Fungemia Caused by Candida Species and Torulopsis glabrata in the Hospitalized Patient: Frequency, Characteristics, and Evaluation of Factors Influencing Outcome

Komshian, Shahe V.; Uwaydah, Ahmad Kanaan; Sobel, Jack D.; Crane, Lawrence R.

doi:10.1093/clinids/11.3.379

Cited by 436 publications

(207 citation statements)

References 25 publications

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“…The mortality rate of candidemia is high (46-75%) [7,9,15] unless neutropenia resolves. Antifungal prophylaxis was unable to reduce its incidence or mortality rate in neutropenic patients in randomized trials [20], except in the case of bone marrow transplantation [5,6].…”

Section: Discussionmentioning

confidence: 99%

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Candidemia in acute leukemia patients

Ribeiro

Sousa

Nunes

et al. 1997

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Fungal infections are an important cause of morbidity and mortality in patients with acute leukemia (AL). Candidemia, once rare, is now a common nosocomial infection because of the intensity of chemotherapy, prolonged neutropenia, administration of broadspectrum antibiotics and use of central venous catheters (CVC). We retrospectively identified patients treated for AL from 6/86 to 6/95 who also had candidemia. We describe 28 patients (incidence 6.3%) with a median age of 39 years, 24 of whom were on remission induction and 4 on postremission chemotherapy. All patients had CVC and empiric antimicrobial therapy, 4 had been given prophylactic antifungal drugs, and 2 had parenteral nutrition. Neutropenia was profound (median leuko-

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Section: Discussionmentioning

confidence: 99%

“…Its incidence is 4-12% [1,4]. There is a growing concern about its high mortality rate (46-75%) [9,15]. Antifungal prophylaxis, by diminishing the burden of Candida in the intestinal flora, may lower the incidence of candidemia and disseminated candidiasis [17].…”

Section: Introductionmentioning

confidence: 99%

Candidemia in acute leukemia patients

Ribeiro

Sousa

Nunes

et al. 1997

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“…Initial treatment with amphotericin B is usually advised [15], but optimal duration of therapy is controversial [16], particularly when infection is not associated with a removable source such as an intravenous catheter. Solomkin et al [17] suggest that a total dose of 6 mg-8 mg/kg may be sufficient to clear fungemia in postsurgical patients [17].…”

Section: Discussionmentioning

confidence: 99%

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Ang

Telenti

King

et al. 1993

Clinical Infectious Diseases

124

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Twenty-six cases of candidemia associated with a well-defined urinary tract source were retrospectively identified and reviewed. Urinary tract abnormalities were present in 23 of 26 patients (88%), 19 (73%) of whom had urinary tract obstruction. Nineteen patients had undergone urinary tract procedures before the onset of candidemia. Episodes of candidemia were brief and low-grade in intensity (median duration, 1 day; median colony count, 1.5 cfu/10 mL of blood).Only eight patients (31%) received >500 mg of amphotericin B. There were five in-hospital deaths (19%); two of these deaths were attributed to candidiasis. No late complications of candidemia were documented for the surviving patients. Patients with urologic pathology and candiduria who undergo surgery or manipulation of the urinary tract are at significant risk for candidemia, and further studies should examine the issue of administration of prophylaxis to this group.Candiduria often presents a dilemma to the clinician, as it may represent colonization or infection. The prevalence of candiduria has been estimated at 0.2%-6% [1, 2] among asymptomatic volunteers and at 6.5%-20% among hospitalized patients [2,3]. Despite the high prevalence of candiduria, it is not well known which patients will develop complications such as candidemia. For patients in the critical care setting, the mortality associated with urine cultures positive for Candida species was 50%, as opposed to 19% for such patients without cultures positive for Candida [4]. On the other hand, Schonebeck and Ansehn [5] observed 40 patients with candiduria that persisted from 1 to 12 months and found that the infection spontaneously resolved in the majority of patients, although five remained candiduric after >12 months. The goal of this retrospective study was to describe the characteristics of candidemia arising in patients with a well-defined urinary tract source of infection. Materials and MethodsAll patients with blood cultures positive for Candida species at the Mayo Clinic from March 1985 to December 1987 were identified through a review of microbiological records. Patients with candidemia were eligible for inclusion in the study if they had concomitant candiduria and no alternative source of candidemia. Candiduria was defined as the pres- ence of Candida species in urine cultures or the presence of yeast in the urine on microscopy. Recovery of Candida species from skin, sputum, or mucous membranes did not constitute criteria for exclusion. All in-patient and out-patient records were reviewed, and the following data were recorded: age, sex, underlying diseases, potential risk factors, clinical and laboratory features, radiological study findings, pathology reports, and treatment and outcome. Blood cultures were done for patients if they had fever or if the clinical circumstances suggested the possibility of systemic infection.The onset of fungemia was defined as the first day on which blood cultures positive for Candida were obtained. Potential risk factors were defined as: (1) administra...

