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Lee EJ, Kim JT. Successful treatment of fungal central thrombophlebitis by surgical thrombectomy in Korea: a case report. JOURNAL OF TRAUMA AND INJURY 2023; 36:276-280. [PMID: 39381693 PMCID: PMC11309263 DOI: 10.20408/jti.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 10/10/2024] Open
Abstract
Fungal thrombophlebitis of the central vein is a rare, life-threatening disease associated with significant morbidity and mortality. It requires immediate central venous catheter removal and intravenous antifungal therapy, combined in some cases with either anticoagulation or aggressive surgical debridement. A 70-year-old male patient injured by a falling object weighing 1,000 kg was transferred to our hospital. A contained rupture of the abdominal aorta with retroperitoneal hematoma was treated with primary aortic repair, and a small bowel perforation with mesenteric laceration was treated with resection and anastomosis. After a computed tomography scan, the patient was diagnosed with thrombophlebitis of the left internal jugular vein and brachiocephalic vein. Despite antifungal treatment, fever and candidemia persisted. Therefore, emergency debridement and thrombectomy were performed. After the operation, the patient was treated with an oral antifungal agent and direct oral anticoagulants. During a 1-year follow-up, no signs of candidemia relapse were observed. There is no optimal timing of surgical treatment for relapsed fungal central thrombophlebitis. Surgical treatment should be considered for early recovery.
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Affiliation(s)
- Eun Ji Lee
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jihoon T. Kim
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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2
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Maulat C, Lapierre L, Migueres I, Chaufour X, Martin-Blondel G, Muscari F. Caval replacement with parietal peritoneum tube graft for septic thrombophlebitis after hepatectomy: A case report. World J Hepatol 2019; 11:133-137. [PMID: 30705726 PMCID: PMC6354118 DOI: 10.4254/wjh.v11.i1.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/04/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.
CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy, the patient’s condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.
CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.
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Affiliation(s)
- Charlotte Maulat
- Digestive Surgery, Toulouse University Hospital, Toulouse 31400, France
| | - Léopoldine Lapierre
- Department of Infectious and Tropical Diseases, Toulouse-Purpan University Hospital, Toulouse 31300, France
| | - Isabelle Migueres
- Digestive Surgery, Toulouse University Hospital, Toulouse 31400, France
| | - Xavier Chaufour
- Vascular Surgery Department, Toulouse-Rangueil University Hospital, Toulouse 31059, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse-Purpan University Hospital, Toulouse 31300, France
| | - Fabrice Muscari
- Digestive Surgery, Toulouse University Hospital, Toulouse 31400, France
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3
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Talaie T, Drucker C, Aicher B, Khalifeh A, Lal B, Sarkar R, Toursavadkohi S. Endovascular Thrombectomy of Septic Thrombophlebitis of the Inferior Vena Cava: Case Report and Review of the Literature. Vasc Endovascular Surg 2018; 52:641-647. [PMID: 29898647 DOI: 10.1177/1538574418779475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We describe the cases of 2 patients who had septic thrombophlebitis and were successfully managed with endovascular thrombectomy. Patient A developed septic thrombophlebitis of the inferior vena cava after several retroperitoneal resections for metastatic renal cell carcinoma. The thrombus was successfully removed via endovascular mechanical balloon thrombectomy. Patient B was a patient with pancreatic adenocarcinoma involving the portal vein who developed a septic inferior vena cava thrombus extending from the level and beyond the renal veins, for which she underwent endovascular thrombectomy. We argue that this approach is safe and feasible. It should be considered as a supplemental treatment modality for select decompensating patients who require lifesaving interventions and have contraindications to traditional management of surgical thrombectomy or excision of the involved venous segment.
