Fungemia
Fungemia is the presence of fungi or yeasts in the blood. It is most commonly seen in immunosuppressed or immunocompromised patients with severe neutropenia, oncology patients, or in patients with intravenous catheters. Recently, it has been suggested the otherwise immunocompetent patients taking infliximab may be at a higher risk for fungemia.
The diagnosis is complicated, as routine blood cultures have poor sensitivity. Treatment involves use of antifungals, e.g. fluconazole or amphotericin.
The two most important risk factors are:
- Use of broad-spectrum antibiotics
- Colonization by fungi (see e.g. candidiasis)
Other risk factors are:
- Dialysis
- Diabetes
- Central venous catheter
- High severity of illness
- Multiple abdominal surgeries
- Use of steroids
- burns
The most commonly known pathogen is Candida albicans, causing roughly 70% of fungemias, followed by Torulopsis glabrata with 10%, and Aspergillus with 1%. However, the frequency of infection by T. glabrata, Candida tropicalis, C. krusei, and C. parapsilosis is increasing, especially when significant use of fluconazole is common.