fungal cystitis

Etiology

risk factors

• indwelling catheter (foley)
• instrumentation of the urinary tract
• diabetes mellitus
• prior antibiotic therapy
• urinary tract pathology
• malignancy

Epidemiology

• common in hospitalized patients

Pathology

• generally benign
• most cases represent colonization rather than infection

Clinical manifestations

• most cases are asymptomatic
• dysuria, frequency, suprapubic discomfort suggest infection

Laboratory

• urinalysis
  • pyuria common with indwelling foley catheter, cannot be used to indicate infection
• culture: neither presence of pseudohyphae nor number of colonies distinguish colonization from infection

Complications

• involvement of kidneys is associated with abstruction & vesiculoureteral reflux
• Candidemia (5% of renal transplant patients with candiduria)

Management

• removal of foley catheter
• treatment NOT associated with improved survival
• rarely requires treatment except with
  • neutropenia
  • low birth weight neonates
  • urinary tract manipulation
• fluconazole, loading dose 400 mg, then 200 mg QD for 14 days
  • recurrence is common after fluconazole stopped
• amphotericin B 0.3-0.7 mg/kg IV for 1-7 days
  • bladder irrigation with amphotericin B will clear funguria but effect is transient
• flucytosine 100 mg/kg/day divided QID for 5-7 days

More general terms

• cystitis
• mycosis; fungal infection