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Affiliation(s)
- Tara Talaie
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles Drucker
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brittany Aicher
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Khalifeh
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brajesh Lal
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rajabrata Sarkar
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shahab Toursavadkohi
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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4
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Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1-50. [PMID: 26679628 PMCID: PMC4725385 DOI: 10.1093/cid/civ933] [Citation(s) in RCA: 1912] [Impact Index Per Article: 239.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
| | - Carol A Kauffman
- Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor
| | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Thomas J Walsh
- Weill Cornell Medical Center and Cornell University, New York, New York
| | | | - Jack D Sobel
- Harper University Hospital and Wayne State University, Detroit, Michigan
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5
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Haltmeier T, Inaba K, Effron Z, Dollbaum R, Shulman IA, Benjamin E, Lam L, Demetriades D. Candida Score as a Predictor of Worse Outcomes and Mortality in Severely Injured Trauma Patients with Positive Candida Cultures. Am Surg 2015. [DOI: 10.1177/000313481508101031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Invasive candidiasis is associated with worse outcomes and increased mortality in critically ill patients. The Candida score (CS) provides a clinical tool for identifying patients at risk for invasive candidiasis. Outcomes of severely injured trauma patients with positive Candida cultures stratified by their CS have not been well described. In this retrospective observational study, all severely injured trauma patients (Injury Severity Score ≥16) admitted to the Los Angeles County and University of Southern California Medical Center from April 2008 to April 2014 with positive Candida cultures were included. Outcomes of patients with a low risk for invasive candidiasis (CS < 3) were compared with those with a high risk (CS ≥ 3). A CS ≥ 3 was significantly associated with higher mortality (35.9% vs 5.0%, P = 0.001), longer length of stay (LOS) (median 49.0 vs 28.0, P = 0.002), longer intensive care unit LOS (35.0 vs 20.0, P < 0.001), requirement for renal replacement therapy (38.5% vs 4.9%, P < 0.001), and increased ventilator days (22.0 vs 12.0, P < 0.001). Multi-variable regression analysis revealed a CS ≥ 3 as a significant predictor for increased mortality [OR 6.983], longer LOS [regression coefficient (RC) 1.572] and intensive care unit LOS (RC 1.698), more frequent need for renal replacement therapy (OR 13.268), and increased ventilator days (RC 1.836). In conclusion, a CS ≥ 3 is significantly associated with increased mortality and worse outcomes in severely injured trauma patients with positive Candida cultures. The CS thus may serve as a clinical tool to predict outcomes in this patient population.
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Affiliation(s)
- Tobias Haltmeier
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
| | - Kenji Inaba
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
| | - Zachary Effron
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
| | - Ryan Dollbaum
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
| | - Ira A. Shulman
- Pathology, Los Angeles County and University of Southern California Medical Center, Los Angeles, California
| | - Elizabeth Benjamin
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
| | - Lydia Lam
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
| | - Demetrios Demetriades
- Departments of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California
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6
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Kim M, Kwon H, Hong SK, Han Y, Park H, Choi J, Kwon TW, Cho YP. Surgical Treatment of Central Venous Catheter Related Septic Deep Venous Thrombosis. Eur J Vasc Endovasc Surg 2015; 49:670-675. [DOI: 10.1016/j.ejvs.2015.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/16/2015] [Indexed: 11/26/2022]
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7
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Inai K, Noriki S, Iwasaki H. Should prophylactic thrombolysis be routine in clinical practice? Evidence from an autopsy case of septicemia. BMC Clin Pathol 2014; 14:6. [PMID: 24475758 PMCID: PMC3909761 DOI: 10.1186/1472-6890-14-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