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“…2,3 The literature shows a continually broadening spectrum of infectious sites. [3][4][5] Reports have shown T. glabrata fungemia associated with thrombophlebitis and hepatic abscesses that cleared with antifungal therapy. 1,2 Our case showed persistent fungemia despite treatment.…”

Section: Discussionmentioning

confidence: 99%

Torulopsis glabrata fungemia as a complication of a clotted transjugular intrahepatic portosystemic shunt

Darwin¹,

Mergner²,

Thuluvath³

1998

Liver Transpl

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Torulopsis glabrata fungemia developed in a patient with a clotted transjugular intrahepatic portosystemic shunt (TIPS) 11 months after placement. Fungemia persisted despite treatment with amphotericin B. On autopsy, T. glabrata was found in the thrombus occluding the TIPS and extending into the splenic and portal vein. TIPS infections may be considered in patients with fungemia. Copyright 1998 by the American Association for the Study of Liver Diseases T orulopsis glabrata (Candida glabrata) is considered to be a saprophyte of humans and to be of limited pathogenicity. 1 Under conditions of altered resistance, this yeast can become pathogenic. 2 We report a patient with T. glabrata fungemia from a clotted transjugular intrahepatic portosystemic shunt (TIPS) that was seeded with yeast. Case ReportA 55-year-old man with end-stage liver disease secondary to cryptogenic cirrhosis underwent TIPS for recurrent variceal bleeding. Two revisions for stent occlusion were done over the next 6 months while he awaited liver transplantation. He was admitted 11 months after TIPS placement with right upper quadrant pain and fever. Evaluation included a right upper quadrant ultrasound that showed a thick-walled gallbladder with cholelithiasis, no ductal dilatation or TIPS flow, bilirubin of 24 mg/dL (direct 15), and alkaline phosphatase of 43 U/L. Broad-spectrum antibiotic therapy was begun, and the patient underwent endoscopic retrograde cholangiopancreatography that showed no common duct stones. Blood cultures drawn 7 days after admission grew T. glabrata. Amphotericin B was started, and the patient underwent cholecystectomy.Complications during hospitalization included a perioperative myocardial infarction and renal failure. Despite 26 days of amphotericin therapy (total, 1,950 mg) and additional flucytosine, multiple blood cultures remained positive for T. glabrata. A transthoracic cardiac echo showed no vegetations. The patient was transferred to our hospital and died on day 27 after the initial admission. On autopsy, T. glabrata was found in thrombus that occluded the TIPS and extended into the splenic and portal vein with no other sites of infection or thrombus found.

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Fungemia Caused by Candida Species and Torulopsis glabrata in the Hospitalized Patient: Frequency, Characteristics, and Evaluation of Factors Influencing Outcome

Cited by 436 publications

References 25 publications

Candidemia in acute leukemia patients

Candidemia in acute leukemia patients

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Torulopsis glabrata fungemia as a complication of a clotted transjugular intrahepatic portosystemic shunt

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