Fungemia

Fungemia
Classification and external resources
ICD-9-CM	117.9
MeSH	D016469

Fungemia (Fungaemia in the UK and other Commonwealth countries) is the presence of fungi or yeasts in the blood. The most common type, also known as Candidemia, Candedemia, or Invasive Candidiasis, is caused by Candida species, but infections by other fungi, including Saccharomyces, Aspergillus and Cryptococcus, are also called fungemia. It is most commonly seen in immunosuppressed or immunocompromised patients with severe neutropenia, oncology patients, or in patients with intravenous catheters. It has been suggested the otherwise immunocompetent patients taking infliximab may be at a higher risk for fungemia.

Diagnosis is difficult, as routine blood cultures have poor sensitivity.

Treatment

Treatment involves use of antifungals such as fluconazole and amphotericin.

Risk factors

The three most important risk factors are:

Use of broad-spectrum antibiotics
Colonization by fungi (see e.g. candidiasis)

Other risk factors are:

Dialysis
Diabetes
Lowered intestinal flora
Suppressed Immune system
Use of yeast probiotics
Central venous catheter
High severity of illness
Multiple abdominal surgeries
Use of steroids
burns

Pathogens

The most commonly known pathogen is Candida albicans, causing roughly 70% of fungemias, followed by Candida glabrata with 10%, Aspergillus with 1% and Saccharomyces as the fourth most common. However, the frequency of infection by C. glabrata, Saccharomyces boulardii, Candida tropicalis, C. krusei and C. parapsilosis is increasing, perhaps because significant use of fluconazole is common or due to increase in antibiotic use.

Symptoms

Symptoms can range from mild to extreme—often described as extreme flu-like symptoms. Many symptoms may be associated with fungemia, including pain, mental disorders, chronic fatigue, and infections. Skin infections can include persistent or non-healing wounds and lesions, sweating, itching, and unusual discharge or drainage.

External links

Abnormal clinical and laboratory findings for blood tests (R70–R79, 790)

Red blood cells

Size	Anisocytosis Macrocyte Microcyte

Shape	Poikilocytosis membrane abnormalities: Acanthocyte Codocyte Ovalocyte Spherocyte Dacrocyte Echinocyte Schistocyte Degmacyte Drepanocyte Stomatocyte Knizocyte

Hemoglobinization	Anisochromia Hypochromia

Inclusion bodies	Developmental Howell–Jolly body Basophilic stippling Pappenheimer bodies Cabot rings Hemoglobin precipitation Heinz body

Other	Rouleaux Reticulocyte Elevated ESR

Lymphocytes

Small molecules

Blood sugar	Hypoglycemia Hyperglycemia Prediabetes Impaired fasting glucose Impaired glucose tolerance Oxyhyperglycemia

Nitrogenous	Azotemia Hyperuricemia Hypouricemia

Proteins

LFT	Elevated transaminases Elevated ALP Hypoproteinemia Hypoalbuminemia

Other	Elevated cardiac markers Elevated alpha-fetoprotein

Minerals

Iron overload disorder

Pathogens/sepsis

Fungal infection and mesomycetozoea (B35–B49, 110–118)

Superficial and
cutaneous
(dermatomycosis):
Tinea = skin;
Piedra (exothrix/
endothrix) = hair

Ascomycota

Dermatophyte
(Dermatophytosis)

By location	Tinea barbae/tinea capitis Kerion Tinea corporis Ringworm Dermatophytids Tinea cruris Tinea manuum Tinea pedis (athlete's foot) Tinea unguium/onychomycosis White superficial onychomycosis Distal subungual onychomycosis Proximal subungual onychomycosis Tinea corporis gladiatorum Tinea faciei Tinea imbricata Tinea incognito Favus

By organism	Epidermophyton floccosum Microsporum canis Microsporum audouinii Trichophyton interdigitale/mentagrophytes Trichophyton tonsurans Trichophyton schoenleini Trichophyton rubrum Trichophyton verrucosum

Other

Basidiomycota

Subcutaneous,
systemic,
and opportunistic

Ascomycota

Dimorphic
(yeast+mold)

Onygenales	Coccidioides immitis/Coccidioides posadasii Coccidioidomycosis Disseminated coccidioidomycosis Primary cutaneous coccidioidomycosis. Primary pulmonary coccidioidomycosis Histoplasma capsulatum Histoplasmosis Primary cutaneous histoplasmosis Primary pulmonary histoplasmosis Progressive disseminated histoplasmosis Histoplasma duboisii African histoplasmosis Lacazia loboi Lobomycosis Paracoccidioides brasiliensis Paracoccidioidomycosis

Other	Blastomyces dermatitidis Blastomycosis North American blastomycosis South American blastomycosis Sporothrix schenckii Sporotrichosis Penicillium marneffei Penicilliosis

Yeast-like

Mold-like

Basidiomycota

Cryptococcus neoformans
- Cryptococcosis
- Trichosporon spp
- Trichosporonosis

Zygomycota
(Zygomycosis)

Mucorales (Mucormycosis)	Rhizopus oryzae Mucor indicus Lichtheimia corymbifera Syncephalastrum racemosum Apophysomyces variabilis

Entomophthorales (Entomophthoramycosis)	Basidiobolus ranarum Basidiobolomycosis Conidiobolus coronatus/Conidiobolus incongruus Conidiobolomycosis

Microsporidia
(Microsporidiosis)

Enterocytozoon bieneusi/Encephalitozoon intestinalis

Mesomycetozoea

Rhinosporidium seeberi
- Rhinosporidiosis

Ungrouped

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