Candida infections of the abdomen and thorax
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
The clinical manifestations of infection with Candida species range from local mucous membrane infections to widespread dissemination with multisystem organ failure. Although Candida are considered normal flora in the gastrointestinal and genitourinary tracts of humans, they have the propensity to invade and cause disease when an imbalance is created in the ecologic niche in which these organisms usually exist. (See "Biology of Candida infections".)
The immune response of the host is an important determinant of the type of infection caused by Candida. The different Candida species generally are capable of producing all of the clinical syndromes, although infection with Candida albicans is the most common. The major importance of identifying the infecting organism is that some species are more resistant to the azole antifungal agents than others. (See "Treatment of candidemia and invasive candidiasis in adults".)
This topic will review the manifestations of Candida infection involving the abdomen and thorax. Other manifestations of Candida infections are discussed separately. (See "Overview of Candida infections" and "Clinical manifestations and diagnosis of candidemia and invasive candidiasis in adults" and "Chronic disseminated candidiasis (hepatosplenic candidiasis)" and "Candida infections in children".)
PERITONITIS AND INTRAABDOMINAL INFECTIONS
Candida species frequently contribute to polymicrobial infections that occur following gut perforation, anastomotic leaks after bowel surgery, and acute necrotizing pancreatitis [1-8]. Discrete abscesses with or without peritonitis can occur.
Candida peritonitis can also complicate continuous peritoneal dialysis in patients with end-stage renal disease. This disorder is discussed elsewhere. (See "Fungal peritonitis in continuous peritoneal dialysis".)
- Calandra T, Bille J, Schneider R, et al. Clinical significance of Candida isolated from peritoneum in surgical patients. Lancet 1989; 2:1437.
- Sandven P, Qvist H, Skovlund E, et al. Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med 2002; 30:541.
- Grewe M, Tsiotos GG, Luque de-Leon E, Sarr MG. Fungal infection in acute necrotizing pancreatitis. J Am Coll Surg 1999; 188:408.
- Hoerauf A, Hammer S, Müller-Myhsok B, Rupprecht H. Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality. Crit Care Med 1998; 26:2010.
- Keiser P, Keay S. Candidal pancreatic abscesses: report of two cases and review. Clin Infect Dis 1992; 14:884.
- Vege SS, Gardner TB, Chari ST, et al. Outcomes of intra-abdominal fungal vs. bacterial infections in severe acute pancreatitis. Am J Gastroenterol 2009; 104:2065.
- de Ruiter J, Weel J, Manusama E, et al. The epidemiology of intra-abdominal flora in critically ill patients with secondary and tertiary abdominal sepsis. Infection 2009; 37:522.
- Montravers P, Lepape A, Dubreuil L, et al. Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study. J Antimicrob Chemother 2009; 63:785.
- Morris AB, Sands ML, Shiraki M, et al. Gallbladder and biliary tract candidiasis: nine cases and review. Rev Infect Dis 1990; 12:483.
- Bozzette SA, Gordon RL, Yen A, et al. Biliary concentrations of fluconazole in a patient with candidal cholecystitis: case report. Clin Infect Dis 1992; 15:701.
- Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007; 20:133.
- Bassetti M, Righi E, Ansaldi F, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med 2015; 41:1601.
- Clancy CJ, Nguyen MH. Finding the "missing 50%" of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 2013; 56:1284.
- Tissot F, Lamoth F, Hauser PM, et al. β-glucan antigenemia anticipates diagnosis of blood culture-negative intraabdominal candidiasis. Am J Respir Crit Care Med 2013; 188:1100.
- Posteraro B, De Pascale G, Tumbarello M, et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1→3)-β-D-glucan assay, Candida score, and colonization index. Crit Care 2011; 15:R249.
- Hanson KE, Pfeiffer CD, Lease ED, et al. β-D-glucan surveillance with preemptive anidulafungin for invasive candidiasis in intensive care unit patients: a randomized pilot study. PLoS One 2012; 7:e42282.
- Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
- Bassetti M, Marchetti M, Chakrabarti A, et al. A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med 2013; 39:2092.
- Haron E, Vartivarian S, Anaissie E, et al. Primary Candida pneumonia. Experience at a large cancer center and review of the literature. Medicine (Baltimore) 1993; 72:137.
- Kontoyiannis DP, Reddy BT, Torres HA, et al. Pulmonary candidiasis in patients with cancer: an autopsy study. Clin Infect Dis 2002; 34:400.
- Franquet T, Müller NL, Lee KS, et al. Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings. Radiology 2005; 236:332.
- Rello J, Esandi ME, Díaz E, et al. The role of Candida sp isolated from bronchoscopic samples in nonneutropenic patients. Chest 1998; 114:146.
- el-Ebiary M, Torres A, Fàbregas N, et al. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med 1997; 156:583.
- Wood GC, Mueller EW, Croce MA, et al. Candida sp. isolated from bronchoalveolar lavage: clinical significance in critically ill trauma patients. Intensive Care Med 2006; 32:599.
- Meersseman W, Lagrou K, Spriet I, et al. Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study. Intensive Care Med 2009; 35:1526.
- Ko SC, Chen KY, Hsueh PR, et al. Fungal empyema thoracis: an emerging clinical entity. Chest 2000; 117:1672.
- Clancy CJ, Nguyen MH, Morris AJ. Candidal mediastinitis: an emerging clinical entity. Clin Infect Dis 1997; 25:608.
- Malani PN, McNeil SA, Bradley SF, Kauffman CA. Candida albicans sternal wound infections: a chronic and recurrent complication of median sternotomy. Clin Infect Dis 2002; 35:1316.
- Glower DD, Douglas JM Jr, Gaynor JW, et al. Candida mediastinitis after a cardiac operation. Ann Thorac Surg 1990; 49:157.
- Pertowski CA, Baron RC, Lasker BA, et al. Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse. J Infect Dis 1995; 172:817.
- Rabinovici R, Szewczyk D, Ovadia P, et al. Candida pericarditis: clinical profile and treatment. Ann Thorac Surg 1997; 63:1200.
- Schrank JH Jr, Dooley DP. Purulent pericarditis caused by Candida species: case report and review. Clin Infect Dis 1995; 21:182.
- Neughebauer B, Alvarez V, Harb T, Keefer M. Constrictive pericarditis caused by candida glabrata in an immunocompetent patient: case report and review of literature. Scand J Infect Dis 2002; 34:615.
- Chaudhary K, Faidas A, Baddour LM. Candida pericarditis: unusual complication following hiatal hernia repair. Infect Dis Clin Pract 1996; 5:339.
- Karp R, Meldahl R, McCabe R. Candida albicans purulent pericarditis treated successfully without surgical drainage. Chest 1992; 102:953.