Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Clinical manifestations and diagnosis of candidemia and invasive candidiasis in adults

Carol A Kauffman, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD


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 [1]. In at least one study, each entity was responsible for approximately one-third of cases [2]. 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'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 21, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. 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.
  2. Leroy O, Gangneux JP, Montravers P, et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006). Crit Care Med 2009; 37:1612.
  3. Wilson ML, Davis TE, Mirrett S, et al. Controlled comparison of the BACTEC high-blood-volume fungal medium, BACTEC Plus 26 aerobic blood culture bottle, and 10-milliliter isolator blood culture system for detection of fungemia and bacteremia. J Clin Microbiol 1993; 31:865.
  4. Muñoz P, Bernaldo de Quirós JC, Berenguer J, et al. Impact of the BACTEC NR system in detecting Candida fungemia. J Clin Microbiol 1990; 28:639.
  5. Gherna M, Merz WG. Identification of Candida albicans and Candida glabrata within 1.5 hours directly from positive blood culture bottles with a shortened peptide nucleic acid fluorescence in situ hybridization protocol. J Clin Microbiol 2009; 47:247.
  6. Shepard JR, Addison RM, Alexander BD, et al. Multicenter evaluation of the Candida albicans/Candida glabrata peptide nucleic acid fluorescent in situ hybridization method for simultaneous dual-color identification of C. albicans and C. glabrata directly from blood culture bottles. J Clin Microbiol 2008; 46:50.
  7. Spanu T, Posteraro B, Fiori B, et al. Direct maldi-tof mass spectrometry assay of blood culture broths for rapid identification of Candida species causing bloodstream infections: an observational study in two large microbiology laboratories. J Clin Microbiol 2012; 50:176.
  8. Reiss E, Obayashi T, Orle K, et al. Non-culture based diagnostic tests for mycotic infections. Med Mycol 2000; 38 Suppl 1:147.
  9. Odabasi Z, Mattiuzzi G, Estey E, et al. Beta-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis 2004; 39:199.
  10. Ostrosky-Zeichner L, Alexander BD, Kett DH, et al. Multicenter clinical evaluation of the (1-->3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis 2005; 41:654.
  11. Obayashi T, Negishi K, Suzuki T, Funata N. Reappraisal of the serum (1-->3)-beta-D-glucan assay for the diagnosis of invasive fungal infections--a study based on autopsy cases from 6 years. Clin Infect Dis 2008; 46:1864.
  12. Mohr JF, Sims C, Paetznick V, et al. Prospective survey of (1→3)-beta-D-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting. J Clin Microbiol 2011; 49:58.
  13. Nguyen MH, Wissel MC, Shields RK, et al. Performance of Candida real-time polymerase chain reaction, β-D-glucan assay, and blood cultures in the diagnosis of invasive candidiasis. Clin Infect Dis 2012; 54:1240.
  14. US Food and Drug Administration. FDA news release. FDA allows marketing of the first test to identify five yeast pathogens directly from a blood sample. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm415728.htm (Accessed on September 24, 2014).
  15. Mylonakis E, Clancy CJ, Ostrosky-Zeichner L, et al. T2 magnetic resonance assay for the rapid diagnosis of candidemia in whole blood: a clinical trial. Clin Infect Dis 2015; 60:892.
  16. Kourkoumpetis TK, Fuchs BB, Coleman JJ, et al. Polymerase chain reaction-based assays for the diagnosis of invasive fungal infections. Clin Infect Dis 2012; 54:1322.
  17. Ahmad S, Khan Z, Mustafa AS, Khan ZU. Seminested PCR for diagnosis of candidemia: comparison with culture, antigen detection, and biochemical methods for species identification. J Clin Microbiol 2002; 40:2483.
  18. McMullan R, Metwally L, Coyle PV, et al. A prospective clinical trial of a real-time polymerase chain reaction assay for the diagnosis of candidemia in nonneutropenic, critically ill adults. Clin Infect Dis 2008; 46:890.
  19. Lau A, Halliday C, Chen SC, et al. Comparison of whole blood, serum, and plasma for early detection of candidemia by multiplex-tandem PCR. J Clin Microbiol 2010; 48:811.