Escolar Documentos
Profissional Documentos
Cultura Documentos
3.0
Incidence of candidaemia
2.5
2.0
1.5
1.0
0
1999 2000 2001 2002 2003
35
Hospital mortality (%)
30
25
20
15
10
5
0
< 12 1224 2448 > 48
Initiation of therapy > 12 h after the first positive blood sample was associated
with a greater risk of mortality than appropriate therapy given within 12 h
3 major categories
1. The Polyenes (Amphotericin B)
2. Triazoles (fluconazole, itraconazole,
voriconazole, posaconazole)
3. Echinocandins (caspofungin, anidulafungin,
micafungin)
IMUNOPATOGENESIS (Guntur, 2000)
IMUNO.COM
LPS bp
C7a CD 4+ TCR
CD 14
TLR 4 IL - 10 IL
IFN - g -4
TLR2 TH - 1 TH - 2 IL - 5 B cell
IL - 6
CSF Ig
IL 8
SEPSIS
IL 6 IL-2
IL -1 N
Compl.
TNF - a CD 8+
MOD NK
TF-VIIA
PaI-1 PGE 2 NO ICAM -1
SHOCK
SEPTIC
Innate and Adaptive Immunity to Fungus
40 35.9%
35
Cause of nosocomial BSI in the ICU
(US; 1995-2002)
30
Cause of infection (%)
25
20 16.8%
15
10.1% 9.8%
10
3.7%
5
0
CoNS Staph Candida Enter E.Coli
BSI=Blood stream infection.
ICU=Intensive care unit.
Wisplinghoff H et al. Clin Infect Dis. 2004;39:309-317.
Recommended duration of therapy or
candidemia :
Wisplinghoff H et al. Clin Infect Dis. 2004;39:309-317., Zaoutis TE et al. Clin Infect Dis 2005;41:1232.
Weinberger M et al, J Hosp Infect 2005;61:146.
Q2: What is the most common Candida species
in your institute?
1. Candida albicans
2. Candida tropicalis
3. Candida glabrata
4. Candida parapsilosis
C. parapsilosis (391) 2 2 1 2 2 2
Superficial infection
Systemic infection
The lancet infectious disease Vol.3 Novermber 2003,p.685-720
Candida score
Total parenteral nutrition * 1
Surgery * 1
Multifocal Candida colonization * 1
Severe sepsis * 2
Morphogenesis
Unicellular yeast (harmeless)
Filamentous (pathogenic) Figure 1. Yeast in Oral Scraping
Biofilm A sample of an oral scraping contains yeast cells
and pseudohyphae
(www.doctorfungus.org)
Principal Cell Wall Polymers
Glucan
Mannan