الفهرس 
Microbiology of Candida InfectionOnly 14 pages are availabe for public view
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Abstract
Infections due to Candida species are major causes of morbidity and mortality in humans, causing a diverse spectrum of clinical disease ranging from superficial and mucosal infections to invasive disease associated with candidemia and metastatic organ involvement, as an entity, candidemia is one of the most common healthcare-associated bloodstream infections in US hospitals, typically ranking as the third or fourth most common cause of healthcare–associated bloodstream infection.
Candidemia refers to the presence of Candida species in the blood, the clinical manifestations vary from minimal fever to a full-blown sepsis syndrome indistinguishable from severe bacterial infection, acute disseminated or invasive candidiasis occurs when visceral sites are infected as a result of hematogones spread.
Prompt and accurate diagnosis of invasive fungal infection is crucial so that appropriate antifungal agents can be started rapidly, however, early diagnosis is not always easy, microscopic examination is rapid and can be helpful but a negative result does not exclude infection Clinicians are required to act definitively and early based on a high index of suspicion.
Several techniques have been developed that decrease the time for identification of the most common Candida species once a blood culture bottle shows growth and yeasts are seen on the smear of the bottle contents.
The development of the Colonization Index has been viewed as a major conceptual advance in the characterization of supporting the progression from colonization to infection in surgical patients.
The (1, 3) β-D-glucan assay is an amoebocyte lysis assay with a sensitivity of 75-100% and a specificity of 88%-100%. It is a broad-spectrum assay that detects Aspergillus, Candida, Fusarium, Acremonium, and Saccharomyces species. Β-D-glucan is a cell wall component in a wide variety of fungi.
The aim of the work is to evaluate the serum (1,3)- β -glucan assay as an effective marker to aid in the early screening and diagnosis of candidiasis in comparison with candida colonization index.
In this study, specimens from all patients for the candida surveillance sites, such as perineal-area, oropharynx, skin (axillary surface), skin breakdown, urine, sputum, and postsurgical drainage will be obtained after fulfillment the inclusion criteria with at least 2 risk factors with signs of sepsis for all patients and colonization index was calculated and the highest value was obtained with positive results of ≥0.5, and negative results less than this value.
Also, for each patient at the onset of sepsis and after fulfillment the inclusion criteria blood specimens were simultaneously obtained for (1, 3)-β-D-Glucan assay (from a peripheral venipuncture and or/ an arterial line) and for culture (from peripheral venipuncture and or/ intravascular catheter) with positive results of (80 pg/ml) for the β-D-Glucan and / or proven invasive candida infection by blood culture wwhenever positive results will be obtained, antifungal therapy will be started.
Our results showed a significant difference between the two modalities for diagnosis of invasive candidiasis as using a single sample of patients obtained at the onset of sepsis in our evaluation which included 26 subjects with invasive candidiasis and 74 with no invasive candidiasis, a β-d glucan level 80 pg/ml had sensitivity and specificity of 96.2% and 91.9% respectively for the confirmed invasive candidiasis.
Also, in this study we found that the candida colonization index using the higher number obtained from the same patients after the onset of the septic syndrome with colonization index of 0.5 had sensitivity and specificity of 46.2% and 55.4% respectively for the confirmed invasive candidiasis.
The 1, 3-β-D glucan assays appears to be useful for critically ill patients with suspicion of sepsis due to invasive candidiasis and could be used in combination with other modalities to improve the diagnostic performance and the efficiency of management in comparison with candida colonization index to start timely the proper management, thus reducing mortality and length of ICU.