Mycology: candidaemia management: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Mycology: candidaemia management

Sample item

A 60-year-old ICU patient on total parenteral nutrition through a central venous catheter develops fever and hypotension. Blood cultures grow budding yeast after 36 hours. What is the most appropriate management?

AWait for repeat cultures and treat as a contaminantBA single oral dose of fluconazole and keep the lineCIntravenous antibacterials only, as yeast in blood is a contaminantDIntravenous echinocandin and removal of the central line

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intravenous echinocandin and removal of the central line

Yeast in a blood culture is never regarded as a contaminant. Candidaemia needs prompt antifungal therapy, with an echinocandin such as caspofungin or micafungin as the usual initial choice in an ill patient, removal of the infected central venous catheter, and a dilated eye examination to look for endophthalmitis. Treatment is continued for at least two weeks after clearance of the blood.

Option by option

A. Wait for repeat cultures and treat as a contaminant
Yeast in blood is never dismissed as a contaminant, and delay raises mortality.
B. A single oral dose of fluconazole and keep the line
A single oral dose is inadequate for bloodstream infection and retaining the line sustains it.
C. Intravenous antibacterials only, as yeast in blood is a contaminant
Antibacterials do not treat fungal infection.
D. Intravenous echinocandin and removal of the central line (correct)
An echinocandin with catheter removal is the standard early management of candidaemia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is D, Intravenous echinocandin and removal of the central line. Yeast in a blood culture is never regarded as a contaminant.

Why is "Wait for repeat cultures and treat as a contaminant" not the answer?

Yeast in blood is never dismissed as a contaminant, and delay raises mortality.

Why is "A single oral dose of fluconazole and keep the line" not the answer?

A single oral dose is inadequate for bloodstream infection and retaining the line sustains it.

Why is "Intravenous antibacterials only, as yeast in blood is a contaminant" not the answer?

Antibacterials do not treat fungal infection.

What concept does this question test?

It tests Mycology: candidaemia management in Microbiology. Candidaemia needs prompt antifungal therapy, with an echinocandin such as caspofungin or micafungin as the usual initial choice in an ill patient, removal of the infected central venous catheter, and a dilated eye examination to look for endophthalmitis. Treatment is continued for at least two weeks after clearance of the blood.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Mycology: candidaemia management?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.