Intra-abdominal candidiasis (IAC) is the most common invasive candidiasis, with a high incidence among critically ill patients, which can significantly increase medical costs and affect prognosis. In order to standardize the diagnosis and treatment of IAC in critically ill patients, experts in related fields were organized by the Peking University Critical Care Medicine (PKUCCM), Committee of Critical Care Medicine and Organ Support, China Association for Promotion of Health Science and Technology organized experts in related fields to initiate and form a working group. Expert writers drafted the consensus based on evidence-based medical evidence. A committee composed of critical care physicians, infectious disease physicians, surgeons, dermatologists specializing in antifungal fields, and clinical pharmacists discussed and revised the consensus draft through a standardized process, and finally formulated this consensus. This consensus contains a total of 20 core recommendations, mainly focusing on the epidemiology, high-risk factors, diagnostic techniques and methods (including traditional microbiological culture techniques, clinical risk prediction tools, serological tests, molecular biological tests, and histopathological examinations) of IAC, diagnostic criteria, stratified treatment strategies, antifungal drug selection, control the sources of infection, combined treatment, de-escalation strategies, drug treatment courses, prognosis, and special types of IAC. The aim is to provide expert guidance for the standardized clinical diagnosis and treatment of IAC in critically ill patients, with a view to improving prognosis of patients.
Humans ; Critical Illness ; Intraabdominal Infections/therapy* ; Antifungal Agents/therapeutic use* ; Consensus ; Candidiasis/drug therapy* ; Critical Care ; Candidiasis, Invasive/diagnosis*

OBJECTIVETo explore the value of serial magnetic resonance imaging (MRI) in the diagnosis of cerebral abscess caused by Candida albicans in premature infants.

METHODSThe clinical data of 8 premature infants with central nervous system invasive fungal infection (IFI) were retrospectively studied. The infants underwent serial cerebral MRI scans (T1WI, T2WI and DWI).

RESULTSCandida albicans was found as pathogen in all of the 8 infants. Seven infants presented with cerebral abscess and 4 infants had concurrent meningitis. Widespread involvements were found on MRI, particular in white matter area of subcortex, centrum semiovale and periventricle. The MR imaging findings in 4 infants within 11 days after IFI showed diffusive and multiple miliary nodes and hyperintense signals on DWI, but obvious changes were not found on T1WI and T2WI. The most striking hyperintense signals on T1WI and hypointense signals on T2WI appeared between 2 and 4 weeks after IFI, and some nodes of rim-like hyperintensity and marked contrast enhancement were also noted on T1WI. Smaller and smaller changes of the miliary foci were seen on T1WI and T2WI 4 weeks later. Delayed myelination and thinner corpus callous were shown in 2 patients at three months.

CONCLUSIONSMRI-DWI and serial MRIs are helpful in the early diagnosis of candida cerebral abscess and the evaluation of treatment outcome in premature infants.

Brain Abscess ; diagnosis ; Candidiasis, Invasive ; diagnosis ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Magnetic Resonance Imaging ; methods ; Male

