Candida infections
Candida species cause a spectrum from mucocutaneous disease (thrush, esophagitis, vulvovaginal candidiasis, intertrigo) to candidemia and invasive candidiasis, the fourth most common cause of bloodstream infection with 30-40% mortality. Diagnosis of invasive disease requires recognizing risk factors because only 40-60% of infected patients have positive blood cultures, and initial therapy is an echinocandin with prompt catheter removal.
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What this article covers
- Overview
Candida is a genus of yeast causing a wide clinical spectrum: mucocutaneous disease (oropharyngeal thrush, esophageal candidiasis, vulvovaginal candidiasis, cutaneous intertrigo, diaper dermatitis…
- Epidemiology
Candida species are the fourth most commonly isolated organism in bloodstream infections, with an associated mortality of 30% to 40%.
- Risk factors
Central venous catheters are the leading risk factor for candidemia and invasive candidiasis.
- Pathophysiology
Candida is normal flora of the gastrointestinal tract, skin, and vagina; disease occurs when local barriers break down (mucosal disruption, catheter breach of skin) or host immunity is impaired…
- Clinical features
Candidemia can present simply as isolated fever or progress to septic shock; focal signs depend on the site of secondary seeding (meningitis, septic arthritis, endocarditis, endophthalmitis).
- Differential diagnosis
Bacterial bloodstream infection/sepsis: overlapping presentation with fever and hemodynamic instability; blood cultures and risk-factor assessment (catheter, neutropenia, TPN) distinguish the two, though both can coexist.
- Diagnosis
Mucocutaneous and vulvovaginal candidiasis are established by direct visualization plus microscopy: a 10% potassium hydroxide (KOH) wet mount showing yeast, hyphae, or pseudohyphae confirms the…
- Management
First, for candidemia or invasive candidiasis, start an echinocandin and remove any intravascular device if present and feasible: caspofungin 70 mg IV loading dose on day 1, then 50 mg IV once daily…
- Complications
Septic shock from candidemia, carrying the highest mortality.
- Prognosis
Candidemia carries a mortality of 30% to 40%, among the highest of common bloodstream pathogens, driven largely by delayed recognition (given the poor sensitivity of blood cultures) and underlying host comorbidity.
- Prevention
Remove unnecessary central venous catheters and minimize catheter dwell time in ICU patients, the single most modifiable risk factor for candidemia.
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