How do you treat candida in the lungs?

Treatment of Candida in Lungs

Growth of Candida from respiratory secretions usually indicates colonization and rarely requires treatment with antifungal therapy. 1

Diagnostic Considerations

Candida isolated from the respiratory tract typically represents colonization rather than true infection. Several key points to understand:

• Candida pneumonia and lung abscess are very uncommon 1
• True pulmonary Candida infection requires histopathological evidence to confirm the diagnosis 1
• Multiple autopsy studies consistently demonstrate the poor predictive value of Candida growth from respiratory secretions, including bronchoalveolar lavage (BAL) fluid 1

When to Suspect True Pulmonary Candidiasis

True Candida pneumonia is generally limited to:

• Severely immunocompromised patients
• Patients with hematogenous spread to the lungs
• CT scan typically shows multiple pulmonary nodules in these cases 1

Treatment Algorithm

1. For respiratory colonization (most cases):

   • No antifungal therapy recommended 1
   • Monitor for signs of invasive disease

2. For confirmed invasive pulmonary candidiasis (requires histopathological evidence):

   • First-line therapy:

     • Fluconazole 400-800 mg (6-12 mg/kg) daily for fluconazole-susceptible isolates 1
     • Echinocandin (caspofungin 70mg loading dose, then 50mg daily; micafungin 100mg daily; or anidulafungin 200mg loading dose, then 100mg daily) for critically ill patients or suspected resistant species 1

   • Alternative therapy:

     • Lipid formulation of amphotericin B (L-AmB) 3-5 mg/kg daily 1
     • Voriconazole 200-300 mg (3-4 mg/kg) twice daily for fluconazole-resistant isolates 1

3. Duration of therapy:

   • Treat until resolution of clinical and radiographic manifestations 1
   • Typically 2-3 weeks minimum after clinical improvement

Special Considerations

Species-Specific Considerations

• For C. glabrata infections: Consider echinocandin or amphotericin B due to frequent fluconazole resistance 2, 3
• For C. krusei infections: Avoid fluconazole (intrinsic resistance); use echinocandin or amphotericin B 2, 3

Immunocompromised Patients

• Lower threshold for antifungal therapy in severely immunocompromised patients with respiratory Candida isolation 1
• More aggressive approach may be warranted in patients with hematologic malignancies or transplant recipients

Important Caveats

• Recent observations suggest that airway colonization with Candida is associated with bacterial colonization/pneumonia and worse clinical outcomes 1
• However, it remains unclear if this relationship is causal or if Candida colonization is simply a marker of disease severity 1
• A decision to initiate antifungal therapy should not be made solely on the basis of respiratory tract culture results 1
• Isolation of Candida from respiratory samples in severely immunosuppressed patients should trigger a search for evidence of invasive candidiasis 1

Source Control

If invasive disease is confirmed:

• Adequate drainage of any associated abscesses or collections is critical 1
• Central venous catheter removal is strongly recommended if present 2

Remember that the vast majority of Candida isolated from respiratory specimens represents colonization rather than infection, and treatment is rarely indicated unless there is histopathological evidence of tissue invasion.