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Berichtet wird uber eine 28-jahrige bis dato nicht bekannt vorerkrankte Patientin, welche mit dem Rettungsdienst in komatosem Zustand auf unsere Intensivstation gebracht wurde. Klinisch bestanden das Bild einer Sepsis, eine massiv erhohte Blutzuckerkonzentration (> 2000 mg/dl) sowie in der korperlichen Untersuchung eine ausgepragte Hautmykose der Leistenregion der stark adiposen Patientin (BMI [Body-Mass-Index]: 33,7kg/m ). Die Sepsistherapie umfasste daher bereits ab dem Aufnahmetag eine kalkulierte antimykotische Therapie. Die Blutkulturdiagnostik bestatigte das Vorhandensein von Candida albicans sowie Candida glabrata. Trotz adaquater antiinfektiver Therapie kam es im weiteren Verlauf zur Entwicklung eines septischen Schocks mit der Notwendigkeit einer Nierenersatztherapie ab dem dritten Tag sowie eines schweren ARDS, sodass die zusatzliche Eskalation der Therapie durch eine venovenose extrakorporale Membranoxygenierung eingeleitet wurde. Trotz aller oben genannten Masnahmen und maximaler intensivmedizinischer Therapie entwickelte die Patientin ein progredientes Multiorganversagen. Beim Auftreten von lichtstarren Pupillen wurde eine zerebrale Computertomographie durchgefuhrt. Diese erbrachte den Nachweis eines ausgepragten generalisierten Hirnodems; eine Blutung wurde ausgeschlossen. Somatosensorisch evozierte Potenziale und Elektroenzephalogramm mit Untersuchung in Wiederholung erbrachten Hinweise auf irreversible Hirnschaden. In Anbetracht dieser infausten Prognose wurden die Therapiemasnahmen limitiert. Die Patientin verstarb am Tag 24 nach der Aufnahme auf der Intensivstation. Das Fallbeispiel zeigt, dass eine antimykotische Therapie durchaus bei klinisch begrundetem Verdacht bereits initial im Rahmen der Sepsistherapie in Betracht gezogen werden sollte. Die Rolle der massiv alterierten Stoffwechselsituation mit massiver Hyperglykamie und Ketoazidose kann nicht abschliesend bewertet werden.

The paper presents a case of generalized candidomycosis in a 67-year old woman. Literature data regarding the cases of respiratory mycoses and candida sepsis are summarized. This case is interesting from the point of view of difficulty of differential diagnosis in patients with respiratory mycosis and tuberculosis, choice of adequate treatment.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors exhibit impressive cardio-renal benefits in patients with a high cardiovascular risk. Genital yeast infections are important side effects of this class of drugs. We report a case of Candida glabrata sepsis secondary to a Candida infection of the urostomy of a patient on SGLT2 inhibitor therapy. In urostomy patients, one should critically evaluate the risk of mycotic infections against the cardiovascular and glycaemic benefits of SGLT2 inhibition. Urostomy patients without a high cardiovascular risk should not be treated with SGLT2 inhibitors.

Aims and objective: To study the profile of Candida infection and antifungal susceptibility (AFS) pattern in neonatal sepsis.Materials and methods: In this prospective observational study, 850 bloo...

Introduction: Steady progress in intensive treatment worldwide has increased the survival of immature neonates, but with multiple invasive procedures, which has increased the risk of infection and, consequently, fungal sepsis. Candida is the dominant cause, with the rise of resistant non-albicans species. The mortality rate is high and requires timely suspicion and adequate treatment to counteract fatal outcomes. Objectives:To analyze the clinical and laboratory characteristics of Candida sepsis, compared to bacterial sepsis, in neonates treated in the neonatal intensive care unit. Methods: A retrospective cohort study conducted at the Intensive care unit of Pediatric Clinic Tuzla over a three-year period (2016-2018) analyzed the clinical and laboratory characteristics of neonates with Candida sepsis, evidenced by positive blood culture. The control group was neonates treated at the same time for proven bacterial sepsis. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results: Out of the total 921 neonates treated over a three-year period, culture-confirmed Candida sepsis was found in 48 (5.2%). Prematurity and low birth weight were the most significant risk factors and affected neonates had a more difficult clinical presentation, more receiving parenteral nutrition, mechanical ventilation, intravenous gamma globulin, and longer intensive treatment. Candida sepsis manifested mainly as late-onset. Laboratory abnormalities mainly included CRP elevation, anemia, leukocyte count deviations, and thrombocytopenia. There was no difference in mortality, 44 neonates recovered (91.7%), while 4 (8.3%) died. Antifungal therapy lasted 20.6 ± 6 days, and intensive treatment 38.2 ± 23.2 days, and was significantly longer compared to the control. All isolates were Candida species without in vitro resistance. In 8 neonates (16.7%) treatment complications were recorded. Conclusions: Neonatal Candida sepsis endangers life, complicates treatment, increases costs and mortality rate. Recovery depends on timely suspicion, adequate treatment, and supervision. Antifungal susceptibility is also important and requires monitoring of local epidemiological dynamics.

