Depending on the site of infection by Candida species (mostly Candida albicans), systemic candidiasis can be broadly classified into 2 entities: candidemia, a bloodstream candidial infection, or disseminated candidiasis, characterized by the infection of one or more organs.

Candidemia is mostly nosocomial in origin and manifests primarily as fever that is unresponsive to antibiotics [1] [2]. Risk factors lowering the immune defense of the individual are frequently present, such as prolonged intravenous catheterization, prosthetic valves, drug abuse, etc [3]. Some patients may also show associated deep-seated infections (disseminated candidiasis) or occasionally features of septic shock.

Disseminated candidiasis may present with fever originating from an unknown source and frequently involves one or more of the following organs: the eyes, central nervous system (CNS), kidneys, heart, musculoskeletal system, etc.

Candida endophthalmitis may arise either from an external source via iatrogenic/ accidental injury or as a consequence of candidemia. Patients may be asymptomatic or may present with pain or visual symptoms such as photophobia, floaters, or scotomas. Fundoscopy may reveal one or many off-white pinhead lesions in the vitreous, extending onto the retina.

The CNS manifestations of disseminated candidiasis vary widely, with meningitis, parenchymal infections, abscesses, mycotic aneurysms, and vasculitis being reported in patients. The usual presenting features include fever, confusion, coma, nuchal rigidity and different sensory/motor symptoms.

Patients may also present with abscesses in the myocardium or pericardium, frequently associated with candidemia. Hypotension, tachycardia, murmurs and rubs are common complaints seen.

Patients with renal candidiasis are mostly asymptomatic and the diagnosis includes a kidney biopsy.

Candidial musculoskeletal infections may involve the joints, muscles or bones, with the vertebral column and knees amongst the common sites affected. The sternum, ribs and lower limbs may also be frequently involved.

Other less common manifestations of systemic candidiasis include cholecystitis, hypersplenism, and peritonitis [4].

• Candidiasis

  Systemic candidiasis is an invasive fungal infection caused by the yeast, Candida, resulting in its dissemination in the blood (candidemia) and/or an involvement of other organs (disseminated candidiasis). [symptoma.com]

  These new syndromes include the focal hepatosplenic candidiasis, Candida peritonitis and systemic candidiasis. [ncbi.nlm.nih.gov]

  1-7 DOI: 10.3923/mj.2011.1.7 A Comprehensive Review of the Occurrence and Management of Systemic Candidiasis as an Opportunistic Infection Srikumar Chakravarthi and Nagaraja Haleagrahara Abstract: Candidiasis is a fungal infection which is prone to [web.archive.org]

• Fever

  The child was well postoperatively until day 9, when he developed fever. Intermittent fever continued despite treatment with several antibiotics. He became seriously ill on day 15 and developed disseminated intravascular coagulation. [ncbi.nlm.nih.gov]

  Candidemia is mostly nosocomial in origin and manifests primarily as fever that is unresponsive to antibiotics. [symptoma.com]

• Malaise

  These toxins will circulate in your blood for a short time until they can be eliminated and can cause weakness, malaise, headache, nausea and other symptoms. This is a good sign and generally the symptoms are mild. [theherbspecialist.com]

  Your doctor should promptly investigate symptoms of illness or general malaise. Candidiasis Yeast Infection Diagnosis For healthy people, most physicians can diagnose a candida infection without laboratory tests. [emedicinehealth.com]

• Splenomegaly

  Clinical symptoms include fever, murmur, congestive heart failure, anemia and splenomegaly. [mycology.adelaide.edu.au]

• Hypotension

  The onset of illness was earlier and was associated with antecedent hypotension, leukocytosis, and a gasless appearance on abdominal radiograph. [ncbi.nlm.nih.gov]

  Hypotension, tachycardia, murmurs and rubs are common complaints seen. Patients with renal candidiasis are mostly asymptomatic and the diagnosis includes a kidney biopsy. [symptoma.com]

