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Author: admin, 11.07.2015Invasive fungal infections are a growing problem in critically ill patients and are associated with increased morbidity and mortality. Fungal colonisation has been associated with the development of IC, yet according to recent data, a small proportion (3%–25%) of colonised patients subsequently develop invasive disease [57,58]. Laboratory Diagnostic MethodsIn the critically ill patient the diagnosis of invasive candidiasis (IC) is not an easy task because signs and symptoms vary from minimal to dramatic while existing diagnostic procedures present several drawbacks.
AspergillusAspergillus spp are moulds which are able to cause life-threatening invasive disease in immunocompromised individuals and local disease in immunocompetent persons. Invasive candidiasis includes candidaemia, disseminated candidiasis with deep organ involvement and chronic disseminated candidiasis. Complex medical and surgical problems, disruption of natural barriers, multiple invasive procedures and prolonged antibiotic treatment are some of the factors contributing to the alarming increase of fungal infections in the Intensive Care Unit (ICU) setting [1,2].
Four classes of antifungal drugs are currently available for the treatment of invasive fungal diseases in critically ill patients. Consider this if critically ill with risk factors for invasive candidiasis and no other known cause of fever.
Moreover in deep-seated candidiasis or in patients under fluconazole prophylaxis, BCs are often negative [36,37].
The purpose of the present review is to provide a practical approach to diagnosis and treatment of invasive fungal infections in the critically ill.
ICU patients with impaired immunity are prone to develop the invasive form of the disease in lungs and sinuses.
According to Ngyuen et al., both real–time PCR and BCs have comparable sensitivities in diagnosing candidaemia (60%) but PCR is invaluable in diagnosing deep–seated candidiasis with negative BCs (sensitivity 88% for PCR vs 17% for BCs) .
Limited data on the incidence of invasive Candida infections (ICI) in the critically ill are available.
Nevertheless the true incidence of invasive candidiasis may be higher not only due to the fact that the percentage of positive cultures lies between 30 and 50% but also because of the difficulty in diagnosing invasive candidiasis without candidaemia [20,21].Candida BSIs are a well-recognized cause of morbidity and mortality among the critically ill.
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