Background: To improve the accuracy in invasive candidiasis diagnostics, a new biomarker panel has been developed and validated on a 165-patient cohort of critically ill adults.Methods: The serum levels of inflammatory biomarkers, C-reactive protein, presepsin (PSEP), procalcitonin (PCT), and of panfungal (1,3)-β-D-glucan (BDG), were correlated with culture-confirmed candidemia or bacteremia in 58 or 107 patients, respectively. The diagnostic effect of the host and pathogen biomarkers was expressed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).Results: For invasive candidiasis, the best performing BDG exhibited 96.6% sensitivity, 97.2% specificity, 94.9% PPV and 98.1% NPV at a cut-off of 200 pg/mL (P ≤ 0.001). PSEP exhibited 100% sensitivity and 100% NPV at a cut-off of 700 pg/mL. Furthermore, PSEP was more accurate for 28-day mortality prediction (AUC = 0.74) than PCT (AUC = 0.31; PCT cut-off 0.5 ng/mL). Finally, PSEP showed a significant serum decrease as early as 14 days after echinocandin therapy initiation (P = 0.0012).Conclusions: At concentrations of BDG > 200 pg/mL and PSEP > 700 pg/mL, the probability of invasive candidiasis in critically ill adults is close to 100% defining a borderline between non-invasive superficial Candida colonization and invasive candidiasis.Trial registration: The study was approved by the University Hospital Ostrava Ethics Committee for Multicenter Clinical Trials (no. 448/2018) and registered in ClinicalTrials.gov (ID: NCT03584594), date of registration June 28,2018.

Ichthyosis which is an inherited keratinisation disorder of the skin, is heterogeneous as clinically. This disease’s clinic is considerably variable from widespread skin dryness to hyperkeratosis. While the prevention of complications such as dehydration, sepsis and electrolyte imbalance, is very important in respect to survival, in premature neonates, more severe complications may be seen. In this case, we reported that a premature infant who developed catastrophic candida sepsis with congenital ichthyosis.

The sustained high morbidity and mortality of Candida sepsis are mainly caused by compromise of host immunity. Clinically, it is often manifested as a significant decrease in CD4+ T cell count, although the mechanism is unclear. We established a lethal mice Candida sepsis model and used Murine Sepsis Score to group mice with different disease severity to establish the influence of T-bet expression on CD4+ T cell count in Candida sepsis. We found that CD4+ T cell count decreased in Candida-infected compared to uninfected mice, and the degree of decrease increased with aggravation of sepsis. Expression of T-bet similarly decreased with worsening of sepsis, but it was significantly enhanced in candidiasis in comparison of naïve state. To clarify its possible mechanism, we measured the activity of mammalian target of rapamycin (mTOR), which is a key regulator of T-bet expression. The mTOR pathway was activated after infection and its activity increased with progression of sepsis. We used mice with T-cell-specific knockout of mTOR or tuberous sclerosis complex (TSC)1 to further inhibit or strengthen the mTOR signaling pathway. We found that mTOR deletion mice had a higher CD4+ T cell count by regulating T-bet expression, and the result in TSC1 deletion mice was reversed. These results demonstrate that T-bet expression mediated by the mTOR pathway influences the CD4+ T cell count in mice with Candida sepsis.

