Source: www.clinicaladvisor.com Author: Carl Sherman Infection with the ubiquitous fungus Candida cuts across a broad spectrum of severity that ranges from common and superficial mucocutaneous variants to invasive disease that can be life-threatening. The addition of important new antifungal agents to the candidiasis armamentarium has led the Infectious Diseases Society of America to issue updated Clinical Practice Guidelines for the Management of Candidiasis to replace the 2004 version. These agents—the echinocandins caspofungin, anidulafungin, and micafungin—are essentially reserved for candidemia and other invasive forms of candidiasis. The Guidelines also incorporate new data on the treatment of mucocutaneous disease and on the prevention of invasive disease in high-risk patients. Office-based primary-care providers “probably see [relatively benign] aspects of candidiasis most often: oropharyngeal infection (thrush) and vaginitis. They will see Candida in urine, where the question is whether it is causing infection or just hanging out,” says Carol A. Kauffman, MD, professor of internal medicine at the University of Michigan in Ann Arbor, chief of infectious diseases in the VA Ann Arbor Healthcare System, and an author of the Guidelines. Candidemia and other forms of invasive candidiasis are generally encountered in the hospital setting (candidemia is the fourth most common nosocomial bloodstream infection in the United States) but may develop in community-dwelling patients as well (e.g., those who are leukemic, have an indwelling catheter, are on dialysis, or are receiving cancer chemotherapy via a port or central line), according to Dr. Kauffman. Muccocutaneous Candidiasis: Oropharyngeal infection, when mild, is best treated topically, with [...]