Clinical manifestations and diagnosis of candidemia and invasive candidiasis in adults
- 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 term candidemia describes the presence of Candida species in the blood. Candida in a blood culture should never be viewed as a contaminant and should always prompt a search for the source. In all cases, candidemia requires treatment with an antifungal agent; it should never be assumed that removal of a catheter alone is adequate therapy for candidemia. (See "Treatment of candidemia and invasive candidiasis in adults".)
Clinical issues related to the clinical manifestations and diagnosis of candidemia will be reviewed here. The epidemiology, pathogenesis, and treatment of candidemia are discussed separately. Candida endocarditis; hepatosplenic candidiasis (chronic disseminated candidiasis); Candida endophthalmitis; Candida infections of the central nervous system, bladder, and kidneys; empiric treatment of presumed invasive candidiasis; and an overview of Candida infections are also presented elsewhere. (See "Epidemiology and pathogenesis of candidemia in adults" and "Treatment of candidemia and invasive candidiasis in adults" and "Candida endocarditis and suppurative thrombophlebitis" and "Chronic disseminated candidiasis (hepatosplenic candidiasis)" and "Treatment of endogenous endophthalmitis due to Candida species" and "Candida infections of the central nervous system" and "Candida infections of the bladder and kidneys" and "Overview of Candida infections".)
Candidemia in neonates and children is discussed in detail separately. (See "Epidemiology and risk factors for Candida infection in neonates" and "Clinical manifestations and diagnosis of Candida infection in neonates" and "Treatment of Candida infection in neonates" and "Prevention of Candida infection in neonates" and "Candidemia and invasive candidiasis in children: Clinical manifestations and diagnosis" and "Candida infections in children: An overview" and "Candidemia and invasive candidiasis in children: Management".)
Candidemia may be only the most obvious manifestation of invasive infection with Candida species. Some experts have proposed dividing invasive Candida infections into three subgroups: candidemia without deep-seated or visceral involvement, candidemia with deep-seated or visceral Candida infection, and deep-seated (visceral) candidiasis without candidemia . In at least one study, each entity was responsible for approximately one-third of cases . The diagnosis of invasive candidiasis is made most easily in those patients with positive blood cultures, but the low sensitivity of blood cultures means that some patients with deep-seated infection may be missed. More rapid techniques for identifying yeasts in blood cultures and refinement of non–culture-based techniques are active areas of investigation. (See 'Diagnosis' below.)
Empiric treatment of patients who are at high risk for invasive infection with Candida species is necessary in some situations and is discussed elsewhere. (See "Treatment of candidemia and invasive candidiasis in adults", section on 'Empiric antifungal therapy'.)
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