Background Although blood cultures are the clinical diagnostic standard for candidemia, their delay in results and low sensitivity has lead to increasing the use of alternate tests and diagnostic algorithms. The T2Candida magnetic resonance assay (T2C) results in a few hours, but concomitant cultures are also needed. We compared results from the T2C with β-d-glucan (BDG), blood cultures (BCx) and the Candida Sepsis Score (CSc) in diagnosis and management of candidemia. Methods This retrospective observational study included patients from July 2017 to December 2018 who had a T2C as well as BCx. Positive (+) and negative (–) results of BCx and BDG within 24 hours (24 h) of T2C were recorded, with clinical data to determine CSc at the time of T2C (recent surgery, severe sepsis, parenteral nutrition, multifocal candida colonization). Results There were 648 T2Cs done over the study period. Only the first +T2C for patients with multiple T2Cs on admission was included. There were 41 patients with +T2, in which 31 had a 24hBCx. Two patients were of pediatric age. There were 7 neutropenic, 1 post-transplant, and 27 intensive care (ICU) patients. Reasons for ordering T2C included sepsis and persistent fevers. In 18 (44%) patients, antifungals were given prior to the T2C. Eight among 31 24hBCx were positive for concordant Candida spp. (26%). Six of these 8 patients were on antifungal therapy when T2C was sent. Seventeen patients had a 24hBDG, with 7 positive (41%). Overall mean CSc in 27 ICU patients with +T2C was 2.2 ± 0.8, and 40% of adult non-neutropenic ICU patients had a CSc of 3 or above. A central line was present in 26 patients, and was removed in 16 after +T2. In 213 patients with −T2C who had 24hBCx, only 1 BCx was positive, from a PICC line in a 2-year-old patient. Seven of the 41 patients with +T2C were treated for deep-seated candidiasis with 6 weeks antifungal therapy or longer; others received 1 to 4 weeks. Thirteen patients died while on antifungal therapy. Conclusion T2Candida was used for diagnosis and management of candidemia in patients who had concomitant blood culture positive in 26%, β-d-glucan positive in 41%, and ICU Candida sepsis score 3 or above in 40% patients. It did not miss candidemia in adults, compared with blood culture within 24 hours. Positive T2Candida helped expedite source control e.g line removal. Disclosures All authors: No reported disclosures.

Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 0-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrition. On day 24 of life, he developed candidemia, treated with 14 day course of fluconazole and shown improvement. Further, on day 60 of life he developed cholestasis, deranged liver function tests and persistent thrombocytopenia along with apnea, bradycardia and desaturations. Blood culture again grew again C. albicansEchocardiography showed large fungal vegetation on tricuspid valve with a mycetoma filling the right ventricle. He was treated with intravenous amphotericin B, fluconazole and upportive measures, but he deteriorated and succumbed after two weeks. J Microbiol Infect Dis 2015;5(3): 142-145

Despite progress in the field of biological sciences, a definitive diagnosis of Candida sepsis remains an elusive target. Candida, which is frequently found in non-immunocompromised patients in intensive care units, causes severe sepsis, septic shock, and multiple-organ failure in a similar fashion as bacteria. Despite its imprecision, the blood and/or sterile-site culture is still the gold standard for diagnosis, although new biological markers are becoming available for earlier and more accurate diagnosis of invasive candidiasis. Mortality remains high due to a number of factors, and early initiation of appropriate antifungal therapy is a critical factor in positive outcomes. Echinocandins are the drug of choice for severe Candida infections in hospitalized patients. Antifungal stewardship programs may decrease the likelihood of resistance strains, and preventive measures are becoming available to lower the rate of fungal infections in intensive care units.

Summary. The third case of a culturally and histologically proven candidosis of the prostate in the world literature available to us is reported. Autopsy of a 59-year-old man with metastasizing bronchial carcinoma as predisposing primary disease revealed a local candidosis of the prostate in the left lobe of the prostate, without evidence of a Candida sepsis. Parallel and different aspects in comparison with the other two cases are described. Zusammenfassung. Der dritte Fall in der Weltliteratur einer kulturell und histologisch gesi-cherten Prostata-Candidose wird beschrieben. Die Obduktion eines 59-jahrigen Mannes mit metastasierendem Bronchialcarcinom als pradis-ponierende Grunderkrankung ergab eine lokale Prostata-Candidose im linken Prostatalappen, ohne Hinweise fur eine Candida-Sepsis. Parallelen und Unterschiede zu den zwei weiteren Kasuisti-ken werden dargestellt.

Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 30-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrition. On day 24 of life, he developed candidemia, treated with 14 day course of fluconazole and shown improvement. Further, on day 60 of life he developed cholestasis, deranged liver function tests and persistent thrombocytopenia along with apnea, bradycardia and desaturations. Blood culture again grew again C. albicans. Echocardiography showed large fungal vegetation on tricuspid valve with a mycetoma filling the right ventricle. He was treated with intravenous amphotericin B, fluconazole and supportive measures, but he deteriorated and succumbed after two weeks. J Microbiol Infect Dis 2015;5(3): 142-145Key words: Prematureneonate, candida sepsis, endocarditis, mycetoma, Prematür yenidoğanlarda mantar miçetoma nadirdir ve sıklıkla mortaliteyle sonuçlanır. Olguların çoğunda tanı postmortem konulur. Burada Candida albicans ile kan dolaşımı enfeksiyonu gelişen, ardından endokardit ve miçetoma ile komplike olan 30 haftalık preterm bir yenidoğan olgusunu sunduk. Bu yenidoğanın başlangıçta çoklu antibiyotik kullanmayı gerektiren Klebsiella sepsisi vardı. Total parenteral beslenme için periferden konulan bir santral venöz kateter kullanıldı. Doğumdan sonraki 24. günde kandidemi gelişti, 14 gün süreyle flukonazol ile tedavi edildi ve iyileşme gösterdi. Daha sonra 60. günde kolestaz gelişti ve bozulan karaciğer fonksiyon testleri ve sürekli trombositopeni ile birlikte apne, bradikardi ve satürasyon bozuklukları ortaya çıktı. Kan kültüründe tekrar C. albicans üredi. Ekokardiyografide sağ ventrikülü dolduran bir miçetoma ile triküspid kapak üzerinde büyük bir mantar vejetasyonu görüldü. Damar yoluyla amfoterisin B ve flukonazol tedavisi yanında diğer gereken tıbbı destekler yapıldı ancak hastanın genel durumu bozularak iki hafta sonra kaybedildi

We report 3 patients who were delivered prematurely and who developed a lens opacity with signs of ocular inflammation at a postgestational age of 10-52 weeks. All patients had been treated for Candida sepsis as neonates. Each patient underwent lensectomy and anterior vitrectomy. In 2 infants Candida albicans was cultured from the lens/anterior chamber membrane; in 1 Candida parapsilosis was cultured from a lens aspirate. Despite eradication of the fungal infection, outcomes were poor: 2 eyes developed glaucoma, and 1 developed a retinal detachment with subsequent phthisis.

Invasive fungal infection is common in the present day NICUs - generally manifesting as candiduria or candida sepsis. Fungal balls in the kidneys are very uncommon and most are amenable to higher antifungal agents. However, we had a child who did not respond to such measures and ultimately needed a surgical removal of the fungal ball in his kidney. We report this case along with a review of literature to highlight about this uncommon, but an important cause of persistent sepsis in pre-term infants and to review the treatment options including a surgical removal.