Background Central venous catheters provide easy access for intravenous infusion and nutrition, but they can bring about complications such as catheter-related infections. Infected central venous catheters often cause nosocomial bloodstream infections with high morbidity and mortality. However, most of the morphological data that have been published are derived from in vitro and in vivo studies and few reports of direct evidence obtained from patient-derived samples have been described. Here we present visual evidence of catheter-related candidemia. To our knowledge, this is the first reported conventional histopathological evidence of a Candida-infected intraluminal thrombus in a patient’s central venous catheter. Case presentation A 62-year-old Japanese female with obstructive jaundice, gastrointestinal bleeding, and liver metastasis from pancreatic head cancer was given an implantable subcutaneous central venous port for nutrition and chemotherapy administration. High fever ensued on day 16 after the central venous port insertion and blood cultures revealed Candida albicans. Although the patient was given 300 mg/day of fosfluconazole according to the suggestion of the infection control team, she died from respiratory failure. Postmortem computed tomography revealed findings consistent with acute respiratory distress syndrome, suggesting that the patient’s course was complicated by catheter-related sepsis. Autopsy revealed a subcutaneous abscess around the port, from which C. albicans was cultured. However, no catheter-adherent thrombus, thrombosis of the great central veins, or endocardial vegetations were detected in the patient. Histological analysis revealed scattered abscesses in several organs including lungs and kidneys. Hyaline membrane formation and Candida colonies were found in the lungs. The central venous port tube, together with the part of the subclavian vein into which it had been inserted, was involved in an intraluminal fibrin thrombus containing neutrophils and macrophages, indicating that the thrombus existed while the patient was alive. Histopathological examination following use of the periodic acid-Schiff reagent and the Grocott stain revealed scattered Candida in the thrombus. Conclusions Prophylactic thrombolysis should be encouraged to prevent central venous catheter-related candidiasis in clinical practice.
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Affiliation(s)
- Kunihiro Inai
- Division of Molecular Pathology, Department of Pathological Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui 910-1193, Japan.
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8
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Bohórquez R, García ÁA, Santacruz D, Zuluaga JF. Trombosis de vena cava superior asociada a catéter en paciente crítico: Reporte de un caso y breve revisión de la literatura. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70154-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Canadian clinical practice guidelines for invasive candidiasis in adults. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2012; 21:e122-50. [PMID: 22132006 DOI: 10.1155/2010/357076] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Candidemia and invasive candidiasis (C/IC) are life-threatening opportunistic infections that add excess morbidity, mortality and cost to the management of patients with a range of potentially curable underlying conditions. The Association of Medical Microbiology and Infectious Disease Canada developed evidence-based guidelines for the approach to the diagnosis and management of these infections in the ever-increasing population of at-risk adult patients in the health care system. Over the past few years, a new and broader understanding of the epidemiology and pathogenesis of C/IC has emerged and has been coupled with the availability of new antifungal agents and defined strategies for targeting groups at risk including, but not limited to, acute leukemia patients, hematopoietic stem cell transplants and solid organ transplants, and critical care unit patients. Accordingly, these guidelines have focused on patients at risk for C/IC, and on approaches of prevention, early therapy for suspected but unproven infection, and targeted therapy for probable and proven infection.
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10
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Caccese R, Carfagna P, Pistilli N, Massetti AP, Falcone M, Venditti M. Candidal thrombophlebitis of central veins: case report and review. Med Mycol 2011; 50:299-304. [PMID: 21905947 DOI: 10.3109/13693786.2011.604046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although candidemia and central catheter septic thrombosis is quite common, central veins thrombophlebitis caused by Candida spp. is a rarely reported complication in critically ill patients. Here we report a case of thrombophlebitis of the right internal jugular and subclavian veins due to Candida albicans which occurred in a patient admitted in the intensive care unit for major trauma. The individual was eventually cured after prolonged course of antifungal therapy. We also review 24 additional cases of Candida induced central veins thrombophlebitis reported since 1978. A central vein catheter was in place in all 25 patients with 21 (84%) being admitted in an intensive care unit, 22 (88%) were receiving total parenteral nutrition and 23 (92%) undergoing a course of antibiotic therapy. Overall mortality was 16%, including two patients who received no therapy and died. In the group of patients receiving only medical therapy, the mortality rate was 13%, while no deaths were observed among those treated with combined medical and surgical therapy. Literature data suggest that Candida caused central veins thrombophlebitis is a rare and probably underdiagnosed infectious complication of the critically ill patient. Despite the dramatic presentation with persistent candidemia, mortality is low even with a conservative medical approach with prolonged fungicidal therapy through the use of amphotericin B or echinocandins. Thus, the decision for a combined surgical debridement should be assessed for each patient.
