Abstract
Candida septic thrombosis of the great central veins is rarely diagnosed during life, and reports of survival with this condition are exceedingly rare. Eight patients with Candida septic thrombosis of the central veins, with six survivors, are reported. Seven of eight patients had multiple organ system failure following surgery or trauma. All patients had received broad spectrum antibiotics and total parenteral nutrition via a central catheter. Every patient showed features of venous thrombosis with localizing extremity edema and high grade candidemia. Intensive amphotericin B therapy (mean daily dose: 0.7 mg/kg) in all patients, combined with 5-fluorocytosine in five cases, resulted in cure and long-term survival in six patients who received 1600 to 3435 mg (mean: 26 mg/kg) total dose. None of these patients developed renal failure, while four showed improving renal function during treatment. In contrast to Candida endocarditis, septic central vein thrombosis caused by Candida appears to be curable medically in the majority of cases with intensive amphotericin B therapy (total dose: greater than or equal to 22 mg/kg), combined when feasible with 5-fluorocytosine.
Full text
PDF![653](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce5a/1250982/296581b9533f/annsurg00105-0133.png)
![654](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce5a/1250982/6e1507ccb5a8/annsurg00105-0134.png)
![655](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce5a/1250982/6a6940752319/annsurg00105-0135.png)
![656](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce5a/1250982/d1cf5f7aa031/annsurg00105-0136.png)
![657](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce5a/1250982/bde53d875e1c/annsurg00105-0137.png)
![658](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce5a/1250982/ade62c7e2206/annsurg00105-0138.png)
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ashcraft K. W., Leape L. L. Candida sepsis complicating parenteral feeding. JAMA. 1970 Apr 20;212(3):454–456. [PubMed] [Google Scholar]
- Brajtburg J., Kobayashi D., Medoff G., Kobayashi G. S. Antifungal action of amphotericin B in combination with other polyene or imidazole antibiotics. J Infect Dis. 1982 Aug;146(2):138–146. doi: 10.1093/infdis/146.2.138. [DOI] [PubMed] [Google Scholar]
- Chastre J., Cornud F., Bouchama A., Viau F., Benacerraf R., Gibert C. Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein: prospective evaluation by phlebography. N Engl J Med. 1982 Feb 4;306(5):278–281. doi: 10.1056/NEJM198202043060506. [DOI] [PubMed] [Google Scholar]
- Curry C. R., Quie P. G. Fungal septicemia in patients receiving parenteral hyperalimentation. N Engl J Med. 1971 Nov;285(22):1221–1225. doi: 10.1056/NEJM197111252852203. [DOI] [PubMed] [Google Scholar]
- Defever K. S., Whelan W. L., Rogers A. L., Beneke E. S., Veselenak J. M., Soll D. R. Candida albicans resistance to 5-fluorocytosine: frequency of partially resistant strains among clinical isolates. Antimicrob Agents Chemother. 1982 Nov;22(5):810–815. doi: 10.1128/aac.22.5.810. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dixon D., Shadomy S., Shadomy H. J., Espinel-Ingroff A., Kerkering T. M. Comparison of the in vitro antifungal activities of miconazole and a new imidazole, R41,400. J Infect Dis. 1978 Aug;138(2):245–248. doi: 10.1093/infdis/138.2.245. [DOI] [PubMed] [Google Scholar]
- Filice G., Yu B., Armstrong D. Immunodiffusion and agglutination tests for Candida in patients with neoplastic disease: inconsistent correlation of results with invasive infections. J Infect Dis. 1977 Mar;135(3):349–357. doi: 10.1093/infdis/135.3.349. [DOI] [PubMed] [Google Scholar]
- Foley F. D. The burn autopsy. Fatal complications of burns. Am J Clin Pathol. 1969 Jul;52(1):1–13. doi: 10.1093/ajcp/52.1.1. [DOI] [PubMed] [Google Scholar]