Summary Left ventricular non-compaction/hypertrabeculation (LVHT) is a rare cardiac abnormality characterized by more than three trabeculations protruding from the left ventricular wall, apically to the papillary muscles, visible in one echocardiographic image plane and intertrabecular spaces, perfused from the ventricular cavity. LVHT is frequently associated with neuromuscular disorders. Differential diagnoses of LVHT are intraventricular thrombi, false tendons, aberrant bands, intramyocardial hematoma, cardiac metastases and the apical type of hypertrophic cardiomyopathy. Intramyocardial abscesses have not been reported as a differential diagnosis of left ventricular non-compaction. In the presented case, cardiac microabscesses as a result of Candida sepsis mimicked left ventricular non-compaction in a 55-year-old man with hypopharyngeal carcinoma who died 20 days after chemotherapy. These microabscesses were not visible on echocardiography but were detected only at histologic examination of the myocardium. This case shows that intramyocardial abscesses as a result of Candida sepsis are a rare differential diagnosis of LVHT. Zusammenfassung Die linksventrikulare Hypertrabekulierung/Noncompaction ist eine seltene kardiale Abnormitat, die durch >3 Trabekel gekennzeichnet ist, die apikal der Papillarmuskeln in das Cavum des linken Ventrikels hineinragen, in einer echokardiographischen Bildebene sichtbar sind, und intertrabekulare Spalten, die mit dem Cavum des linken Ventrikels kommunizieren. Die linksventrikulare Hypertrabekulierung/Noncompaction ist haufig mit neuromuskularen Erkrankungen assoziiert. Differentialdiagnosen der linksventrikularen Hypertrabekulierung/Noncompaction umfassen ventrikulare Thromben, aberrante Sehnenfaden, intramyokardiale Hamatome, kardiale Metastasen und den apikalen Typ der hypertrophen Kardiomyopathie. Intramyokardiale Abszesse als Differentialdiagnose der linksventrikularen Hypertrabekulierung/Noncompaction sind bisher nicht bekannt. Bei einem 55-jahrigen Mann, der 20 Tage nach Chemotherapie wegen eines exulzerierenden Plattenepithelcarzinoms des Hypopharynx verstarb, tauschten kardiale Mikroabszesse bei Candida-Sepsis linksventrikulare Hypertrabekulierung/Noncompaction vor. Diese Mikroabszesse waren echokardiographisch nicht sichtbar und wurden erst bei der histologischen Untersuchung des Herzens entdeckt. Dieser Fall zeigt, das intramyokardiale Abszesse bei Candida-Sepsis eine seltene Differentialdiagnose der linksventrikularen Hypertrabekulierung/Noncompaction darstellen.

The objective of this observational cohort study at Georgetown University Hospital from January 1, 1994 through December 31, 1997 was to investigate race, Candida sepsis, and duration of oxygen exposure in infants with retinopathy of prematurity (ROP) with birth weight ≤1,000 g. The incidence of ROP was 70.8% (114/161). The incidence of stage III or greater ROP in the Caucasian infants was significantly higher at 46.7% (14/30) than in the African-American infants at 23.8% (20/84) with p < 0.02. In addition, the incidence of threshold disease was higher in Caucasian infants 33.3% (10/30) when compared to African-American infants 9.5% (8/84) with p < 0.002. Using multiple logistic regression, African-American race was found to be an independent protective factor against developing severe ROP [adjusted odds ratio 0.39; 95% confidence interval (UCI) 0.16–0.97]. Extremely-low-birth-weight African-American infants with comparable severity of illness (including birth weight, gestational age, duration of supplemental oxygen exposure, and Candida sepsis) are less likely to develop severe ROP than Caucasian infants.

We report a case of congenital cutaneous candidiasis (CCC) progressing to candidemia in an extremely low birth weight infant. A high level of suspicion concerning candida sepsis as well as timely diagnostic work-up and treatment can be lifesaving when a preterm infant presents with lesions suggestive of congential cutaneous candidiasis.

A 56-year-old man with a history of intravenous drug use and multiple infectious complications developed candida fungemia, which was initially treated with fluconazole and then liposomal amphotericin. At admission, he had normal calcium, phosphate, and magnesium but developed persistent hyperphosphatemia (phosphotungstate on Beckman DCxI) with values of 5 to 6.5 mg/dL (reference interval 2.5–4.5 mg/dl) despite only mild, stable renal …

Serious infections due to Candida species are an emerging nosocomial problem. Therapy for culture-proven candidemia in nonneutropenic patients has been studied extensively, and these studies suggest that fluconazole and conventional amphotericin B are equivalent treatments under most circumstances. Empiric antifungal therapy for the seriously ill, febrile, nonneutropenic intensive care unit patient has been less well studied, but an understanding of the important risk factors for invasive candidiasis can help guide rational therapeutic choices. The important role of empiric antifungal therapy in the persistently febrile neutropenic host has been well established. The role of the lipid formulations of amphotericin B in the treatment of candidiasis remains unclear, but these compounds should be considered in any patient requiring amphotericin B with significant renal dysfunction. The trend towards nonalbicans Candida species as a cause of invasive candidiasis, together with an improved understanding of antifungal susceptibility data, should help clinicians and investigators devise new and better approaches to the treatment of this important nosocomial infection.

The incidence of candidemia and invasive Candida infections has increased substantially over the last 2 decades. These infections are associated with risk factors that characterize intensive care unit patients. Candidemia and invasive Candida are highly morbid and associated with significantly increased mortality. Outcomes in the intensive care setting depend on physician awareness and rapid intervention. The epidemiology of the disease, its diagnostic challenges, and management strategies, including prophylactic, preemptive, and definitive therapeutic approaches, are presented herein.