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Affiliation(s)
- Roberta Caccese
- Department of Emergency Medicine, San Giovanni-Addolorata Hospital, Rome, Italy
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11
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Lee JS, Kim KW. Disseminated septic emboli, septic thrombosis of the vena cava and the common iliac and renal veins, and retroperitoneal abscess secondary to pyogenic spondylitis of the lumbar spine: a case report. J Bone Joint Surg Am 2011; 93:e59. [PMID: 21655878 DOI: 10.2106/jbjs.j.01157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jun-Seok Lee
- Department of Orthopaedic Surgery, Dongshin General Hospital, Hongeun-dong 430, Seodaemoon-ku, 120-848, Seoul, South Korea.
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12
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Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503-35. [PMID: 19191635 PMCID: PMC7294538 DOI: 10.1086/596757] [Citation(s) in RCA: 2011] [Impact Index Per Article: 134.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.
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Affiliation(s)
- Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.
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13
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Hong SK, Nam SH, Kim HC. Fatal peripheral candidal suppurative thrombophlebitis in a postoperative patient. J Korean Med Sci 2008; 23:1094-6. [PMID: 19119456 PMCID: PMC2610646 DOI: 10.3346/jkms.2008.23.6.1094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 01/25/2008] [Indexed: 11/29/2022] Open
Abstract
We report a case of fatal fungal peripheral suppurative thrombophlebitis, caused by Candida albicans, which was disseminated to the blood, lungs, eyes, and spine. Clinical suspicion and aggressive management are important in managing fungal peripheral suppurative thrombophlebitis. Early clinical suspicion is important in managing fungal peripheral suppurative thrombophlebitis, and radical excision of the affected veins, recognition of metastatic foci, and use of systemic antifungal agents are essential to avoid septic shock and death.
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Affiliation(s)
- Suk-Kyung Hong
- Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Korea
| | - So-Hyun Nam
- Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Cheol Kim
- Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Korea
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14
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Gallien S, Sordet F, Enache-Angoulvant A. Traitement des candidémies chez un patient porteur d’un cathéter vasculaire. J Mycol Med 2007. [DOI: 10.1016/j.mycmed.2006.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Meda MS, Lopez AJ, Guyot A. Candida inferior vena cava filter infection and septic thrombophlebitis. Br J Radiol 2007; 80:e48-9. [PMID: 17495055 DOI: 10.1259/bjr/13944004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Candida infection following central venous catheterization (CVC) is a well known complication, most common infection being that caused by Candida albicans. Less common is infection with Candida glabrata. Candida septic thrombophlebitis of the central veins is an uncommon complication after CVC. We report the first case of inferior vena cava filter infection with C. glabrata following septic thrombophlebitis of the femoral veins and discuss management of this rare complication.
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Affiliation(s)
- M S Meda
- Department of Microbiology, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
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16
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Neofytos D, Pfaller MA, Diekema DJ, Horn D. A case of recurrent episodes of Candida parapsilosis fungemia. Mycopathologia 2007; 162:295-8. [PMID: 17039276 DOI: 10.1007/s11046-006-0060-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 07/31/2006] [Indexed: 10/24/2022]
Abstract
Candida species is the fourth most commonly isolated organism in blood stream infections in the hospital setting. Patients with candidemia frequently succumb to this infection. For those that survive an initial candidemia, an increasing number of cases of breakthrough or recurrent candidemias have been reported in the literature. We report three episodes of C. parapsilosis fungemia in a cancer patient. Molecular testing was performed and confirmed that all these episodes occurring within an eight-month period were caused by the same organism. The incidence of recurrent candidemia is likely to increase in the near future. Studies and therapeutic interventions for patients at risk for recurrent candidemias are warranted.