- Garrison R. N., Richardson J. D., Fry D. E. Catheter-associated septic thrombophlebitis. South Med J. 1982 Aug;75(8):917–919. doi: 10.1097/00007611-198208000-00004. [DOI] [PubMed] [Google Scholar]
- Goldstein E., Hoeprich P. D. Problems in the diagnosis and treatment of systemic candidiasis. J Infect Dis. 1972 Feb;125(2):190–193. doi: 10.1093/infdis/125.2.190. [DOI] [PubMed] [Google Scholar]
- Jarrett F., Maki D. G., Chan C. K. Management of septic thrombosis of the inferior vena cava caused by Candida. Arch Surg. 1978 May;113(5):637–639. doi: 10.1001/archsurg.1978.01370170099020. [DOI] [PubMed] [Google Scholar]
- Jordan W. M., Bodey G. P., Rodriguez V., Ketchel S. J., Henney J. Miconazole therapy for treatment of fungal infections in cancer patients. Antimicrob Agents Chemother. 1979 Dec;16(6):792–797. doi: 10.1128/aac.16.6.792. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krause W., Matheis H., Wulf K. Fungaemia and funguria after oral administration of Candida albicans. Lancet. 1969 Mar 22;1(7595):598–599. doi: 10.1016/s0140-6736(69)91534-7. [DOI] [PubMed] [Google Scholar]
- Marsh P. K., Tally F. P., Kellum J., Callow A., Gorbach S. L. Candida infections in surgical patients. Ann Surg. 1983 Jul;198(1):42–47. doi: 10.1097/00000658-198307000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Munster A. M. Septic thrombophlebitis. A surgical disorder. JAMA. 1974 Nov 18;230(7):1010–1011. [PubMed] [Google Scholar]
- Ryan J. A., Jr, Abel R. M., Abbott W. M., Hopkins C. C., Chesney T. M., Colley R., Phillips K., Fischer J. E. Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients. N Engl J Med. 1974 Apr 4;290(14):757–761. doi: 10.1056/NEJM197404042901401. [DOI] [PubMed] [Google Scholar]
- Seelig M. S. The role of antibiotics in the pathogenesis of Candidainfections. Am J Med. 1966 Jun;40(6):887–917. doi: 10.1016/0002-9343(66)90204-x. [DOI] [PubMed] [Google Scholar]
- Solomkin J. S., Flohr A. B., Quie P. G., Simmons R. L. The role of Candida in intraperitoneal infections. Surgery. 1980 Oct;88(4):524–530. [PubMed] [Google Scholar]
- Solomkin J. S., Flohr A., Simmons R. L. Candida infections in surgical patients. Dose requirements and toxicity of amphotericin B. Ann Surg. 1982 Feb;195(2):177–185. doi: 10.1097/00000658-198202000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stein J. M., Pruitt B. A., Jr Suppurative thrombophlebitis. A lethal iatrogenic disease. N Engl J Med. 1970 Jun 25;282(26):1452–1455. doi: 10.1056/NEJM197006252822603. [DOI] [PubMed] [Google Scholar]
- Stone H. H., Kolb L. D., Currie C. A., Geheber C. E., Cuzzell J. Z. Candida sepsis: pathogenesis and principles of treatments. Ann Surg. 1974 May;179(5):697–711. doi: 10.1097/00000658-197405000-00024. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sud I. J., Feingold D. S. Effect of ketoconazole on the fungicidal action of amphotericin B in Candida albicans. Antimicrob Agents Chemother. 1983 Jan;23(1):185–187. doi: 10.1128/aac.23.1.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutton A. Miconazole in systemic candidiasis. Arch Dis Child. 1983 Apr;58(4):319–319. doi: 10.1136/adc.58.4.319. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Torres-Rojas J. R., Stratton C. W., Sanders C. V., Horsman T. A., Hawley H. B., Dascomb H. E., Vial L. J., Jr Candidal suppurative peripheral thrombophlebitis. Ann Intern Med. 1982 Apr;96(4):431–435. doi: 10.7326/0003-4819-96-4-431. [DOI] [PubMed] [Google Scholar]
- Warnock D. W., Johnson E. M., Richardson M. D., Vickers C. F. Modified response to ketoconazole of Candida albicans from a treatment failure. Lancet. 1983 Mar 19;1(8325):642–643. doi: 10.1016/s0140-6736(83)91809-3. [DOI] [PubMed] [Google Scholar]