Fungemia

Fungemia
Other names	Fungaemia
Specialty	Infectious disease

Fungemia is the presence of fungi or yeasts in the blood. The most common type, also known as candidemia, candedemia, or systemic candidiasis, is caused by Candida species; candidemia is also among the most common bloodstream infections of any kind.[1] Infections by other fungi, including Saccharomyces, Aspergillus and Cryptococcus, are also called fungemia. It is most commonly seen in immunosuppressed or immunocompromised patients with severe neutropenia, cancer patients, or in patients with intravenous catheters. It has been suggested the otherwise immunocompetent patients taking infliximab may be at a higher risk for fungemia.

Diagnosis is difficult, as routine blood cultures have poor sensitivity.[2]

Signs and symptoms

Symptoms can range from mild to extreme—often described as extreme flu-like symptoms. Many symptoms may be associated with fungemia, including pain, acute confusion, chronic fatigue, and infections. Skin infections can include persistent or non-healing wounds and lesions, sweating, itching, and unusual discharge or drainage.

Risk factors

The most important risk factors are:

Use of broad-spectrum antibiotics
Active infection by fungi (see e.g. candidiasis)

Other risk factors are:

Dialysis
Diabetes
Lowered intestinal flora
Suppressed immune system
Use of yeast probiotics[3]
Central venous catheter
High severity of illness
Multiple abdominal surgeries
Use of steroids
burns

Pathogens

The most commonly known pathogen is Candida albicans, causing roughly 70% of fungemias, followed by Candida glabrata with 10%, Aspergillus with 1% and Saccharomyces as the fourth most common. However, the frequency of infection by C. glabrata, Saccharomyces boulardii, Candida tropicalis, C. krusei and C. parapsilosis is increasing, perhaps because significant use of fluconazole is common or due to increase in antibiotic use.

Candida auris is an emerging multidrug-resistant (MDR) yeast that can cause invasive infections and is associated with high mortality. It was first described in 2009 after being isolated from external ear discharge of a patient in Japan. Since the 2009 report, C. auris infections, specifically fungemia, have been reported from South Korea, India, South Africa, and Kuwait. Although published reports are not available, C. auris has also been identified in Colombia, Venezuela, Pakistan, and the United Kingdom.[4]

Treatment

Neutropenic vs non-neutropenic candidemia is treated differently.[5]

An intravenous echinocandin such as anidulafungin, caspofungin or micafungin is recommended as first-line therapy for fungemia, specifically candidemia.[5] Oral or intravenous fluconazole is an acceptable alternative.[5] The lipid formulation amphotericin B is a reasonable alternative if there is limited antifungal availability, antifungal resistance, or antifungal intolerance.[5]

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References

"Statistics". Invasive Candidiasis. United States: Centers for Disease Control and Prevention. 13 November 2019. Retrieved 24 Dec 2019.
Finding the “Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care, Cornelius J. Clancy and M. Hong Nguyen. 2013-04-04 Oxford Journals, Medicine & Health, Clinical Infectious Diseases, Volume 56, Issue 9 Pp. 1284-1292 see online: http://cid.oxfordjournals.org/content/early/2013/02/15/cid.cit006.full (help with the difficult English wiki reference system is appreciated)
Herbrecht R, Nivoix Y (2005). "Saccharomyces cerevisiae fungemia: an adverse effect of Saccharomyces boulardii probiotic administration". Clinical Infectious Diseases. 40 (11): 1635–7. doi:10.1086/429926. JSTOR 4484255. PMID 15889361.
"Clinical Alert to U.S. Healthcare Facilities - June 2016 | Candida auris | Fungal Diseases | CDC". 2019-01-24.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD (2016). "Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 62 (4): 409–17. doi:10.1093/cid/civ1194. PMID 26810419.

External links

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[1] "Statistics". Invasive Candidiasis. United States: Centers for Disease Control and Prevention. 13 November 2019. Retrieved 24 Dec 2019.

[2] Finding the “Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care, Cornelius J. Clancy and M. Hong Nguyen. 2013-04-04 Oxford Journals, Medicine & Health, Clinical Infectious Diseases, Volume 56, Issue 9 Pp. 1284-1292 see online: http://cid.oxfordjournals.org/content/early/2013/02/15/cid.cit006.full (help with the difficult English wiki reference system is appreciated)

[3] Herbrecht R, Nivoix Y (2005). "Saccharomyces cerevisiae fungemia: an adverse effect of Saccharomyces boulardii probiotic administration". Clinical Infectious Diseases. 40 (11): 1635–7. doi:10.1086/429926. JSTOR 4484255. PMID 15889361.

[4] "Clinical Alert to U.S. Healthcare Facilities - June 2016 | Candida auris | Fungal Diseases | CDC". 2019-01-24.

[IDSA2016-5] Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD (2016). "Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 62 (4): 409–17. doi:10.1093/cid/civ1194. PMID 26810419.