Endogenous infantile Candida endophthalmitis is a rare but potentially devastating condition resulting from sequestration of the fungus within the lens after systemic infection. We report the case of a 20-week-old girl with a history of Candida sepsis who presented with bilateral Candida albicans endophthalmitis 15 weeks after completing a 6-week course of intravenous antifungal therapy. Prompt vitrectomy resulted in salvage of the right eye, although a total retinal detachment occurred. Cataract extraction and administration of intravenous and intravitreal amphotericin B preserved vision in the left eye.

The existence of chitotriosidase, a human chitinolytic enzyme, hydrolyzes artificial chitotrioside substrates, but its specific function in humans is unknown. The homologous chitinases have an anti-fungal action in plants. In patients with Gaucher disease, chitotriosidase activity is markedly elevated and is a marker for response to specific treatment. In all populations, 6% of individuals are enzyme deficient but completely healthy. It was hypothesized that chitotriosidase deficient persons may be more vulnerable to fungal infections. Thus, the objective of the study was to ascertain the prevalence of homozygosity for the mutation of chitotriosidase among survivors of Candida sepsis. The prevalence of homozygosity among survivors was similar to that in the normal population. Although the cohort is the largest of its kind, since only survivors were tested, further studies should include all patients with Candida sepsis for comparison of survival rates among deficient versus sufficient individuals, and thereby elucidate if this enzyme has an anti-fungal function in man. Several theories are considered to explain the results.

Candida albicans resides on epithelial surfaces as part of the physiological microflora. However, under certain conditions, it may cause life-threatening infections, including Candida sepsis. We have recently shown that human β-defensins (hBDs) hBD-2 and hBD-3 are upregulated in Candida esophagitis and that this antifungal host response is distinctly regulated by NF-κB and MAPK/activator protein-1 (AP-1) pathways. Here, we show that C. albicans induces hBD-2 through an autocrine IL-1β loop and that activation of the epidermal growth factor receptor (EGFR) by endogenous transforming growth factor-α (TGF-α) is a crucial event in the induction of hBD-3. To further dissect upstream signaling events, we investigated expression of the central sheddases for EGFR ligands ADAM10 and ADAM17 in the healthy and infected esophagus. Next, we used pharmaceutical inhibitors and small-interfering RNA-mediated knock down of ADAM10 and ADAM17 to reveal that ADAM17-induced shedding of TGF-α is a crucial step in the induction of hBD-3 expression in response to Candida infection. In conclusion, we describe for the first time an autocrine IL-1β loop responsible for the induction of hBD-2 expression and an ADAM17-TGF-α-EGFR-MAPK/AP-1 pathway leading to hBD-3 upregulation in the course of a Candida infection of the esophagus.

Purpose: Various pancreaticojejunostomy (PJ) techniques have been devised to minimize the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study describes a modification of the mattress suture PJ technique, which we call “inverted mattress PJ (IM)”. The results of an IM group and a historical consecutive control group were compared to determine how the IM technique affected POPF. Methods: From 2003 to 2010, 186 consecutive patients underwent PD. A former group of 52 consecutive patients who underwent conventional duct-to-mucosa PJ (DM) was used as a historical control group. The IM technique was utilized for the IM group (134 patients). The clinicopathological features and surgical outcomes of the 2 groups were compared, with a particular focus on postoperative POPFs. Results: The average surgery duration was shorter in the IM group (580.3 minutes vs. 471 minutes, P ＜ 0.001). Grades B and C POPFs occurred less frequently in the IM group, but the difference was not statistically significant (17.3% vs. 9.7%, P = 0.200). However, no grade C POPF occurred in the IM group compared with 5.8% of grade C POPFs (3/52) in the DM group (P = 0.020). Three patients died (1 in the DM group and 2 in the IM group). The causes of death were arrhythmia in 2 cases and Candida sepsis in 1 case. POPF was not causally related to the 3 deaths. Conclusion: IM end-to-side PJ shortened operation time and increased safety with no incidence of grade C POPF.

