Serious
Yeast Infections Introduction: There are three
major serious candida infections that need to be dealt with here: sepsis, peritonitis
and meningitis. All of these are life threatening conditions, which when missed
would quickly lead to death. The reason yeast infections are infecting a person
systemically (such as in sepsis and in meningitis) is often because of a compromise
of the immune system. In the case of peritonitis there usually
is a defect such as a perforated ulcer or an intrusion from the gut after prolonged
antibiotic therapy that dysbalanced the bowel flora and allowed the yeast bugs
to penetrate into the normally sterile peritoneal cavity. Often in these conditions
there would be a weakness of the immune system at the same time. Candida
Sepsis
About
80% of the major fungal systemic infections are due to Candida albicans. It is
the most common fungus infection in people with compromised immune systems such
as cancer patients, AIDS patients, patients who are treated with chemotherapy
for leukemia or cancer. Any of the above conditions, particularly when coupled
with other factors such as hospitalization or intravenous therapy for another
illness or antibiotic therapy for bacterial infections, can suddenly turn into
this emergency situation, Candida sepsis. Normally blood is sterile with no growth
of bacteria or blood. However, with Candida sepsis blood cultures will suddenly
grow Candida albicans, which would establish the diagnosis. Symptoms:
The only clue that a systemic yeast infection is present may be a high
fever, weakness and further deterioration and symptoms similar to bacterial sepsis.
On top of these symptoms there are the other symptoms of the underlying conditions
such as esophageal candidiasis or other Candida infection as mentioned above.
The eyes can get infected via the blood stream and this can turn into blindness,
if untreated. Treatment: In a life threatening situation
like this the physician will take all the necessary cultures (blood cultures and
swabs) and send them to the lab. However, the physician will not wait for the
results, but go with the clinical diagnosis and start intravenous therapy with
the amphotericin B, which is an antifungal antibiotic, right away. By the time
the cultures come back the patient is usually much better and the physician can
now decide whether to switch the medication to another antifungal therapy, based
on culture and sensitivity results. High dose fluconazole therapy may have to
be given and in some AIDS patients and other high risk patients this may have
to be continued on an ongoing basis as a maintenance therapy. Candida
Peritonitis This is a serious illness, which usually
happens in postoperative patients. Examples are patients who had an ulcer or a
diverticular disease with an abscess, which may have perforated and was surgically
repaired. Because of the bacterial peritonitis that these patients were found
to have, high and prolonged antibiotic therapy for the bacterial peritonitis had
to be employed. This can result at times in a therapy induced Candida peritonitis
as one of the complications. Normally the peritoneal cavity is free of
bacteria or yeast bugs. The contents of the gut contains yeast bugs as part of
the natural flora. When this leaks into the peritoneal cavity, the yeast infection
is only a small part of the mixed infection in the peritoneal cavity initially.
Later, when the bacteria are all treated and eradicated with the antibiotics,
the yeast infection is the only infection that stays behind. Unfortunately these
patients are often in septic shock from the bacterial peritonitis or septicemia
and the prognosis is very guarded when a Candida peritonitis sets in. Symptoms: High
fever and abdominal pain are the main symptoms. There is usually a rigid abdomen,
which the physician will detect and the bowel sounds are absent when the physician
uses the stethoscope to listen to the abdomen. Treatment: Treatment
for this is usually intravenous amphotericin B.
Candida
Meningitis This clinical entity usually does not
occur without a prior history of a bacterial infection that was treated extensively
with antibiotics. Or there may be an underlying other disease such as leukemia
or a prior kidney transplant, for which the person is on immunosuppressive therapy.
It is in these high risk settings that Candida meningitis occurs. It often occurs
also when the patient is suffering from Candida septicemia. When yeast bugs are
in the blood stream already, it takes very little for the infection to migrate
via the blood stream onto the meningeal surfaces of the brain, which are normally
bug free. When this occurs the patient gets sick very quickly and the physician
needs to act fast to rescue this patient. Symptoms: Candida
meningitis tends to not be as acute as bacterial meningitis. However, the symptoms
are similar, only they are developing over several days or weeks instead of in
one day as with bacterial meningitis. Headaches, a stiff neck, fever, vomiting
are all warning signs. With no treatment this will progress to a drowsiness, unconsciousness,
possibly seizures and death. The physician will intervene and do a thorough neurological
examination, a CT scan and a lumbar puncture to obtain a cerebrospinal fluid sample
for culturing. Following this there likely will be institution of therapy. Treatment:
There is no standard regimen for Candida meningitis. Usually amphotericin
B intravenously is the therapy of choice. Sometimes this has to be given through
a catheter intrathecally (into the space where the cerebrospinal fluid is, so
that the medication reaches higher concentrations in the meningeal area. Depending
on the results of the culture and sensitivity testing this regimen may have to
be combined with flucytosine, another antifungal medication. In AIDS patients
there have been a number of cases where resistant yeast infections have been found
and several newer antifungal medications in combination may have to be given by
the physician (Ref. 1, p. 1220).
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