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La candidiasis invasiva se ha convertido en un problema de salud pública debido a las altas tasas de morbimortalidad asociadas. Al igual que otras infecciones sistémicas, es esencial realizar un diagnóstico lo más certero y precoz posible. A pesar de su escasa sensibilidad (50%), el hemocultivo sigue siendo la mejor técnica para el diagnóstico de la candidemia. Para aumentar el rendimiento diagnóstico se han comercializado nuevas técnicas independientes del cultivo, entre las que destacan la detección de anticuerpos antimicelio y la de antígeno (1-3)-β-D-glucano. La combinación de 2 técnicas que detecten antígeno, anticuerpos, (1-3)-β-D-glucano o ADN parece ser la mejor alternativa para optimizar el diagnóstico de la candidiasis invasiva. El fluconazol y, en ocasiones, la anfotericina B, continúan siendo los antifúngicos de elección para el tratamiento de las candidiasis. En los últimos años se han introducido nuevos antifúngicos con el objetivo de mejorar el pronóstico de algunas formas clínicas de esta enfermedad. Las equinocandinas y los triazoles de segunda generación tienen una actividad antifúngica superior al fluconazol, y en los ensayos clínicos de candidiasis de diferentes localizaciones han mostrado un excelente perfil de eficacia y seguridad. Las posibles interacciones medicamentosas de alguno de estos compuestos son relevantes. La aportación de los nuevos antifúngicos para la terapéutica de las candidiasis se ha de definir en los próximos años.
Palabras clave:
Candidiasis
Anticuerpos antimicelio
(1-3)-β-D-glucano
Equinocandinas
Triazoles
Invasive candidiasis has become a public health problem due to the high associated rates of morbidity and mortality. As in other systemic infections, accurate and early diagnosis is essential. Despite its limited sensitivity (50%), blood culture continues to be the most effective technique for the diagnosis of candidemia.
New culture-independent techniques have been marketed with the aim of improving diagnostic yield. Among these techniques, the most notable are (1-3)-β-D-glucan and anti-germ-tube antibody detection. However, the best option to optimize the diagnosis of invasive candidiasis seems to be the combination of two techniques that detect antigen, antibodies, (1-3)-β-D-glucan or DNA.
Fluconazole, and sometimes amphotericin B, remain the antifungal agents of choice for the treatment of candidiasis.
In the last few years, new antifungal agents have been introduced with the aim of improving the prognosis of some clinical presentations of this disease. The echinocandins and second-generation triazoles show greater antifungal activity than fluconazole. Moreover, clinical trials of candidiasis in different localizations have shown that these drugs have excellent efficacy and safety profiles. The potential for drug interactions with some of these antifungal agents is considerable. The contribution of the new antifungal drugs in the treatment of candidiasis should be defined in the near future.
Key words:
Candidiasis
Anti germ-tube antibodies
(1-3)-β-D-glucan
Echinocandins
Second-generation triazoles
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