Editing Fungal infections (section)

== Risk factors ==

* Diabetes
* Neutropaenia
* Organ transplantation/immunosuppression
* Malignant disease
* CVC
* Candida infection
** The source of the pathogen in surgical patients is usually the digestive tract
** Multiple scoring systems exist to predict risks
** Becomes invasive only when it changes from yeast to hyphal form!
** Disseminated candidal disease can cause septic shock
** Very high false negative rate for cultures
** Indistinguishable from bacterial sepsis clinically
*** Can look for purpura fulminans or unexplained myalgias
*** Diagnosis essentially requires strong clinical suspicion for susceptible patients
** Symptomatic candiduria should be treated. Asymptomatic should only be treated after instrumentation or renal transplant, or if the patient is neutropaenic. Changing IDC is required.
** Need two positive samples to consider a patient infected as opposed to contaminant. Whether that is blood culture, histological evidence, or line culture.
*** If accompanied by temp >38.5 or <36, unexplained prolonged hypotension (SBP<80 for 2 hours, unresponsive to fluid), and absence of response to adequate antibiotics, then considered severe candidiasis.
** Some authorities believe candida pneumonia does not exist in immunocompetent hosts