BACKGROUND: The incidence of candidemia has increased, and an early differentiation of transient or central venous catheter (CVC)-related candidemia from deep-seated invasive candidiasis is often difficult. The Pastorex Candida antigen assay (Sanofi Diagnostics Pasteur, Marnes-la-Coquette, France) is known to be an useful and specific tool for the diagnosis of invasive candidiasis. We assessed the clinical significance of Pastorex Candida antigen assay in patients with candidemia. METHODS: Eighty-five sera from 27 patients with candidemia and 42 control sera (32 patients with superficial Candida colonization and 10 healthy subjects) were tested. The Pastorex Candida latex agglutination test was performed to evaluate the presence of Candida mannan antigen. Candidemia was divided into 3 categories; (i) transient, (ii) CVC-related, and (iii) non-CVC-related persistent types. RESULTS: Thirty-two patients with superficial Candida colonization and 10 healthy subjects were negative for the Pastorex Candida antigen. Of the 85 sera from 27 patients with candidemia, 14 (16.4%) were positive for the Pastorex Candida antigen. The Pastorex Candida antigen was detected neither in 6 patients with transient candidemia nor 15 patients with CVC-related candidemia. Conversely, it was detected in at least one serum sample of 5 of the 6 (83.3%) patients with non-CVC-related persistent candidemia. Of the 24 sera from 6 patients with non-CVC-related persistent candidemia, 14 (58.3%) were positive for the Pastorex Candida antigen. Overall, the sensitivity and specificity of the Pastorex Candida antigen assay for the diagnosis of non-CVC-related persistent candidemia were 83.3% and 100%, respectively. CONCLUSIONS: Our data suggest that the Pastorex Candida antigen assay has a potential for the differential diagnosis of non-CVC-related persistent candidemia from transient or CVC-related candidemia.
Candida* ; Candidemia* ; Candidiasis, Invasive ; Central Venous Catheters ; Colon ; Diagnosis ; Diagnosis, Differential ; Humans ; Incidence ; Latex Fixation Tests ; Mannans ; Sensitivity and Specificity

In the past decades there has been a dramatic increase in the number of opportunistic fungal infections. Establishing the diagnosis of opportunistic fungal infections in compromised patients is not simple. The laboratory diagnostic tests include microscopic examination, culture and serological tests. Although the most reliable method is the histologic examination, various opportunistic fungal agents can reveal similar histologic morphology. Culture should be attempted, however, the isolation of these organisms from cultures must be interpretated with caution, because the causing agents for opportunistic fungal infections are common laboratory contaminants. Serology for fungal infections has limited value except cryptococcal antigen: the usefulness of detection of antigenemia in invasive candidiasis and invasive aspergillosis has been limited by the rapid clearance of Candida mannan and Aspergillus galactomann from serum, which results in only moderate sensitivity for the disease. Therefore, it should be appreciated that every laboratory test, for the diagnosis of opportunistic infections, has its limitations and should be interpreted with caution.
Aspergillosis ; Aspergillus ; Candida ; Candidiasis, Invasive ; Clinical Laboratory Techniques* ; Diagnosis ; Diagnostic Tests, Routine ; Fungi ; Humans ; Mannans ; Opportunistic Infections ; Serologic Tests

BACKGROUND: The early diagnosis of invasive candidiasis is the most important for reducing of morbidity and mortality rates in the immunocompromised patients. The study of antigen detection was performed by Cand-Tec kit, but antibody detection by Western blot, had not been reported. OBJECTIVE: We reviewed 62 cases of suspected invasive candidiasis(10), immunocompromised patients with leukemia, leukopenia, pneumonia, et al(44) and normal colonization control(8) in the urine and sputum for the immunological diagnosis of invasive candidiasis by Cand-Tec and Western blot assays. METHODS: The antigen and antibody detection were done by both Cand-Tec kit and Western blot assay, in the sera of the patients collected from several hospitals. RESULTS: The sera from 4(40%) and 8(80%) of 10 suspected invasive candidiasis had a threshold positive titers of > or = 1:4 by latex agglutination (Cand-Tec) and the results of positive antibody to the immunodominant antigen (47KDa) of Candida spp. by Western blot assay, each other. Both antigen and antibody we.e detected from 21(47%) of 44 patients in the immunocompromised group and 1(12%) of 8 cases with normal flora, separately, but the antibodies from 3(18%) of 16 healthy controls were detected by Western blot analysis, only. CONCLUSION: This study confirm that the Western blot method of detecting antibody against immunodominant antigen(47KDa) of Candida spp. was more effective than antigen detection by Cand-Tec method for immunodiagnosis of invasive candidiasis.
Agglutination ; Antibodies ; Blotting, Western ; Candida ; Candidiasis, Invasive* ; Colon ; Diagnosis* ; Early Diagnosis ; Humans ; Immunocompromised Host ; Immunologic Tests ; Latex ; Leukemia ; Leukopenia ; Mortality ; Pneumonia ; Sputum