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Systemic Candidiasis

Moniliasis Systemic

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).


Presentation

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]
  • Home Diseases Systemic candidiasis Title Other Names: Systemic candida infections; Invasive Candidiasis Systemic candidiasis includes a spectrum of yeast infections caused by different species (types) of Candida. [1] It is a serious infection that can[rarediseases.info.nih.gov]
  • Candidiasis. Medscape Reference. October 2014; . Invasive Candidiasis. Centers for Disease Control and Prevention. February 2014; .[web.archive.org]
  • These new syndromes include the focal hepatosplenic candidiasis, Candida peritonitis and systemic candidiasis.[ncbi.nlm.nih.gov]
  • Systemic candidiasis resulted in a significant prolongation of ICU and hospital length of stay, thus increasing extensively total hospitalization costs.[ncbi.nlm.nih.gov]
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]
  • A Caucasian male with newly diagnosed acute myeloid leukaemia (AML M1) developed severe and persistent fever associated with a micropustular eruption scattered over the trunk and limbs during induction chemotherapy.[ncbi.nlm.nih.gov]
  • The patients' general condition was very poor and they presented a high fever at the onset of the illness. Candida spp. were isolated from blood in all cases, and histology showed yeasts in two of them.[ncbi.nlm.nih.gov]
  • 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]
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
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[web.archive.org]
  • 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]
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).[web.archive.org]
Cutaneous Manifestation
  • We report three cases of systemic candidiasis (SC) with cutaneous manifestations in immunocompromised patients.[ncbi.nlm.nih.gov]
  • Abstract The cutaneous manifestations of 18 infants treated for systemic candidiasis during a 3 3/4-year period were examined.[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]
  • It's confusing and overwhelming when you first realize you've been dealing with Candida. We want to reach those people and let them know there's a clear path to wellness, and Candida Force is an essential part of their healing."[news-medical.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]
Stroke
  • The risk of stroke and heart disease is increased dramatically when a woman is estrogen-dominant. ... 2.[gilbertssyndrome.com]

Workup

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.

Bilirubin Increased
  • One month after discontinuation of ketoconazole, the liver enzyme concentrations decreased; however, over the next five months, liver enzymes and bilirubin increased.[ncbi.nlm.nih.gov]

Treatment

  • Fluconazole is the treatment of choice for Candida albicans, but treatment response is unknown for other Candida spp., which may require treatment with amphotericin B.[ncbi.nlm.nih.gov]
  • Miconazole was used in this desperate situation for the treatment of life-threatening candidiasis. Both infants responded well to treatment and recovered.[ncbi.nlm.nih.gov]
  • Early diagnosis and treatment is essential to reduce mortality and may be aided by ultrasound examination of the commonly involved organs - the brain and kidneys.[ncbi.nlm.nih.gov]
  • Treatment with antifungal drugs (amphotericin B and 5-flucytosine) was effective for systemic candidiasis, but candida endophthalmitis developed.[ncbi.nlm.nih.gov]
  • In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken.[ncbi.nlm.nih.gov]

Prognosis

  • Systemic candidiasis following cardiac surgery, previously regarded as fatal, has now a much improved prognosis. Prognosis depends largely on early diagnosis and treatment. Four of five patients we recently treated for this disease survived.[ncbi.nlm.nih.gov]
  • This syndrome has a favorable prognosis. Conclusions as to the more indolent nature of this syndrome cannot be made; however, this topic warrants further investigation.[ncbi.nlm.nih.gov]
  • […] organ (s) or body system is infected. [1] As of 2016, medical researchers are hoping T2 magnetic resonance testing will be able to more accurately and easily detect all forms of systemic candidiasis. [5] Last updated: 12/15/2016 The long-term outlook ( prognosis[rarediseases.info.nih.gov]
  • Expectations (prognosis) Thrush in infants may be painful, but is rarely serious. Because of discomfort, it can interfere with eating. If it does not resolve on its own within 2 weeks, call your pediatrician.[web.archive.org]

Etiology

  • The etiologic agents were Candida albicans (21 cases), C. tropicalis (3 cases), and C. krusei (1 case). The mean interval of PCR-ELISA positivity in blood samples before the manifestation of clinical signs was 12.6 days.[ncbi.nlm.nih.gov]
  • We report the prevalence, clinical findings, histologic findings, etiologic Candida species, underlying conditions, treatment modalities, and outcomes of the cases and compare them with the previous reports.[ncbi.nlm.nih.gov]
  • The etiology of Crohn’s disease (CD), an autoimmune, inflammatory bowel disease (IBD) which affects approximately one million people in Europe, is still unclear.[doi.org]
  • All appear to be caused by traumatic inoculation of the etiological fungi into the subcutaneous tissue.[ncbi.nlm.nih.gov]

Epidemiology

  • The epidemiology of Candida fungal infections is on the rise and it is a common cause of systemic infections.[scialert.net]
  • By combining molecular epidemiology with the traditional “shoe leather” epidemiology of contact tracing and interviewing patients, we will further our understanding of C. auris to achieve better control of future outbreaks.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Reviewed by: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine.[web.archive.org]
  • References: [1] [2] [3] [4] Pathophysiology Clinical features Local mucocutaneous Oropharyngeal ( oral thrush ) Pseudomembranous candidiasis White plaque in the oral cavity that can be scraped off, giving way to red, inflamed, or bleeding areas.[amboss.com]
  • Numerous interactions between fungi and bacteria and the complex immune response to gastrointestinal commensal or pathogenic fungi all impact on the pathophysiology of inflammatory bowel disease and other gastrointestinal inflammatory entities such as[doi.org]
  • It may also help bring better insight into the current treatment and pathophysiology of cancer which has itself been shown to be a risk factor to the predisposition of candidiasis.[dx.doi.org]

Prevention

  • However, publication biases preclude any definite conclusions for prevention of infection.[ncbi.nlm.nih.gov]
  • Basic Information You can obtain information on this topic from the Centers for Disease Control and Prevention (CDC).[web.archive.org]
  • Discussion of surveillances and reports will be useful to improve our understanding of the importance of systemic Candida infections and to facilitate the prioritization of the investigation as well as the prevention efforts.[scialert.net]
  • Where to Start You can obtain information on this topic from the Centers for Disease Control and Prevention (CDC).[rarediseases.info.nih.gov]

References

Article

  1. Guery BP, Arendrup MC, Auzinger G, et al. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis. Intensive Care Med. 2009;35(1):55-62.
  2. Picazo JJ, González-Romo F, Candel FJ. Candidemia in the critically ill patient. Int J Antimicrob Agents. 2008;32(Suppl 2):S83-85.
  3. Fridkin SK. The changing face of fungal infections in health care settings. Clin Infect Dis 2005;41:1455.
  4. Blot SI, Vandewoude KH, De Waele JJ. Candida peritonitis. Curr Opin Crit Care. 2007;13(2):195-9.
  5. Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses. Clin Infect Dis. 2006;43:S15-S27.
  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.
  8. 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;15.39(2):199-205.

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Last updated: 2019-07-11 21:03