  Physical examination reveals fever, hypotension, shock, tachycardia, and new murmurs or rubs (or recent changes in previously detected murmurs). [emedicine.medscape.com]

• Hepatosplenomegaly

  The patient's history includes the following: Fever unresponsive to broad-spectrum antimicrobials Right upper quadrant pain Abdominal pain and distension Jaundice (rare) Physical examination findings include right upper quadrant tenderness and hepatosplenomegaly [emedicine.medscape.com]

  Symptoms include fever, hepatosplenomegaly and increased blood concentrations of alkaline phosphatases. Histopathology shows diffuse hepatic and/or splenic necrotic lesions or abscesses containing small numbers of pseudohyphae. [mycology.adelaide.edu.au]

  Clinical features are fever (unresponsive to broad-spectrum antibiotics), abdominal pain, tender hepatosplenomegaly, vomiting, dysphagia and jaundice. It may be a form of inflammatory immune reconstitution syndrome. [patient.info]

• Hepatomegaly

  All patients with CSC had fever and hepatomegaly, and five complained of abdominal pain. Seven patients had neutrophilic leukocytosis and six an increased serum alkaline phosphatase activity. [ncbi.nlm.nih.gov]

• Maculopapular Rash

  Each had either leukaemia or lymphoma, and developed a similar erythematous maculopapular rash which, in places, was purpuric. [ncbi.nlm.nih.gov]

• Confusion

  The usual presenting features include fever, confusion, coma, nuchal rigidity and different sensory/motor symptoms. Patients may also present with abscesses in the myocardium or pericardium, frequently associated with candidemia. [symptoma.com]

  Often Candida Symptoms can be confusing as they can be similar to other conditions. For instance, many symptoms can overlap with chronic fatigue syndrome, which cause some to believe that many with that condition could be misdiagnosed. [candidafood.com]

  As the candida spreads, symptoms grow more diffuse and convoluted: Depression, lethargy, mental confusion/fog, mood swings, PMS, confused thyroid function, susceptibility to infections (sinus, respiratory, bladder, gums, etc.), sensitivity to pollutants [breathing.com]

  There have been a number of other books written on systemic Candidiasis which have been considered as classics as they set the path for thinking about this systemic disease with so many symptoms that the diagnosis is often confusing – it was termed by [detoxmetals.com]

  The Third Stage of Candida may involve MENTAL and BEHAVIORAL RESPONSES: Inability to concentrate, not being able to read or follow a television program or carry on a hobby, serious forgetfulness, memory loss, mental confusion, not being able to think [phr.net]

• Motor Symptoms

  The usual presenting features include fever, confusion, coma, nuchal rigidity and different sensory/motor symptoms. Patients may also present with abscesses in the myocardium or pericardium, frequently associated with candidemia. [symptoma.com]

A positive fungal culture forms the mainstay of diagnosis for systemic candidiasis. However, cultures from non-sterile sites such as the mouth, vagina, stool, sputum or skin are not beneficial in establishing a diagnosis. They may, however, serve as an indication to begin empirical antifungal therapy in clinically susceptible patients.

A positive blood culture helps in the diagnosis but is only seen in 50-60 % of patients with systemic candidiasis [5] [6] [7]. Cultures from other sterile sites such as the pericardium or the cerebrospinal fluid are diagnostic of invasive disease and should be followed by a prompt initiation of appropriate therapy.

A nonculture assay measuring the serum β-glucan, a component of the fungal cell wall, shows a high specificity for systemic candidiasis [8]. A negative assay reduces the chances of the patient suffering from an invasive disease.

An ophthalmological examination is to be conducted in patients showing manifestations of candidial endophthalmitis as well as in all patients suffering from candidemia. Urinalysis and a subsequent kidney biopsy may help in establishing the diagnosis of renal candidiasis.

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6. Bodey GP. Fungal infections complicating acute leukemia. J Chronic Dis 1966;19:667.
7. Hart PD, Russell E Jr, Remington JS. The compromised host and infection. II. Deep fungal infection. J Infect Dis 1969;120:169.
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