Sepsis can occur during disseminated candidiasis, but its pathogenesis differs from that caused by typical prokaryotic pathogens. Complex interactions between defects in host defense and "relative" virulence factors expressed by Candida lead to dissemination of the saprophyte to parenchymal organs, and subsequently to onset of multiorgan failure. This review focuses first on the pathophysiology of Candida sepsis, detailing current understanding of host-pathogen interactions. We then consider the choice of antifungal and supportive treatments.

A 30-year-old man under treatment for acute leukemia died of Candida sepsis and Pneumocystis carinii pneumonia. A small granuloma containing Pneumocystis carinii was found in one optic nerve.

Purpose: The kidney is a common site of end organ involvement in patients with candidemia. This study was undertaken to inves- tigate clinical features and outcomes of renal mycetoma complicated by Candida sepsis in neonates. Methods: A retrospective analysis of the medical records and radiologic images was conducted in a neonatal intensive care unit over a 9-year period (2002-2010). Results: During the study period, there were 69 episodes of Candida sepsis. C. albicans was the most common pathogen (49.2%), and C. parapsilosis was the second (42%), but emerging. Of the 42 patients who underwent ultrasound examination in early phase of infection, renal mycetoma was observed in 8 cases (19.1%). Renal mycetoma was more frequently developed in patients with C. albicans sepsis than those with non-albicans candidemia, but the result was not significant. The demographic characteristics of the two groups of patients who had Candida sepsis (with renal mycetoma vs. without renal mycetoma) were similar. Candiduria was more common in the mycetoma group (P

IL-1β plays an important role in antifungal defense. The inflammasome is thought to be required for caspase-1 activation and processing of the inactive precursor pro-IL-1β into its active form. Contradictory data have been reported regarding the role of the inflammasome in Candida sepsis. In order to address these discrepancies, we investigated host defense against disseminated candidiasis in knockout mice defective in the various components of the inflammasome.

Recent epidemiologic literature indicates that candidal species resistant to azoles are becoming more prevalent in the face of increasing incidence of hospitalizations with candidemia. Echinocandins, a new class of antifungal agents, are effective against resistant candidal species. As delaying appropriate antifungal coverage leads to increased mortality, we evaluated the cost-effectiveness of 100 mg daily empiric micafungin (MIC) vs. 400 mg daily fluconazole (FLU) for suspected intensive care unit-acquired candidemia (ICU-AC) among septic patients.We designed a decision model with inputs from the literature in a hypothetical 1000-patient cohort with suspected ICU-AC treated empirically with either MIC or FLU or no treatment accompanied by a watchful waiting strategy. We examined the differences in the number of survivors, acquisition costs of antifungals, and lifetime costs among survivors in the cohort under each scenario, and calculated cost per quality adjusted life year (QALY). We conducted Monte Carlo simulations and sensitivity analyses to determine the stability of our estimates.In the base case analysis, assuming ICU-AC attributable mortality of 0.40 and a 52% relative risk reduction in mortality with appropriate timely therapy, compared with FLU (total deaths 31), treatment with MIC (total deaths 27) would result in four fewer deaths at an incremental cost/death averted of $61,446. Similarly, in reference case, incremental cost-effectiveness of MIC over FLU was $34,734 (95% confidence interval $26,312 to $49,209) per QALY. The estimates were most sensitive to the QALY adjustment factor and the risk of candidemia among septic patients.Given the increasing likelihood of azole resistance among candidal isolates, empiric treatment of ICU-AC with 100 mg daily MIC is a cost-effective alternative to FLU.

Candida spp. is the third most common reason for sepsis in the ICU, not differentiating our results from the classic pattern of ICU-acquired infection. Prevention of sepsis development and identification of potentially modifiable risk factors are important goals in intensive care patents. Preemptive treatment of Candida sepsis accepted by some authors is defined as an early antifungal treatment given to patients with evidence of substantial colonization in the presence of multiple risk factors for Candida infection prior to establishing the diagnosis by cultures. Our aim was to form a focused group of patients with significant risk for Candida sepsis; to prove the feasibility and efficacy of our preemptive scheme for antimycotic treatment in order to reduce the risk of development of proved Candida sepsis.

Background: Candida species are becoming one of the most common pathogens associated with nosocomial infection in the neonatal intensive care units (NICU). This study was undertaken to investigate clinical features and radiologic findings of meningitis complicating candida sepsis in the neonates.