From the Guidelines
Yes, a patient with a fungal blood infection can be deathly sick, with mortality rates ranging from 10% to 47% depending on the severity of illness, underlying health status, and promptness of treatment. The risk of mortality is influenced by factors such as increasing age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, infecting Candida species, immunosuppressive agents, preexisting renal dysfunction, venous catheter retention, and antifungal selection 1. Patients with candidemia often present with severe symptoms, including high fever, chills, rapid heart rate, low blood pressure, confusion, and may progress to septic shock and multiple organ failure.
The severity of fungal bloodstream infections stems from the fungi's ability to invade tissues, form biofilms resistant to treatment, and trigger overwhelming inflammatory responses that damage vital organs. Common causative fungi include Candida species, especially Candida albicans. Treatment typically involves immediate administration of systemic antifungal medications, such as echinocandins, azoles, or amphotericin B, depending on the suspected organism 1. Source control, such as removing infected catheters or draining abscesses, is also crucial.
Key considerations in managing candidemia include:
- Early initiation of effective antifungal therapy and source control to reduce mortality rates 1
- Selection of antifungal agents based on factors such as the infecting Candida species, patient's underlying health status, and antifungal resistance patterns 1
- Monitoring for complications, such as ocular involvement, and performing dilated funduscopic examinations to detect endophthalmitis 1
- Determining the duration of antifungal therapy, which should be at least 14 days following documented clearance of Candida species from the bloodstream and resolution of signs and symptoms attributable to infection 1.
From the Research
Fungal Blood Infections
- Fungal bloodstream infections (FBI) are a serious condition that can be life-threatening, with a mortality rate of 36% in ICU patients 2.
- Invasive candidiasis is the most common fungal infection in patients attending health services and is associated with high mortality rates and prolonged hospital stay 3.
- Patients with fungal blood infections can be critically ill, with risk factors for mortality including age, serum albumin, APACHE II score, and length of stay in ICU 2.
Symptoms and Diagnosis
- Fungal blood infections can be difficult to diagnose, as they often do not present with specific symptoms 4.
- Rapid and accurate diagnosis is crucial to reducing mortality rates, and molecular techniques can be used in conjunction with standard mycological methods to improve diagnosis 4.
Treatment Options
- Echinocandins, amphotericin B, and azoles are commonly used to treat fungal blood infections, with echinocandins being recommended as first-line treatments for invasive candidiasis 3, 5, 6.
- The choice of treatment depends on various factors, including the type of fungal infection, patient condition, and antifungal susceptibility 5, 4.
- Echinocandins have been shown to have the highest rate of treatment success compared to amphotericin B and triazoles 6.
Patient Condition
- Patients with fungal blood infections can be deathly sick, with high mortality rates and prolonged hospital stays 3, 2.
- The condition of the patient can affect the choice of treatment, with clinicians considering factors such as age, serum albumin, and APACHE II score when selecting a treatment option 2, 5.