3
Î Ophthalmological findings of choroidal and vitreal infection are
minimal until recovery from neutropenia. Therefore, dilated
fundoscopic examinations should be performed within the first week
after recovery from neutropenia (S/L).
Î In the neutropenic patient, sources of candidiasis other than a central
venous catheter (e.g., gastrointestinal tract) predominate. Catheter
removal should be considered on an individual basis (S/L).
Î G-CSF-mobilized granulocyte transfusions can be considered in cases of
persistent candidemia with anticipated protracted neutropenia (W/L).
IV. Chronic Disseminated (Hepatosplenic) Candidiasis
Î Initial therapy with lipid formulation AmB, 3-5 mg/kg daily OR an
echinocandin (micafungin 100 mg daily, caspofungin, 70 mg loading
dose, then 50 mg daily, or anidulafungin, 200 mg loading dose, then
100 mg daily), for several weeks is recommended, followed by oral
fluconazole, 400 mg (6 mg/kg) daily, for patients who are unlikely to
have a fluconazole-resistant isolate (S/L).
Î Therapy should continue until lesions resolve on repeat imaging,
which is usually several months. Premature discontinuation of
antifungal therapy can lead to relapse (S/L).
Î If chemotherapy or hematopoietic cell transplantation is required,
it should not be delayed because of the presence of chronic
disseminated candidiasis, and antifungal therapy should be continued
throughout the period of high risk to prevent relapse (S/L).
Î For patients who have debilitating persistent fevers, short term
(1-2 weeks) treatment with non-steroidal anti-inflammatory drugs or
corticosteroids can be considered (W/L).
V. Empirical Treatment for Suspected Invasive Candidiasis in
Non-Neutropenic Patients in the Intensive Care Unit (ICU)
Î Empirical antifungal therapy should be considered in critically ill
patients with risk factors for invasive candidiasis and no other known
cause of fever and should be based on clinical assessment of risk
factors, surrogate markers for invasive candidiasis and/or culture data
from non-sterile sites (S/M). Empirical antifungal therapy should be
started as soon as possible in patients who have the above risk factors
and who have clinical signs of septic shock (S/M).
Î Preferred empirical therapy for suspected candidiasis in non-
neutropenic patients in the ICU is an echinocandin (caspofungin,
loading dose of 70 mg, then 50 mg daily; micafungin, 100 mg daily;
anidulafungin, loading dose of 200 mg, then 100 mg daily) (S/M).
