Laboratory Findings

T2Candida Panel

The T2Candida Panel detects the following species of Candida direct from whole blood: C. albicansC. tropicalisC. parapsilosisC. krusei and C. glabrata.

A positive T2Candida Panel result enables clinicians to quickly treat patients with appropriate therapy – reducing costs, adverse outcomes and patient mortality

A negative T2Candida Panel result enables physicians to avoid unnecessary antifungal use – reducing antimicrobial costs, toxicity and resistance. 




In the patient with immunocompromise, infectious esophagitis is most commonly associated with Candida spp., herpes simplex virus (HSV), and cytomegalovirus (CMV); it is less commonly associated with Cryptosporidium, Mycobacterium avium complex, histoplasmosis, leishmaniasis, and syphilis.



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In immunocompromised hosts, fluconazole, 200 mg PO on day 1 followed by 100 mg daily for 2–3 weeks, is treatment of choice; alternatives include itraconazole, 200 mg PO bid, or ketoconazole, 200–400 mg PO daily; long-term maintenance therapy is often required. Poorly responsive pts or those who cannot swallow may respond to caspofungin 50 mg IV qd for 7–21 days.



Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.


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