Candidíase sistêmica
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- febre
Other diagnostic factors
- taquicardia
- taquipneia
- hipotensão
- enchimento capilar lentificado
- confusão mental aguda
- débito urinário diminuído
- baixa saturação de oxigênio
- erupção cutânea
- hepatoesplenomegalia
- hipotermia
Risk factors
- uso de cateter venoso central
- exposição a antibióticos de amplo espectro
- diálise renal
- cirurgia
- nutrição parenteral
- Uso de imunossupressores
- colonização em múltiplos locais
- uso de substâncias por via intravenosa
Diagnostic investigations
1st investigations to order
- hemocultura
- Hemograma completo
- gasometria arterial
- níveis de lactato
- exames de coagulação
- testes de função renal
- testes da função hepática
- glicose sérica
Investigations to consider
- 1,3-beta-D-glicano
- espectrometria de massa por tempo de voo com ionização/dessorção a laser assistida por matriz (MALDI-TOF)
- ensaio de ressonância magnética T2
- biópsia tecidual
- ultrassonografia
- Tomografia computadorizada (TC)
- RNM
- tomografia por emissão de pósitrons com flúor-18 fluordesoxiglucose (18F-FDG-PET)/TC
Emerging tests
- reação em cadeia da polimerase
Treatment algorithm
suspeita diagnóstica
diagnóstico confirmado: pacientes não neutropênicos (sem complicações)
diagnóstico confirmado: pacientes neutropênicos (sem complicações)
diagnóstico confirmado: com complicações
Contributors
Authors
Brenda L. Tesini, MD
Assistant Professor
Infectious Diseases
Departments of Medicine and Pediatrics
University of Rochester Medical Center
Rochester
NY
Disclosures
BLT is a Merck Manuals editorial board member, and Society for Healthcare Epidemiology of America (SHEA) Guidelines Liaison Committee vice chair. She has received grant funding from the Centers for Disease Control (CDC).
Ramia Zakhour, MD
Associate Professor
Pediatric Infectious Diseases
Department of Pediatrics
McGovern Medical School
Houston
TX
Disclosures
RZ declares that she has no competing interests.
Acknowledgements
Dr Brenda L. Tesini and Dr Ramia Zakhour would like to gratefully acknowledge Dr Jack D. Sobel and Dr Sanjay G. Revankar, previous contributors to this topic.
Disclosures
JDS declares that he has no competing interests. SR has received grants for research from Astellas, Gilead, and Merck, and has been involved in clinical trials for Cidara and Astellas.
Peer reviewers
Paschalis Vergidis, MD, MSc
Associate Professor
Infectious Diseases
Mayo Clinic College of Medicine and Science
Rochester
MN
Disclosures
PV has received research funding from Cidara, Scynexis, F2G, Ansun and has served on advisory roles for AbbVie and Scynexis (all fees paid to Mayo Clinic). He has received honoraria from the Merck Manuals and Current Fungal Infection Reports.
Jean-Michel Livrozet, MD
Praticien hospitalier
Service de medecine de la Transplantation et d'Immunologie clinique
Hopital Edouard Herriot
Lyon
France
Disclosures
JML has been invited by Astellas, the manufacturer of micafungin, to attend a symposium, and invited by Gilead Sciences, manufacturer of liposomal amphotericin B, to attend different HIV conferences, and has been paid by Gilead Sciences for running HIV educational programs.
Matthew Falagas, MD, MSc, DSc
Director
Alfa Institute of Biomedical Sciences
Marousi
Athens
Greece
Disclosures
MF declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Tsay SV, Mu Y, Williams S, et al. Burden of candidemia in the United States, 2017. Clin Infect Dis. 2020 Dec 3;71(9):e449-53.Full text Abstract
Centers for Disease Control and Prevention. Candida auris (C. auris): C.auris for healthcare and laboratory professionals. 2024 [internet publication].Full text
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Sepse bacteriana
- Febre induzida por medicamento
- Embolia pulmonar
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- Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021
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