Invasive Fungal Disease

Infection & Sepsis · ICU Decoded chapter 39 · Free in full

Cited to IDSA Candidiasis 2016 / Aspergillosis.

Key points

Candidemia: echinocandin first (caspofungin 70/50), remove lines, dilated ophthalmologic examination in symptomatic patients or when clinically indicated, repeat cultures q24–48 h.
Treat ≥2 wk after first NEGATIVE culture; azole step-down if stable + susceptible.
Invasive aspergillosis: voriconazole is first-line; galactomannan/β-D-glucan plus CT halo sign help in neutropenics.
Mucormycosis: amphotericin B with urgent surgical debridement; reverse immunosuppression.
Isavuconazole is now an accepted first-line alternative for invasive aspergillosis and mucormycosis.

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