Consensus statement on the management of invasive candidiasis in Indian scenario

Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines.

Transbronchial needle aspiration in undiagnosed radiographic shadows.

Background: Transbronchial needle aspiration (TBNA) is diagnostic in benign and malignant pulmonary lesions. The technique of TBNA has made mediastinal and hilar nodes accessible. In addition to its usefulness in central airway lesions, TBNA has been found to increase the diagnostic yield in peripheral lesions also. Aim: To evaluate the role of transbronchial needle aspiration (TBNA) in cases of unconfirmed radiographic shadows. Material and Methods: A detailed clinical history was recorded in all the 54 patients, who presented with an unconfirmed radiographic shadow. Thereafter, fibreoptic specimens of bronchial aspirate and TBNA were collected, and subjected to Ziehl-Neelsen staining, Graim’s staining, fungal smear, culture for pyogenic organisms and acid fast bacilli and cytological examination by H & E stain and Papanicolaou staining.Bronchial biopsy was collected in cases wherever feasible and specimens were paraffin embedded cut into 3-5 mm thickness and stained with H & E stain. Results: Out of 54, 48.1% were diagnosed to be having bronchogenic carcinoma, 20.4% each pneumonia and tuberculosis, while one patient had primary fungal infection (Candida abbicaus). The overall diagnostic yield was highest with TBNA (85.2%) followed by transbronchial biopsy (48.2%) and bronchial aspiration (42.7%) cases. Conclusion: TBNA offers an unique opportunity to make a pathological diagnosis at the time of bronchoscopy. It is equally effective in diagnosing various infective conditions like pneumonia and tuberculosis.