1/34. Candida dubliniensis candidemia in patients with chemotherapy-induced neutropenia and bone marrow transplantation.The recently described species Candida dubliniensis has been recovered primarily from superficial oral candidiasis in hiv-infected patients. No clinically documented invasive infections were reported until now in this patient group or in other immunocompromised patients. We report three cases of candidemia due to this newly emerging Candida species in hiv-negative patients with chemotherapy-induced immunosuppression and bone marrow transplantation.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
2/34. Clinical manifestations and molecular epidemiology of late recurrent candidemia, and implications for management.The aim of this study was to define the epidemiology and clinical manifestations of late recurrent candidemia. For this purpose, late recurrent candidemia was defined as an episode of candidemia occurring at least 1 month after the apparent complete resolution of an infectious episode caused by the same Candida sp. A total of five patients with recurrent candidemia were investigated. For all patients, isolates from the initial and recurrent episodes of candidemia were available for in vitro susceptibility testing and genetic characterization by dna-based techniques. The results revealed the following salient features: prolonged duration between the initial and recurrent episodes (range, 1-8 months); recurrence of candidemia despite anti-fungal therapy; importance of retained intravascular catheters, neutropenia, and corticosteroids as factors predisposing to recurrence; high morbidity and mortality; no emergence of antifungal drug resistance between the initial and recurrent episodes; and relapse of infection due to the original infecting strain, rather than reinfection with a new strain. These findings raise several issues about the management and follow-up of patients with candidemia, which require assessment in future studies.- - - - - - - - - - ranking = 2.2keywords = candidemia (Clic here for more details about this article) |
3/34. Catheter-related candidemia caused by Candida lipolytica in a patient receiving allogeneic bone marrow transplantation.Candida lipolytica was recovered from the blood and the central venous catheter in a patient receiving allogeneic bone marrow transplantation. Two C. lipolytica strains from different geographical areas and the ATCC 9773 strain of C. lipolytica were used as controls. C. lipolytica was identified by standard methods. MICs indicated antifungal susceptibilities to amphotericin b, fluconazole, and itraconazole for all strains. in vitro testing and scanning electron microscopy showed that C. lipolytica was capable of producing large amounts of viscid slime material in glucose-containing solution, likely responsible for the ability of the yeast to adhere to catheter surfaces. Restriction fragment length polymorphisms revealed an identical profile for all clinical isolates, unrelated to those observed for the control strains. This finding suggested the absence of microevolutionary changes in the population of the infecting strain, despite the length of the sepsis and the potential selective pressure of amphotericin b, which had been administered to the patient for about 20 days. The genomic differences that emerged between the isolates and the control strains were indicative of a certain degree of genetic diversity between C. lipolytica isolates from different geographical areas.- - - - - - - - - - ranking = 0.8keywords = candidemia (Clic here for more details about this article) |
4/34. Two cases of fungemia due to Candida lusitaniae and a literature review.Reported here are two cases of candidemia caused by Candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin b, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the Candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.- - - - - - - - - - ranking = 0.2keywords = candidemia (Clic here for more details about this article) |
5/34. Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit.This report describes the nosocomial acquisition of Candida parapsilosis candidemia by one of the six premature newborns housed in the same room of a neonatal intensive care unit at the Ospedale Santa Chiara, Pisa, italy. The infant had progeria, a disorder characterized by retarded physical development and progressive senile degeneration. The infant, who was not found to harbor C. parapsilosis at the time of his admission to the intensive care unit, had exhibited symptomatic conjunctivitis before the onset of a severe bloodstream infection. In order to evaluate the source of infection and the route of transmission, two independent molecular typing methods were used to determine the genetic relatedness among the isolates recovered from the newborn, the inanimate hospital environment, hospital personnel, topically and intravenously administered medicaments, and indwelling catheters. Among the isolates collected, only those recovered from the hands of two nurses attending the newborns and from both the conjunctiva and the blood of the infected infant were genetically indistinguishable. Since C. parapsilosis was never recovered from indwelling catheters or from any of the drugs administered to the newborn, we concluded that (i) horizontal transmission of C. parapsilosis occurred through direct interaction between nurses and the newborn and (ii) the conjunctiva was the site through which C. parapsilosis entered the bloodstream. This finding highlights the possibility that a previous C. parapsilosis colonization and/or infection of other body sites may be a predisposing condition for subsequent C. parapsilosis hematogenous dissemination in severely ill newborns.- - - - - - - - - - ranking = 1keywords = candidemia (Clic here for more details about this article) |
