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Weese-Mayer et al looked at factors important in the development of candidemia in 20 case patients less than 4 months of age who were matched with control infants by birth weight and date of admission to the neonatal intensive care unit. Univariate analysis identified duration of hyperalimentation, administration of fat emulsion, endotracheal intubation or tracheostomies or both ( p = 0.01), and antibiotic therapy ( p = 0.0002) as risks significantly associated with the development of candidemia. Antibiotic therapy had the greatest association with candidemia when discriminate function analysis was used to evaluate risk factors independently. No predictive discriminate function distinguishing infants at risk for candidemia was possible from the study. Fifteen of twenty-two episodes of candidemia were cured after two episodes, and death followed infection in five. Removal of catheters only resulted in clearance of infection in 9 of 22 patients (41%). Therapy with combination of amphotericin B and 5-fluorocytosine (5-FC) was successful in 4 of 5 patients (80%). Five of 20 infected patients (25%), compared with 1 of 20 (5%) control patients, died in this series.
NEW SIGNS AND SYMPTOMS
Differentiating infection from colonization is difficult and is a major handicap in the prevention and therapy of candidiasis in hospitalized patients. Helpful clinical findings that may be suggestive of infection caused by candida species include endophthalmitis, macronodular skin lesions, suppurative peripheral thrombophlebitis, hepatitis, purpura fulminans, bullous dermatitis, epiglottitis, and candida osteomyelitis. It usually is not possible to differentiate bacterial infections from local or systemic candidiasis by these clinical signs and symptoms. Neutropenia or the presence of nonalbicans species are factors associated with a reduced likelihood of candida endophthalmitis developing or becoming clinically recognizable infections.
HEPATIC CANDIDIASIS
Although not rare, hepatosplenic candidiasis is rarely recognized ante mortem. Immunocompromised patients are especially at risk for liver and spleen abscess caused by Candida species. This has been demonstrated by the increased number of the infections in these patients in the last 10 to 15 years. Thaler et al, using information from literature review and their own experience at the National Cancer Institute, concluded that the signs and symptoms of hepatosplenic candidiasis are reasonably characteristic. Useful findings in a cancer patient recently recovered from an episode of neutropenia include persistent fever, abdominal symptoms, and elevated alkaline phosphatase concentrations. Canadian viagra online
Ultrasonography is more specific than the more sensitive noninvasive technique of CT at detecting candida hepatosplenic abscesses; however, both techniques are subject to false-negative results. It is important to establish the diagnosis with certainty because the therapy required to ensure cure for hepatic candidiasis is a long course of amphotericin B (up to one year and 9 g). Liposomal amphotericin B or amphotericin B and 5-FC are options for therapy. Cure is documented by absence of symptoms, normalization of laboratory results, and disappearance of lesions by invasive and noninvasive techniques.