Please tell me about candidemia

I would ask my mom’s doctor, but I’m in NJ, and they’re in Hawaii, and communication is difficult. The web is astonishingly silent on the subject, except for complicated medical journal information (and a very short article on wiki).

Last night, my mother’s doctor told my sister that because of the antibiotics she’s taking for Klebsiella pneumonia (contracted in the hospital, of course), she has a yeast infection in her blood. A look at the Merck manual tells me that’s called candidemia. Unfortunately, the book gave no other information. The doctor said it’s very serious, especially if it was caught by the medical staff late, and I guess they’re treating it with antifungals. They won’t know for 24 to 48 hours if they’ve caught it early enough.

I’m not sure what this all means. If they caught it late, does that mean it won’t be responsive to the antifungals? They said it could spread to her IV and breathing tubes, but if they remove them and replace them with clean ones, will that solve the problem? I’m gathering from the talk my sister had with the doctor, we’re in the serious she-could-die territory, but my mom has this way of kicking death in the ass (she’s been in and out of ICU for a variety of reasons over the past 4 years, and she always walks out), and I’m wondering if candidemia is really treatable or if she’s finally met her match.

Here is a Wikipedia article as a start for you, that will give you a search term to use. (I had a hunch and tried searching Candida on Wikipedia to find that.) I’d bet the Mayo clinic would have good information on it. Prayers for your sister.

Thanks for the Wiki links; I hadn’t seen either of those (the wiki I found was fungemia, apparently another word for candidemia). They’re not giving me what I need though, unfortunately. I had checked the Mayo Clinic last night, no luck, but I checked again with some of the search terms suggested by the wiki articles you linked to, and there’s nothing there. Thanks for your good thoughts.

Weird! Paging QTM and other doctors, can you give good online resources or help assuage the OP’s fears?

As you’ve already discovered, candidemia is bad news. That being said, some of its lethality is due to the fact that it often complicates the course of people who are very sick with other things such as leukemia, lymphoma, transplants, people treated with steroids for severe systemic disease, etc. Diabetes is another common association.

Treatment of candidemia involves removing the source (if possible) such as an infected intravenous or other “line”, as well as with antibiotics (often Amphotericin for true candidemia).

Here’s a link (sorry, it’s full of jargon. But it should be of some interest).

Best of luck.

Thanks for the link. It wasn’t too difficult to read. Unfortunately my mom has all kinds of other illnesses at the moment, which makes this all very difficult. The doc said the candidemia could spread to her IV line and her breathing tube, but could it also spread to an artificial object completely in her body? I’m thinking of her pacemaker now.

Gah. I hope the doctor calls my sister soon.

Candidemia is the commonest kind of yeast infection in the blood (“candida” is a kind of yeast and “-emia” is in the blood). It’s not the only kind of fungus that gets in the blood but it’s the commonest.

You pretty much only get infected with yeast inside of the body itself if your immune system has crapped out or if all the bacteria (which compete with candida) get bumped off with antibiotics.

By itself it’s not necessarily a horrendous condition. Normally though, to get it in the first place you have an underlying serious condition. Think of it as a weakly pathogenic (disease-causing) organism that shows up only because the immune system is feeble and competitor organisms (bacteria) have been killed off by antibiotics.

A few other points:

  1. It could be a contaminant in the blood culture. Not saying it is, but not out of the question. Candida spores are everywhere.

  2. If it is in her blood, the question is whether it’s just confined to the blood stream or has gained a foothold in the tissues somewhere or in any tubes she has stuck in her. Those kinds of sources are much tougher to sterilize. I suspect that’s what they mean by “early” and “late.” “Early” meaning caught before the blood infection seeds the body. Replacing tubes if they are the source is very effective but it’s tough to prove they are the (only) nidus (source).

  3. Antifungals are tricky but potentially effective antibiotics. It’s all about the underlying physiology of the patient, in the end. Most of used to taking care of sick folks have seen assorted cases of candidiasis and candidemia come through it just fine. Let’s hope your mom is one of them.

Thank you very much. That makes things clearer. The latest is that the docs think the antifungals are working but she’s still very sick, so nothing is certain.

She has some serious underlying conditions (like Stage 4 breast cancer; the pleural effusion caused by the cancer is what put her into the hospital in the first place). Her lungs are a mess at the moment. I guess it’s just a matter of waiting now. Thanks for your reply.

Coming back to say, I am praying for your mother, I wrote sister, but meant mother. I am glad you did get some more answers, but also wanted to let you know people were still praying for her to pull through this.

Having just spent a month running an ICU, I’d concur that it’s bad news. Putting it on top of a Klebs pneumonia (Klebs is a bug that I am very, very afraid of) is not good news. With a malignant pleural effusion, I would state that the situation sounds pretty grim unfortunately.

Fungemia (fungus in the blood, which includes candidemia) is what we start to suspect in very sick people with poor immune systems when they don’t improve on normal antibiotics, or if they grow fungus in their blood cultures. You mentioned your mother has cancer. Is she currently undergoing chemotherapy and in a chemo-induced immunosuppressed state?

As others have mentioned, the first step is getting rid of the source, which is usually an indwelling intravenous catheter. The second step is adding on antifungals. For Candida, one can start with IV fluconazole unless the patient is very ill. This is because fluconazole doesn’t cover some species of Candida, and while awaiting speciation it may be necessary to cover C. glabrata empirically. In this case, empiric amphotericin or caspofungin may be called for.