Candida yeast is the most common causative agent behind reported cases of invasive fungal infections, and this has a lot to do with the widespread prevalence of this fungus in and around the human body. This yeast fungus forms a part of the natural microflora of the skin, vaginal tract, and the gastrointestinal tract of many people. Thus, it always poses a distinct possibility of turning into an opportunistic pathogen, and causing a wide gamut of symptoms by infecting different parts of the body. However, most of these infections such as the ones involving the skin surface or the oral cavity tend to be largely superficial in their extent. This makes these infections quite easy to treat with a number of potent antifungal medications on offer. However, the Candida infection that spread to the bloodstream is quite distinct from these other types of infections because the crude estimate of fatality in such cases tends to be around 50% to 60%. Thus, presence of Candida yeast in the bloodstream or Candidemia is something that no one can afford to take lightly.
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Who Can Get Candidemia?
The occurrence of Candida yeast in the bloodstream is exceedingly rare in healthy individuals, and only the presence of certain underline health issues predisposes a person towards the development of this dangerous infection. Candidemia is one of the most common types of infections in people undergoing hospitalization for organ transplant or repeated intestinal surgeries. Since, the yeast resides naturally on the skin surface of most humans; any puncture in the skin barrier can provide it a direct route to the bloodstream. This is often the case with patients having a center venous catheter are at a particularly heightened risk of contracting this infection. Since, a center venous catheter is essentially a tube inserted into one of the main blood vessels for delivering medications, or chemotherapy, or nutritional supplements directly to the heart; they provide a potent route for the Candida fungus to enter the bloodstream.
Candidemia can also affect patients with massive weakened immune functions due to a variety of underlying causes such as organ transplant, or ongoing chemotherapy to combat higher stages of cancer. Moreover, it can occur in people having undergone massive dosage of prophylactic broad-spectrum antibiotic treatment to rid the body of any bacterial antigen, which can provide an opportunity for the Candida yeast to proliferate and cause a major infection. Moreover, people receiving large dosages of corticosteroid to combat health conditions such as asthma and COPD can also become vulnerable to fungal infection entering their bloodstream. Finally, Candidemia can occur in people with specific disease conditions that tend to impair immune function such as severe diabetes, or HIV infection. Thus, Candida infection of the bloodstream usually strike people with prior health issues, which explain the reported high fatality rate associated with this infection.
Is Candidemia Difficult to Treat?
Candidemia can turn out to be even more difficult to treat if it becomes invasive and starts infecting any of the internal organs such as heart, brain, eyes, and kidneys. Candida albicans used to be the most common species linked directly with cases of infection of the bloodstream by this yeast fungus. However, there has been gradual change in the favor of the non-albicans species of Candida such as Candida glabrata and Candida parapsilosis causing more of the infections nowadays, with some of them being resistant to many of the most widely prescribed antifungal medications such as the Azole drugs.
The most common problem with diagnosing suspected cases of Candidemia is lack of any specific or exclusive symptoms, which can help in prompt detection. However, some of the Candidemia symptoms such as fever and chill, along with fatigue and general weakness are associated with most systemic infections. Apart from that, patients suffering from systemic Candida infection can also experience instances of muscle aches, skin rashes, low blood pressure, and abdominal pain. In addition, there might vision changes or loss of vision due to the spread of the infection to the eyes. Similarly, instances of sustained headaches and neurological deficits points out likely spread of the fungal infection to the brain.
How to Detect Candidemia?
The diagnosis tests available for detection of systemic Candidemia are also not 100% reliable, with blood tests often proving to be effective in detection in only 50% of the cases. Moreover, they require at least 40 hours for proper species identification, as well as, susceptibility tests. Other more advanced tests include immunoenzymatic tests, and molecular tests for detecting the DNA material of the Candida yeast. Thus, there are no prompt and simple diagnostic tests available on hand for prompt detection of the Candida infection in the bloodstream.
Research on Fluconazole:
A study in 2000 published in the ‘Oxford Journals’ looked at the treatment with fluconazole for Candidemia in blood and marrow transplant cases. Weekly mouthwashes were done to study fluconazole resistance in 1475 isolates from patients. 44% got colonized by candida species during blood and marrow transplant. Candidemia developed in only 4.6% patients. Some patients with colonizing Candida albican strains and invasive Candida albican strains were fluconazole-resistant are still remained in their body.
Another study published in the ‘Oxford Journals’ was carried out on 13 episodes of Candidemia was carried out on HIV infected patients. 11 acquired nosocomial Candidemia. 9 cases showed Candida albicans and 2 each of Candida glabrata and Candida krusei. 11 patients who received flucanozole still had different strains of the Candida species in their body, including the four non-albicans species. Anti-fungal therapy made no difference.
Both studies indicate the widespread occurrence of the candida growth, both in bone and marrow transplant cases and HIV patients. However, these studies prove that fluconazole isn’t very effective in most cases at treating Candidemia. Also having a blood and marrow transplant can increase the chances of developing Candidemia. More research needs to be carried out on other antifungal medication.
Candidemia Treatment Options:
Candidemia treatment options that respond well are with the use of popular of antifungal medication such as the Polyenes, Azoles, and Echinocandin. However, the choice of medication depends upon a number of factors such as the age and health condition of the patient, in addition to, the species of Candida yeast that is involved in the infection.
Candidemia in Marrow Transplant Recipients – 2000 – by Kieren A. Marr, Kristy Seidel, Theodore C. White, and Raleigh A. Bowden (J Infect Dis)
Candidemia in Late-Stage AIDS – 1998 – by Odile Launay, Olivier Lortholary, Claire Bouges-Michel, Bernard Jarrousse, Michéle Bentata, Loïc Guillevin (Clin Infect Dis)