Candidemia in the patient with malignancy

Abstract

Invasive fungal infections are a common life-threatening disease and a major cause of morbidity, particularly in patients with malignancies, and Candida spp. is the most common isolated fungi in bloodstream. Candidemia is the focus of this review, which covers an approach to diagnosis and treatment, with an emphasis on patients with malignancies. Acute leukemia, lymphoma, or myelodysplastic syndrome are the most common hematological malignancies associated with candidemia, while among solid tumors, gastrointestinal cancer has the majority of fungemia cases. Epidemiologic trends show there is a discrepancy between malignancies, where there is an important prevalence of non-albicans Candida in hematological malignancy patients. Diagnosis is challenging, and a high index of suspicion is required to select at-risk patients for early empiric therapy with the goal of reducing mortality. There is an increased effort to improve understanding of individualized approaches to the patient based on precision medicine and to improve diagnosis in the future. The basis of treatment is prompt therapy with echinocandins and target therapy based on susceptibility and minimum inhibitory concentrations (MICs).

Predominance of Candida Glabrata among Non-albicans Candida Species in a 16-Year Study of Candidemia at a Tertiary Care Center in Lebanon

“…Speciation of non-albicans Candida was performed in 72 of 110 episodes of NAC. Of the speciated non-albicans Candida, C. glabrata was the most common (37), followed by C. tropicalis (14), C. parapsilosis (6)…”

“…It is often associated with a high mortality rate of approximately 40–60% and a significant economic burden [ 2 , 3 , 4 , 5 ]. Due to the growing number of immunocompromised patients and critically ill patients, as well as the increasing use of invasive devices and antibiotics, the incidence of candidemia has been increasing around the world [ 2 , 6 ]. Particularly, there has been a rise in the incidence of non- albicans candidemia (NAC) [ 7 ].…”

<p>An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies</p>

“…87,88 The source of infections in people with Candida is usually endogenous because it is present in the body as normal flora, and proper prophylaxis can help controlling it. 89 A study in China after a seven-year experience reported that C. tropicalis is the most common cause of candidemia among patients with acute leukemia, and the vast majority of these infections are endogenous. The results of this study showed that empiric antifungal treatment before the first positive culture helps patients to survive, and utilizing prophylaxis new drugs, including voriconazole and posaconazole, may result in a decreased candidemia incidence and a better chance of cure and survival.…”

“…Methods used to diagnose candidiasis include blood culture and serological tests to detect β-D-glucan. 88 , 89 In addition, molecular methods, such as PCR-RFLP, Real-time PCR Fluorescence Resonance Energy Transfer probe assay and T2 Magnetic Resonance (T2MR), can help to control the chronic disseminated candidiasis as they allow rapid identification of the Candida species. 99 – 101 T2MR-based biosensing is able to detect different targets within complex matrices such as blood.…”

Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital

“…A growing population of immunocompromised patients has resulted in frequent diagnoses of invasive fungal infections (IFIs), including those caused by unusual yeasts ( Dabas et al, 2017 ). Invasive candidiasis is a growing concern worldwide with high morbidity and mortality; it affects patients of all ages, including patients with malignancies, HIV-negative immunocompromised (IC) patients, and non-immunocompromised (NIC) patients among those who are critically ill, often admitted to an intensive care unit (ICU), or diagnosed with diabetes mellitus or uncontrolled hyperglycemia requiring invasive mechanical ventilation ( Berdal et al, 2014 ; Bitar et al, 2014 ; Epelbaum and Chasan, 2017 ; Alves et al, 2018 ; Ding et al, 2018 ; Mantadakis et al, 2018 ). Although Candida albicans is still the leading cause of fungemia, epidemiological switch and species distribution have shifted toward non- C. albicans in recent decades, especially in patients with severe health conditions ( Canton et al, 2012 ; Pfaller et al, 2015 ; Taei et al, 2019 ; Xiao et al, 2020 ).…”