Experience with systemic candidiasis in the burned patient

Law, Ed; Kim, E J; Stiertiz, D D; MacMillan, Bruce G.

doi:10.1097/00006534-197309000-00050

Cited by 7 publications

(13 citation statements)

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“…Environmental fungi can reach the blood via indwelling catheters and i.v. needles and flourish in peri-catheteral sleeve thrombi (Anderson and Yardley, 1972) or in the endocardium, traumatized by tubes that reach the heart (Law et al, 1972;MacMillan, Law and Holder, 1972). Intratracheal intubation can push oral Candida into the lower respiratory passages and lead to pulmonary infection, serving as the focus for endocardial invasion, as with primary pulmonary fungal pathogens (Buchbinder and Roberts, 1972).…”

Section: Iatrogenic Factorsmentioning

confidence: 99%

Fungal endocarditis: patients at risk and their treatment

Seelig

Goldberg

Kozinn

et al. 1979

Postgraduate Medical Journal

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Section: Iatrogenic Factorsmentioning

confidence: 99%

Fungal endocarditis: patients at risk and their treatment

Seelig

Goldberg

Kozinn

et al. 1979

Postgraduate Medical Journal

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“…Although this fungus is frequently cultured from burn patients, it is generally not lethal. Law et al (14) reported that of 385 patients, 65.7% had at least one positive culture for C. albicans but that only 8.7% of these patients died. Once the yeast becomes systemic, however, the patients are at great risk.…”

mentioning

confidence: 99%

“…Examinations of cases of severe mycotic infections in burned patients have revealed that Candida sepsis is generally preceded or accompanied by bacterial sepsis (7,14,23,32). Of the 25 cases of systemic candidosis in one study (9), all had at least one other infectious complication.…”

mentioning

confidence: 99%

Increased susceptibility to lethal Candida infections in burned mice preinfected with Pseudomonas aeruginosa or pretreated with proteolytic enzymes

Neely¹,

Law²,

Holder³

1986

Infect Immun

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Lethal Candida infections in burn patients are frequently preceded by or occur concomitantly with bacterial infections, which are often due to Pseudomonas aeruginosa. In this study, we developed a burned, mixed-challenge mouse model, which was designed to determine whether and how a recent bacterial infection could influence the development of subsequent candidosis. In this model, burned mice that were preinfected with a sublethal challenge of elastase-producing P. aeruginosa strain WR-5 and then sublethally challenged with Candida albicans exhibited a mortality rate of 60%, while unburned mice challenged in the same way and burned mice that received only one challenge organism exhibited mortality rates of <10%. Quantitative microbial counts performed with the kidneys, livers, and eschars of burned mice challenged with both organisms indicated that the deaths were due to Candida infection. Substitution of an elastase-negative P. aeruginosa strain for strain WR-5 in the model resulted in significantly lower mortality rates and lower microbial numbers in the organs. When the Pseudomonas enzyme elastase was substituted for the elastasepositive bacteria in the model, both the mortality rates and the organ counts were comparable to the values found after preinfection with strain WR-5. Another protease, thermolysin, was substituted for the elastase and produced similar mortality results. When the protease inhibitor a2-macroglobulin was given to burned mice infected with the two organisms, it prevented the deaths due to Candida infection. We concluded that this model is one way to study bacterial-fungal infections in burned mice, that recent Pseudomonas infections could predispose burned mice to fatal candidosis, and that the proteolytic activity generated by the bacteria was primarily responsible for the establishment of lethal fungal infections.

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“…In immunocompromised patients, however, it is clear that the majority of patients with candidemia have evidence of invasive infection and that the frequency of transient candidemia in this group of patients probably is no greater than transient bacteremia with gram-negative organisms (6,7). In the past, it has been suggested that candidemia, especially when associated with an intravascular catheter, may be a transient phenomenon and may not indicate the presence of invasive disease.…”

Section: G P B O D E Y * E J Anaissiementioning

confidence: 99%