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Affiliation(s)
- Dionissios Neofytos
- Division of Infectious Diseases and Environmental Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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17
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Burgmans MC, Rommes JH, Spronk PE, van Nidek RJPB, Bouma WH, Gratama JWC. Septic Thrombosis of the Inferior Vena Cava Treated with Percutaneous Mechanical Thrombectomy. J Vasc Interv Radiol 2006; 17:1697-702. [PMID: 17057014 DOI: 10.1097/01.rvi.0000240734.93460.83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present report describes a patient with septic thrombosis of the inferior vena cava (IVC) related to a subhepatic abscess adjacent to the IVC. Despite prolonged antimicrobial therapy and systemic anticoagulation, sepsis and septic embolism persisted while the size of the thrombus increased. Percutaneous mechanical thrombectomy was performed, resulting in removal of the infected thrombus and complete clinical recovery.
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Affiliation(s)
- Mark C Burgmans
- Department of Radiology, Gelre Hospitals, site Lukas, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
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18
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Sims CR, Ostrosky-Zeichner L, Rex JH. Invasive Candidiasis in Immunocompromised Hospitalized Patients. Arch Med Res 2005; 36:660-71. [PMID: 16216647 DOI: 10.1016/j.arcmed.2005.05.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 05/24/2005] [Indexed: 11/17/2022]
Abstract
The frequency of infections by Candida species is increasing worldwide, with candidemia representing the fourth most common bloodstream infection in the U.S. The risk of infection is especially high in the immunocompromised, hospitalized patient. The treatment of and prophylaxis for Candida infection have led to the emergence of resistant species and the acquisition of resistance in previously susceptible species. Current therapeutic options include amphotericin B and its lipid compounds, fluconazole, itraconazole, voriconazole, and caspofungin. Research is focusing on better diagnostics and the evaluation of strategies such as prophylaxis in high-risk hosts and pre-emptive therapy.
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Affiliation(s)
- Charles R Sims
- Laboratory of Mycology Research, Division of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
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19
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Abstract
Candida species have become predominant pathogens in critically ill patients. In this population, invasive candidiasis is associated with a poor prognosis but adequate management can limit the attributable mortality. Adequate management, however, is hampered by a problematic diagnosis as the clinical picture of invasive disease is non-specific and blood cultures have a low sensitivity. Moreover, it is often hard to differentiate colonisation from infection and many critically ill patients are heavily colonised with Candida species, especially when receiving broad-spectrum antibacterials. The question of which antifungal agent to choose has become more complex as the development of new drugs raises promising expectations. Until the 1980s therapy for invasive candidiasis was limited to amphotericin B, but with the advent of new antifungal agents, such as azoles and echinocandins, less toxic therapeutic options are possible and doors have opened towards prevention and optimised therapy in the case of documented candidiasis. Through the arrival of these new antifungal agents, a range of therapeutic strategies for the management of invasive candidiasis has been developed: antifungal prophylaxis, pre-emptive therapy, and empirical and definitive antifungal therapy. Each of these strategies has a specific target population, as defined by specific underlying conditions and/or individual risk factors. Antifungal prophylaxis, in order to prevent candidal infection, is based on the type of underlying diseases with a high risk for invasive candidiasis. Individual risk factors are not taken into account. Potential indications are bone marrow transplantation, liver transplantation, recurrent gastrointestinal perforations or leakages, and surgery for acute necrotising pancreatitis. Pre-emptive therapy is also a preventive strategy. It can be recommended on the basis of an individual risk profile including overt candidal colonisation. Empirical therapy is started in patients with a risk profile for invasive candidiasis. It is recommended in the presence of clinical signs of infection, deteriorating clinical parameters, or a clinical picture of infection not responding to antibacterials but in the absence of a clear causative pathogen. Definitive antifungal therapy is defined as therapy in patients with documented invasive infection. The main goal is to maintain a balance between optimal prevention and timely initiation of therapy on one hand, and to minimise selection pressure in order to avoid a shift towards less susceptible Candida species on the other hand.
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Affiliation(s)
- Stijn Blot
- Intensive Care Department, Ghent University Hospital, Ghent, Belgium.
