Candida infection

No test has demonstrated reliable accuracy in the clinical setting for diagnosis of disseminated Candida infection. Blood cultures are positive in only 25% to 45% of neutropenic patients with disseminated candidiasis. Fluorescence in situ hybridization has excellent sensitivity and specificity in the identification of C. albicans from blood. 

It is also very important, if possible, to discontinue or lower the doses of drugs with anticholinergic effects antihistamines, antipsychotics, antidepressants, uro-logic spasmolytics, anti-arrhythmics, drugs for Parkinson s disease and more. Prophylactic treatment against Candida infection, bacteria and caries can also be useful (Mouly et al. 2007). 

Myeloperoxidase is an extremely potent, antimicrobial protein that is present in neutrophils at up to 5% of the total cell protein. Its role in the killing of a wide range of bacteria, fungi, viruses, protozoa and mammalian cells (e.g. tumour cells) is well established from in vitro studies. It also plays an important role in the inactivation of toxins and the activation of latent proteases, as well as in other functions described in section 5.4.1. In view of this apparent central role in neutrophil function during host defence, one would think that any deficiencies in this enzyme would have disastrous consequences on the ability of the host to combat infections. Until the early 1980s, this key role for myeloperoxidase in host protection seemed substantiated by the extremely low incidence of reports of patients with deficiencies of this enzyme. Indeed, up to this time, only 15 cases from 12 families had been reported worldwide. Sometimes these patients were asymptomatic but often suffered Candida infections, particularly if their myeloperoxidase deficiency was also associated with diabetes mellitus. 

Lehrer, R. I., Cline, M. J. (1969). Leukocyte myeloperoxidase deficiency and disseminated candidiasis The role of myeloperoxidase in resistance to Candida infection. J. Clin. Invest. 48,1478-87. 

Griseofulvin and terbinafine are indicated in the management of fungal nail infections. Nystatin (polyene antifungal) is indicated in the management of Candida infections and is not indicated for fungal nail infections. 

Cross S A, Scott LJ. (2008) Micafungin A review of its use in adults for the treatment of invasive and oesophageal candidiasis, and as prophylaxis against Candida infections. Drugs 68 2225-2255. 

Carter NJ, Keating GM. (2009) Micafungin A review of its use in the prophylaxis and treatment of invasive Candida infections in pediatric patients. Paediatr Drugs 11 271-291. 

Undecylenic acid, like zinc undecylenate, is very effective as an external drag for treating moderate dermatophyte infections and yeast dermatitis, but it is not effective for shingles and for Candida infections. Synonyms of this drug are benzevrine, micocid, undetin, and others. 

Tolnaftate is used as an external drag for moderate dermatophyte infections (shingles), and it is not effective for treating Candida infections. Synonyms of this drag are tinatox, tonof-tal, timoped, tinaderm, tinactin, and others. 

Candidemia For the treatment of candidemia in nonneutropenic patients and the following Candida infections disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds. 

Candidemia in nonneutropenic patients and other deep tissue Candida infections - See the following table. Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer. 

Candidemia in nonneutropenic patients and other deep tissue Candida infections... 

Systemic Candida infections For the treatment of candidemia and disseminated Candida infections, daily doses of 6 to 12 mg/kg/day have been used. 

Administer caspofungin by slow intravenous (IV) infusion over approximately 1 hour. Candidemia and other Candida infections Administer a single 70 mg loading dose on day 1, followed by 50 mg/day thereafter. The patient s clinical and microbiological response should dictate duration of treatment. In general, continue antifungal therapy for at least 14 days after the last positive culture. 

For the treatment of patients with esophageal candidiasis, and for prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT). 

Treatment of esophageal candidiasis-Prophylaxis of Candida infections in HSCT recipients-... 

Topical formulations of nystatin and of amphotericin B are useful in the management of Candida albicans infections of the skin. Both antibiotics are ineffective against dermatophytes. The use of nystatin is limited to topical treatment of cutaneous and mucosal Candida infections because of its narrow spectrum and its negligible absorption from the gastrointestinal tract. Hypersensitivity reactions are rare. It is not known whether topical nystatin can cause fetal harm when used by a pregnant woman. Amphotericin B has broader antifungal activity but its topical use is restricted to Candida. Topical use of amphotericin B has shown minimal absorption through the skin and is well tolerated. Limited human surveillance data do not indicate any harm to mother or fetus, but relative safety is still unknown. 

Methylrosanilinum chloride (Gentian violet) is a desinfectant with antifungal activity against yeasts. As a aqueous solution it is used topically to treat Candida infections. Adverse effects include severe irritation, temporary staining of skin, permanent staining of fabrics. Animal carcinogenicity has been described (restricted use in some countries). 

Ketoconazole remains useful in the treatment of cutaneous and mucous membrane dermatophyte and yeast infections, but it has been replaced by the newer triazoles in the treatment of most serious Candida infections and disseminated mycoses. Ketoconazole is usually effective in the treatment of thrush, but fluconazole is superior to ketoconazole for refractory thrush. Widespread dermatophyte infections on skin surfaces can be treated easily with oral ketoconazole when the use of topical antifungal agents would be impractical. Treatment of vulvovaginal candidiasis with topical imidazoles is less expensive. 

Miconazole (Monistat) is a broad-spectrum imidazole antifungal agent used in the topical treatment of cutaneous dermatophyte infections and mucous membrane Candida infections, such as vaginitis. Minimal absorption occurs from skin or mucous membrane surfaces. Local irritation to skin and mucous membranes can occur with topical use headaches, urticaria, and abdominal cramping have been reported with treatment for vagiiutis. 

Naftifine hydrochloride (Naftin) is available for topical use only in the treatment of cutaneous dermatophyte and Candida infections it is as effective as topical azoles for these conditions. 

Diarrhea, dyspepsia, nausea, Candida infection, evidenced by sore mouth or tongue... 

The effect of dexamethasone has been assessed in a retrospective chart review study in neonates weighing less than 1200 g, both with (n = 65) and without (n = 269) Candida sepsis dexamethasone therapy and prolonged antibiotic therapy were associated with Candida infection (342). 

Topical administration to the nose The safety of nasal glucocorticoids in the treatment of allergic rhinitis has been reviewed (434,435). The local application of glucocorticoids for seasonal or perennial rhinitis often results in systemic adverse effects. The use of nasal sprays containing a glucocorticoid that has specific topical activity (such as beclomethasone dipropionate or flunisolide) seems to reduce the systemic adverse effects, but they can nevertheless occur, even to the extent of suppression of basal adrenal function in children (436). Local adverse effects include Candida infection, nasal stinging, epistaxis, throat irritation (437), and, exceptionally, anosmia (438). 

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