Candida sepsis B37.7

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Candidosis disseminated; Disseminated Candidosis

Definition
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Septic seeding of Candida albicans or other Candida species (especially in immunosuppression), mostly after candidoses of internal organs (lung, heart, intestine, CNS).

Etiopathogenesis
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Haematogenic spread of the pathogens.

Localization
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Generalized to trunk, face, extremities.

Clinical features
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Exanthema with 2-5 mm large reddish papules and pustules, possibly with purpura, fever, reduced general condition, vomiting, diarrhoea, weight loss.

Diagnosis
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Blood culture.

Therapy
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  • Amphotericin B (e.g. Amphotericin B Bristol-Myers-Squibb) i.v. in combination with Flucytosin (e.g. Ancotil) i.v. Amphotericin B: day 1: 0.1 mg/kg bw, day 2: 0.2 mg/kg bw, day 3: 0.3 mg/kg bw then 0.3 (-1.0) mg/kg bw/day i.v., Flucytosin 150 mg/kg bw in 4 ED.
  • Alternatively: Liposomal amphotericin B (e.g. AmBisome) initial 1 mg/kg bw i.v.; if required, stepwise increase to 3 mg/kg bw i.v. or Fluconazole (e.g. Diflucan) i.v. 2 times/day 200 mg.
  • In case of failure of all above mentioned therapies:
    • Attempt with caspofungin (e.g. Cancidas): initial 70 mg/day i.v. up to and including 7 days after the symptoms have subsided.
    • Alternatively voriconazole: 2 times/day (every 12 hours) 6 mg/kg bw. Maintenance dose from day 2: 2 times/day 4 mg/kg bw i.v. up to and including 7 days after remission.
    • Alternatively posaconazole: 2 times/day 400 mg (10 ml) p.o. (daily dose 800 mg) or 4 times/day 200 mg (5 ml) p.o. The duration of therapy depends on the severity of the underlying disease, recovery from immunosuppression and clinical response.
    • Alternatively, anidulafungin: Initial 200 mg i.v. as single dose. Subsequently, 100 mg i.v. once/day according to the clinical response.

Progression/forecast
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Awkward.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020