Overview
Fungemia refers to the presence of fungi in the bloodstream, often caused by Candida species but can also involve other yeasts like Kodamaea ohmeri. It typically occurs in immunocompromised hosts and can lead to systemic infections with potential ocular involvement 12.Diagnosis
Blood Cultures: Essential for definitive diagnosis, utilizing instruments like BACTEC 9240 for accurate detection of Candida species and other fungi 3.
Ophthalmologic Evaluation: Fundus examination by an ophthalmologist recommended for patients with fungemia to assess for ocular involvement 1.
Risk Factors: Consider diabetes and HIV history, though these show only trends as risk factors 1.Management
First-Line Antifungal Therapy: Fluconazole or echinocandins (e.g., caspofungin) for severe cases 2.
Targeted Therapy: Adjust based on specific fungal species identified (e.g., Torulopsis glabrata may require specific antifungal agents) 4.
Address Underlying Conditions: Treat any underlying infections or sources of fungemia (e.g., renal calculi) 4.Special Populations
Pediatrics: Extremely uncommon but can occur in preterm neonates, often with poor outcomes despite therapy 2.
Comorbidities: Diabetes and HIV may confer increased risk, though evidence is limited 1.Key Recommendations
Perform systematic fundus evaluation by an ophthalmologist in patients with fungemia to screen for ocular involvement (Evidence: Moderate) 1.
Utilize blood culture systems like BACTEC 9240 for reliable detection of fungemia (Evidence: Strong) 3.
Initiate targeted antifungal therapy based on the identified fungal species and severity of infection (Evidence: Moderate) 24.References
1 Restrepo Arango M, Cadavid Usuga JC, Velazquez Ossa LF, Donado Gómez JH, Higuita Duque LN, Neira Gomez JP. Risk factors for ophthalmologic involvement and ocular findings in patients diagnosed with fungemia in a high-complexity hospital in the city of Medellín, Colombia. Annals of medicine 2022. link
2 Poojary A, Sapre G. Kodamaea ohmeri infection in a neonate. Indian pediatrics 2009. link
3 Siemann M, Rabenhorst G. Detection of fungemia from blood cultures using the BACTEC 9240 instrument. Zentralblatt fur Bakteriologie : international journal of medical microbiology 1998. link80143-6)
4 Beckwith DG, Saunders CD, Anderson JR. Torulopsis glabrata fungemia secondary to stone colonization. Urology 1978. link90300-x)