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An ongoing dialogue on HIV/AIDS, infectious diseases,
January 21st, 2014
Unanswerable Questions in Infectious Diseases: The Positive Cultures for Candida in an ICU Patient
OK, gang. You did such a bang-up job on Question #1 that I can’t resist getting another consult.
Here’s the case: Patient in intensive care, has been there for some time — at least a week, probably weeks. Perhaps he/she had surgery (especially abdominal surgery) that didn’t go well, or has severe cardiovascular disease, or multiple trauma from an MVA, or suffered a large intracerebral hemorrhage or stroke. There have been several antibiotic “courses” directed at fevers of too many origins.
Each day you see the patient, and each day there’s a fever — generally 100.5 or a bit higher. Normotensive. Nothing obvious on exam. Labs show a WBC of 11-15 — in other words, not normal but not horribly abnormal either. LFTs are fine.
All bacterial cultures are unrevealing. Several sputum cultures, however, are positive for Candida; a urine culture (from a foley catheter) is positive also. If the patient has an abdominal drain, it has a few yeast in there too. Imaging is non-specifically abnormal — some pleural effusions, but no obvious pneumonia; CT shows no abscess.
So here’s the question:
Should patients in the ICU be given systemic treatment for Candida spp. if they have positive cultures from multiple sites other than blood?
Or just go ahead and vote, and have at it in the comments section.