture
management
■Assess risk factors for infection
■Obtain material for microscopic examination and/or culture
■If immunocompromised or seriously ill, empirical therapy should
be started before results of studies known
specific therapy
■Different species of Candida have different sensitivities: ampho-
tericin B and lipid formulations of amphotericin B are active against
most species except C lusitaniae; azoles (miconazole and ketocona-
zole) and triazoles (fluconazole and itraconazole) active against C
albicans, C tropicalis and C parapsilosis, but have unreliable activity
against C glabrata and are inactive against C krusei
■Superficial infections of skin and mucous membranes treated with
topical agents such as nystatin, clotrimazole or miconazole; refrac-
tory cases treated with fluconazole
■Esophageal candidiasis treated with fluconazole, or for refractory
cases amphotericin B
■Line-related candidemia can be treated with fluconazole for at least
2 weeks after last positive culture; C glabrata and C krusei should
be treated with amphotericin B; line removal critical for successful
outcome