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Gazon M, Robert MO, Duperret S, Branche P, Viale JP. Failure of new antifungals to control Candida thrombophlebitis. Intensive Care Med 2005; 31:752-3. [PMID: 15782319 DOI: 10.1007/s00134-005-2591-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2005] [Indexed: 11/30/2022]
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Pan SC, Hsieh SM, Chang SC, Lee HT, Chen YC. SepticCandida kruseithrombophlebitis of inferior vena cava with persistent fungemia successfully treated by new antifungal agents. Med Mycol 2005; 43:731-4. [PMID: 16422304 DOI: 10.1080/13693780500302593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Treatment of Candida krusei fungemia can be problematic. We describe a 44-year-old critically ill, non-immunocompromised patient who had persistent Candida krusei fungemia complicated with septic thrombophlebitis of the inferior vena cava. Successful treatment was achieved by parenteral caspofungin followed by prolonged oral voriconazole. Persistent fungemia in the face of ongoing antifungal therapy and prompt removal of central line should alert physicians to the diagnosis of septic thrombophlebitis. Though combined therapy with amphotericin B and surgical intervention probably remains the treatment of choice, prolonged new antifungal agents, which have better efficacy, tolerability and bioavailability, may be a useful alternative where the central veins are relatively inaccessible or the patient is at high operative risk.
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Affiliation(s)
- Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Pacifico L, Panero A, Colarizi P, Matrunola M, Simonetti AF, Chiesa C. Neonatal Candida albicans septic thrombosis of the portal vein followed by cavernous transformation of the vessel. J Clin Microbiol 2004; 42:4379-82. [PMID: 15365049 PMCID: PMC516300 DOI: 10.1128/jcm.42.9.4379-4382.2004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report two premature neonates with Candida albicans septic thrombosis of the portal vein who developed, in very early childhood, the sonographic appearance of cavernous transformation of the vessel and/or clinical signs of extrahepatic portal hypertension.
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Affiliation(s)
- Lucia Pacifico
- Institute of Pediatrics, La Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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Molina L, Hernando S, del Palacio A. [Peripheral thrombophlebitis in a patient undergoing abdominal surgery]. Enferm Infecc Microbiol Clin 2004; 22:295-6. [PMID: 15207122 DOI: 10.1016/s0213-005x(04)73090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Molina
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Miceli M, Atoui R, Walker R, Mahfouz T, Mirza N, Diaz J, Tricot G, Barlogie B, Anaissie E. Diagnosis of Deep Septic Thrombophlebitis in Cancer Patients by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography Scanning: A Preliminary Report. J Clin Oncol 2004; 22:1949-56. [PMID: 15143089 DOI: 10.1200/jco.2004.10.160] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the role of the fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan in the diagnosis and management of deep septic thrombophlebitis (STP). Patients and Methods We conducted a prospective observational evaluation of FDG-PET in patients with cancer and suspected STP. Retrospective evaluation of patients with cancer and deep venous thrombosis (DVT) who underwent FDG-PET and extremity duplex scan (DS) was also performed. Results Strong venous uptake was observed in FDG-PET of nine STP episodes versus 0 of 27 DVT episodes (P < .001). FDG-PET identified central vein STP in five patients, whereas DS and venography were negative in five and two of these patients, respectively. FDG-PET diagnosis of STP resulted in therapeutic changes in all patients. In four patients, follow-up FDG-PET confirmed resolution. Conclusion In cancer patients, FDG-PET identifies STP even in areas not optimally visualized by DS or venography, distinguishes STP from DVT, and leads to significant therapeutic changes.