6/34. Persistence of the same candida albicans strain despite fluconazole therapy. documentation by pulsed-field gel electrophoresis.candida albicans and other Candida species have emerged as major nosocomial pathogens associated with a high mortality. Therapeutic options for fungal infections are limited. amphotericin b has been the mainstay of treatment for serious systemic candidal infections, but it is relatively toxic and associated with a variety of side effects. fluconazole has been proposed as alternative therapy for the treatment of systemic candidiasis including candidemia. We report the case of a patient with fungemia in whom fluconazole failed to eradicate C. albicans and C. tropicalis. These pathogens were recovered from sputum and urine cultures, respectively, on day 12 of intravenous fluconazole therapy. Molecular epidemiologic techniques employing pulsed-field gel electrophoresis confirmed the persistence of the same C. albicans strain. Susceptibility studies showed a marked change in MICs of fluconazole between 24 and 48 hr, with an increase from less than or equal to 1.25 to greater than 80 micrograms/ml. Controlled trials will be needed to delineate the role of fluconazole in the treatment of disseminated candidiasis and its efficacy in comparison with amphotericin b. amphotericin b should remain the drug of choice for such infections until data from controlled trials are available.- - - - - - - - - - ranking = 0.2keywords = candidemia (Clic here for more details about this article) |
7/34. Unusual course of treatment of a patient diagnosed with pemphigus Vulgaris (case report).The case report is describing patient with an autoimmune disease, pemphigus Vulgaris. This patient arrived to the general practitioner with pemphigus Vulgaris after 20 days from the first manifestation of the disease. Despite intensive care, patient dies forty-seventh day after first clinical manifestation of the illness of candidemia. candidiasis was diagnosed only in postmortem examination.- - - - - - - - - - ranking = 0.2keywords = candidemia (Clic here for more details about this article) |
8/34. Caspofungin in a pediatric patient with persistent candidemia.OBJECTIVE: To describe the response of a child with persistent fungemia to caspofungin, a member of the echinocandin class of antifungals. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit at a university teaching hospital. PATIENT: A 3-yr-old female with persistent candidemia. INTERVENTION: After >5 wks of persistent candidemia, caspofungin was added to an antifungal regimen that included amphotericin b and flucytosine. MEASUREMENTS AND MAIN RESULTS: The addition of caspofungin resulted in rapid clearance of the candidemia. The child recovered without evidence of further fungal infection or overt toxicity. CONCLUSION: Caspofungin was administered safely in this pediatric patient and possibly contributed to her clinical improvement. Caspofungin may be considered in children with severe persistent fungal infections that are not responsive to standard therapy. More study in pediatric patients is necessary before recommending its general use.- - - - - - - - - - ranking = 1.4keywords = candidemia (Clic here for more details about this article) |
9/34. Late onset Candida parapsilosis endocarditis after surviving nosocomial candidemia in an infant with structural heart disease.The incidence of nosocomial candidemia is increasing. Late onset endocarditis after surviving nosocomial fungemia is described in adults. We report a case of late onset Candida parapsilosis endocarditis of a structurally abnormal aortic valve in an infant surviving nosocomial candidemia.- - - - - - - - - - ranking = 1.2keywords = candidemia (Clic here for more details about this article) |
10/34. Management of endogenous fungal endophthalmitis with voriconazole and caspofungin.PURPOSE: Voriconazole, a new generation triazole, has been shown to achieve therapeutic intraocular levels after oral administration. Caspofungin is the first approved agent from a new class of antifungals, the echinocandins. This series describes experience at two centers using these novel antifungals to treat endogenous fungal endophthalmitis. DESIGN: Retrospective review. methods: Treatment of five patients with Candida endophthalmitis are reviewed. Postmortem intraocular voriconazole concentrations on a sixth patient are presented as well. RESULTS: All patients had systemic cultures positive for Candida species. Three patients had prompt resolution of intraocular mycosis with intravenous and oral voriconazole, caspofungin, or both. The fourth patient with bilateral disease responded well to i.v. voriconazole and caspofungin but had a recurrence when discharged on oral voriconazole and i.v. caspofungin. This patient had a bowel resection with an ileostomy; therefore, absorption of oral voriconazole may have been inadequate. Bilateral amphotericin b intravitreal injection ultimately treated this patient. The fifth patient received 100 microg/0.1 ml of intravitreal voriconazole (final vitreous concentration approximately 25 microg/ml) followed by oral voriconazole and responded favorably. Our sixth patient had multisystem failure and passed away 1 week after initiating intravenous voriconazole for non-ocular candidemia. Postmortem HPLC analysis of the aqueous and vitreous revealed voriconazole concentrations of 1.52 microg/ml and 1.12 microg/ml, respectively (MIC90 of candida albicans is 0.06 microg/ml). CONCLUSIONS: Voriconazole and caspofungin appear to be powerful weapons to add to the existing armamentarium against fungal endophthalmitis. Further studies are warranted to define precisely the role of these new agents alone or in combination with other antifungals.- - - - - - - - - - ranking = 0.2keywords = candidemia (Clic here for more details about this article) |
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