From the Guidelines
Candidemia typically presents with nonspecific signs and symptoms, including fever, chills, hypotension, tachycardia, and altered mental status, which can make diagnosis challenging 1. The clinical manifestations of candidemia can vary, but common symptoms include:
- Fever and chills that persist despite antibiotic therapy
- Hypotension, tachycardia, and altered mental status, particularly in severe cases advancing to septic shock
- Myalgias, abdominal pain, or nausea and vomiting
- Skin manifestations, such as a diffuse maculopapular rash or characteristic lesions like erythematous papules, pustules, or nodules, which may indicate disseminated candidiasis
- Ocular involvement with blurred vision, eye pain, or floaters, suggesting endophthalmitis, a serious complication requiring prompt ophthalmologic evaluation Laboratory findings typically show leukocytosis, though neutropenia may be present in immunocompromised patients 1. Candidemia should be suspected in high-risk patients, such as those with central venous catheters, receiving total parenteral nutrition, on broad-spectrum antibiotics, immunocompromised, or with recent abdominal surgery, who have persistent fever despite antibacterial therapy 1. Definitive diagnosis requires blood cultures positive for Candida species, though these may take several days to grow, highlighting the importance of recognizing clinical signs for early empiric treatment 1. The management of candidemia involves removing any contaminated central venous catheters and administering antifungal therapy, with echinocandins being a preferred option for most patients 1. It is essential to consider the local epidemiology and rates of antifungal resistance when making therapeutic decisions, as well as the patient's individual risk factors and clinical presentation 1.
From the FDA Drug Label
An independent Data Review Committee (DRC), blinded to study treatment, reviewed the clinical and mycological data from this study, and generated one assessment of response for each patient A successful response required all of the following: resolution or improvement in all clinical signs and symptoms of infection, blood cultures negative for Candida, infected deep tissue sites negative for Candida or resolution of all local signs of infection, and no systemic antifungal therapy other than study drug Patients were randomized in 2:1 ratio to receive either voriconazole (n=283) or the regimen of amphotericin B followed by fluconazole (n=139). Patients were treated with randomized study drug for a median of 15 days. Most of the candidemia in patients evaluated for efficacy was caused by C. albicans (46%), followed by C. tropicalis (19%), C. parapsilosis (17%), C. glabrata (15%), and C krusei (1%).
The signs and symptoms of candidemia are not explicitly listed in the provided text, but it can be inferred that they include clinical signs of infection.
- The clinical signs and symptoms of infection must show resolution or improvement for a successful response to be considered.
- Blood cultures must be negative for Candida.
- Infected deep tissue sites must be negative for Candida or show resolution of all local signs of infection. However, the exact signs and symptoms are not specified in the text. 2
From the Research
Signs and Symptoms of Candidemia
The signs and symptoms of candidemia are not explicitly stated in the provided studies. However, the studies discuss the diagnosis, treatment, and management of candidemia, which can be associated with severe sepsis, high mortality, and significant economic burden 3, 4, 5.
Risk Factors for Candidemia
The risk factors for candidemia include:
- Intensive care unit (ICU) stay 5, 6
- Presence of intravascular line 6
- Previous antibiotic exposure 6
- Surgical intervention 6
- Mechanical ventilation 6
- Total parenteral nutrition 6
- Urinary catheters 6
- Solid organ cancer 6
- Haematology malignancy 6
- Steroid use 6
- Diabetes 6
- Chemotherapy 6
Diagnosis and Treatment of Candidemia
The diagnosis of candidemia is critical to initiate antifungal agents promptly, and delay in administration increases mortality 5. Non-culture based methods, such as mannan, anti-mannan, β-d-glucan, and polymerase chain reaction, have emerged for diagnosis, but remain investigational or require additional testing in the ICU setting 5. The antifungal armamentarium has expanded with the advent of lipid formulations of amphotericin B, the newest triazoles, and the echinocandins, which have shown to be efficacious and well-tolerated antifungal therapies 3, 5.
Outcomes of Candidemia
The outcomes of candidemia can be severe, with high mortality rates, especially in patients with Candida albicans and those who are elderly, have undergone surgical intervention, or have a history of ICU stay 6. However, the use of fluconazole has shown to increase survival rates 6.