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Affiliation(s)
- Marisa Miceli
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, 72205, USA
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Chakrabarti C, Sood SK, Parnell V, Rubin LG. Prolonged candidemia in infants following surgery for congenital heart disease. Infect Control Hosp Epidemiol 2004; 24:753-7. [PMID: 14587937 DOI: 10.1086/502126] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe a group of infants with complex congenital heart disease (CCHD) who had candidemia postoperatively and to perform a case-control study of risk factors. DESIGN Descriptive and case-control study. SETTING Tertiary-care medical centers. PATIENTS Infants with CCHD who underwent cardiac surgery and developed candidemia. Controls were matched for congenital heart disease lesions, age, and postoperative hospital stay. RESULTS Of 95 infants younger than 6 months with CCHD who underwent cardiac surgery between January 1999 and April 2001, 6 (6.3%) developed candidemia with 5 different species. The candidemia was prolonged (range, 12 to 32 days; median, 17 days). The interval between cardiac surgery and onset of candidemia was 12 to 57 days (median, 24 days). All had a central venous catheter inserted 8 to 50 days prior to the onset of candidemia. The mortality rate was 83%, compared with 13% for the group without candidemia. A univariate analysis of the potential risk factors revealed that duration of total parenteral nutrition (TPN), duration of antibiotics, intraoperative cardiopulmonary bypass time, and documentation of an intravascular thrombus were associated with candidemia. In multivariate analysis, long duration of TPN and documentation of a thrombus were associated with candidemia. CONCLUSIONS Candidemia following cardiac surgery for infants with CCHD was persistent and associated with high mortality. The variety of species indicates that this was not a common-source outbreak. Risk factors associated with candidemia were duration of TPN and documentation of an intravascular thrombus.
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Affiliation(s)
- Chandrama Chakrabarti
- Department of Pediatrics Schneider Children's Hospital, New Hyde Park, New York 11040, USA
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Polak A. Antifungal therapy--state of the art at the beginning of the 21st century. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 2003; Spec No:59-190. [PMID: 12675476 DOI: 10.1007/978-3-0348-7974-3_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The most relevant information on the present state of the art of antifungal chemotherapy is reviewed in this chapter. For dermatomycoses a variety of topical antifungals are available, and safe and efficacious systemic treatment, especially with the fungicidal drug terbinafine, is possible. The duration of treatment can be drastically reduced. Substantial progress in the armamentarium of drugs for invasive fungal infections has been made, and a new class of antifungals, echinocandins, is now in clinical use. The following drugs in oral and/or intravenous formulations are available: the broad spectrum polyene amphotericin B with its new "clothes"; the sterol biosynthesis inhibitors fluconazole, itraconazole, and voriconazole; the glucan synthase inhibitor caspofungin; and the combination partner flucytosine. New therapy schedules have been studied; combination therapy has found a significant place in the treatment of severely compromised patients, and the field of prevention and empiric therapy is fast moving. Guidelines exist nowadays for the treatment of various fungal diseases and maintenance therapy. New approaches interfering with host defenses or pathogenicity of fungal cells are being investigated, and molecular biologists are looking for new targets studying the genomics of pathogenic fungi.
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Ferretti G, Mandala M, Di Cosimo S, Moro C, Curigliano G, Barni S. Catheter-related bloodstream infections, part I: pathogenesis, diagnosis, and management. Cancer Control 2002; 9:513-23. [PMID: 12514569 DOI: 10.1177/107327480200900610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, Craven DE. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001; 32:1249-72. [PMID: 11303260 DOI: 10.1086/320001] [Citation(s) in RCA: 817] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2000] [Indexed: 11/03/2022] Open
Affiliation(s)
- L A Mermel
- Division of Infectious Diseases, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
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Blasco-Navalpotro M, Jordán M, Camarena JJ, Borrás S. Clinical microbiological case: thermointolerant microorganism growth in blood cultures and catheter tip. Clin Microbiol Infect 2001; 7:273-4, 285. [PMID: 11422255 DOI: 10.1046/j.1198-743x.2001.00257.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, Craven DE. Guidelines for the management of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2001; 22:222-42. [PMID: 11379714 DOI: 10.1086/501893] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.
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Affiliation(s)
- L A Mermel
- Division of Infectious Diseases, Brown University School of Medicine, Rhode Island Hospital, Providence, USA
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