Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre diagnóstico y tratamiento de la candidiasis invasiva

Abstract

Candida yeasts are ubiquitous commensals, which can cause opportunistic infection in any location of the body. The source of infection may be both endogenous and exogenous. Invasive candidiasis encompasses different entities ranging from invasive candidiasis to disseminated multiorgan infection. Invasive candidiasis is the third leading cause of nosocomial bloodstream infection and the fourth of all nosocomial infections. It is also the most common invasive fungal infection in non-neutropenic critically ill patients, with a remarkable increase in the last 20 years owing to the increased survival of these patients and to more complex diagnostic, therapeutic and surgical procedures. Its incidence in infants, according to recent reviews, stands at 38.8 cases/100,000 children younger than 1 year. Candida albicans remains the most frequent isolate in invasive infections, although infections caused by other species have risen in the last years, such as C. kruzsei, C. glabrata and C. parapsilosis; the latter causing invasive candidiasis mainly associated with central venous catheter management, especially in neonatal units. The overall mortality of invasive candidiasis is high, with 30-day mortality reaching 20-44% in some series involving paediatric patients. This report provides an update on incidence, epidemiology, clinical presentation, diagnosis, treatment and outcome of invasive infection by Candida spp. in the paediatric patient.

Systemic Candidiasis

“…During treatment, control blood cultures should be performed every 2 or 3 days until they are negative. After discontinuation of treatment and during the subsequent 3 months, evolution must be monitored and a high index of suspicion maintained, investigating possible recurrences in the event of a new febrile episode in a susceptible patient [2].…”

“…Empirical treatment should be started in patients with neutropenia and persistent fever for more than 5 days. It is considered in critically ill patients in whom no other cause can be found to explain the fever, and in the presence of serological markers of candidemia [1], [2].…”

“…The disease caused by this microorganism is very broad, ranging from mucocutaneous infection in healthy patients to severe invasive disease in patients with risk factors. The importance of invasive candidiasis is due to its high frequency and high mortality [1,2].…”

Situación de la resistencia antifúngica de especies del género Candida en Perú

“…Se reporta baja sensibilidad (40 % a 75 %) (26) hemocultivos en enfermos con candidemia y en la mayoría de los casos el diagnóstico es presuntivo, ello conduce a una hospitalización prolongada, alta tasa de mortalidad, de alrededor del 50 %, y en una carga financiera para los sistemas de salud. Actualmente hay avances en el diagnóstico laboratorial de candidemia mediante la detección de antígenos, y material genético, utilizando pruebas moleculares.…”

Ocorrência das espécies de leveduras isoladas de sangue e cateter de pacientes internados em Hospital Público Infantil de São Paulo (período 2007 a 2010).

“…No recém-nascido, a colonização pode ocorrer durante a passagem através do canal do parto onde as leveduras podem ser ingeridas. A ocorrência comum das leveduras no trato vaginal de mulheres grávidas e sua presença na cavidade oral de seus recém-nascidos têm levado alguns autores a considerar a candidíase vaginal como a principal causa de candidíase neonatal enquanto que outros autores não consideram a mucosa vaginal como a principal via de transmissão para os recém-nascidos (CARAMALAC et al, 2007;FIGUERAS et al, 2011;WAGGONER-FOUNTAIN et a.l, 1996). A transmissão pode se dar de forma pós-natal, por contaminação cruzada por outros indivíduos ou, como já foi citado anteriormente, por trabalhadores da área da saúde (FIGUERAS et al, 2010).…”