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].

• Splenomegaly

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

• Candidiasis

  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]

  However, the most common symptoms of invasive candidiasis are fever and chills that don’t improve after antibiotic treatment for suspected bacterial infections. [cdc.gov]

  Most patient report flank pain, abdominal cramps, nausea, vomiting, fever, chills and hematuria. Physical examination reveals abdominal pain, costovertebral-angle tenderness, and fever. [emedicine.medscape.com]

• Recurrent Infection

  Prevention If you have frequent outbreaks of thrush, your doctor may recommend taking antifungal medication on a regular basis to avoid recurrent infections. [web.archive.org]

  This can lead to recurrent infections that resist treatment and become a debilitating health problem. Reduced oxygen supplies: Oxygen will help kill germs, bacteria, virus and fungus; candida is a fungus. [breathing.com]

  For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections (strong recommendation; high-quality evidence). 130. [doi.org]

  Immunocompromised individuals such as HIV, cancer, ICU, surgical, and transplant patients can experience recurrent infections or candidemia, but anti-fungal drugs, such as clotrimazole (Lotrimin, Mycelex), can help in their situation [23]. [microbewiki.kenyon.edu]

• Anemia

  A 15 year old girl with aplastic anemia developed a heparin-like anticoagulant during the course of systemic candidiasis. [ncbi.nlm.nih.gov]

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

  The factors associated include old age and denture-wearers (due to reduced vertical dimension), vitamin B12 deficiency and iron deficiency anemia ( Jenkins et al., 1977 ). [doi.org]

  Iron deficiency anemia and deficiencies including vitamins B1, B2, B6, C, and folic acid are associated with heightened infection rates. [emedicine.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]

• Constipation

  Digestive: Intestinal distress and digestive issues: indigestion, bloating, gas, constipation or diarrhea, nausea, acid reflux, mucus and candida in stool. Allergies: Allergies and food sensitivities, leaky gut syndrome. [candidaspecialists.com]

  Many symptoms can develop, such as gas, bloating, indigestion, heartburn, nausea, constipation and/or diarrhea, and major cravings for sugar, starches and alcohol, which are the foods the candida increasingly demands. [breathing.com]

  Crook, M.D. [1] It is spuriously claimed that chronic yeast infections are responsible for many common disorders and non-specific symptoms including fatigue, weight gain, constipation, dizziness, muscle and joint pain, asthma, and others. [2] Background [en.wikipedia.org]

• 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]

• Photophobia

  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. [symptoma.com]

  There may be eye pain, inability to look into light (photophobia), floaters or black spots in vision, blurring of vision, fever etc. Renal or Hepatic Candidiasis Renal and Hepatic disease features are seen. [news-medical.net]

  […] joints, spleen, and/or eyes. [1] [2] [3] Candidemia may be present, but not in all cases. [1] Signs and symptoms depend on the organ or system infected. [1] [2] [3] For example, when Candida infects the eye, symptoms may include blurred vision with photophobia [rarediseases.info.nih.gov]

  Eye injury Ophthalmic surgery Underlying risk factors for candidemia Asymptomatic and detected upon physical examination Ocular pain Photophobia Scotomas Floaters Physical examination reveals fever. [emedicine.medscape.com]

• Skin Rash

  Skin Rash or Irritation One symptom of systemic yeast infection is a skin rash or irritation. These rashes can appear anywhere on the body. Some common locations for babies include around the mouth and diaper area. [healthyliving.azcentral.com]

  Get emergency medical help if you have: hives, severe skin rash ; wheezing, difficult breathing; cold sweats, feeling light-headed; swelling of your face, lips, tongue, or throat. [drugs.com]

  Candida symptoms of skin may include: Fungal infections in the skin such as athlete’s foot, jock itch, ringworm. Fungal skin rash. Candida rash or yeast rash: redness, sore itchy skin. [candidaspecialists.com]

  rash is the first sign of infection Extremely varied appearance Papules, abscesses, plaques, blisters, sinuses, ulcers, cellulitis or purpura (bleeding into the skin) Blastomycosis Papules, nodules, warty lesions Pustules, abscesses, ulcers and scars [dermnetnz.org]

• Withdrawn

  Gentian Violet Policy Withdrawn FDA has revoked its interim policy permitting the use of gentian violet at levels up to 8 parts per million (ppm) as a mold inhibitor in poultry feed (Federal Register, August 15, 1991). [extoxnet.orst.edu]

  Oral ketoconazole was withdrawn in 2013 because of concerns about liver damage [ 14 ]. Invasive candidal infections [ 2, 4 ] The term invasive candidiasis encompasses a variety of severe candidal infections: Candidaemia - the most common form. [patient.info]

  Patients showing clinical signs of liver damage should be immediately withdrawn from the drug. [gilbertssyndrome.com]

• Confusion

  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]

  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]

  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]

  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]

  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]

• Burning Sensation

  Because yeast infections and urinary tract infections can have similar symptoms, such as a burning sensation when urinating, it is important to see your doctor so that he or she can determine the cause of the symptoms and treat them with the correct medication [web.archive.org]

  CONCLUSIONS: Itching or burning sensations after sex were the most common symptoms associated with penile colonisation with candida and were present in more than one third. [dx.doi.org]

  Burning and itching is another symptom. There may also be a starchy odor. Women with vaginal yeast infections often have burning when they urinate. Unlike urinary tract infections, this burning sensation is usually felt as the urine exits the body. [healthyliving.azcentral.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.

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]

Other management strategies and second-line treatments: Voriconazole (may be an alternative or a step-down treatment). [patient.info]

Treatment Regimens Table 1. Table 1. [doi.org]

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]

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]

What Is the Prognosis? Once treatment starts, most candidiasis infections get better within about 2 weeks. Recurrences are fairly common. Long-lasting thrush is sometimes related to pacifiers. [healthychildren.org]

[…] 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]

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]

Candida sp are commensal organisms that inhabit the GI tract and sometimes the skin (see Candidiasis (Mucocutaneous) : Etiology ). Unlike other systemic mycoses, candidiasis results from endogenous organisms. [merckmanuals.com]

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]

The epidemiology of Candida fungal infections is on the rise and it is a common cause of systemic infections. [scialert.net]

The epidemiology of species responsible for invasive candidiasis, both at local and worldwide levels, has been changing - shifting from Candida albicans to non-albicans species, which can be resistant to fluconazole (Candida krusei and Candida glabrata [ncbi.nlm.nih.gov]

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]

The patient's history commonly reveals the following: Several days of fever that is unresponsive to broad-spectrum antimicrobials; frequently the only marker of infection Prolonged intravenous catheterization A history of several key risk factors (see Pathophysiology [emedicine.medscape.com]

However, publication biases preclude any definite conclusions for prevention of infection. [ncbi.nlm.nih.gov]

This review provides an overview on predisposition factors, prevention and diagnosis of candidiasis, highlighting alternative approaches for candidiasis treatment. [hdl.handle.net]

NHS Choices: Oral Thrush (Adults) Provides information on the fungal infection thrush or candida, its symptoms, causes, diagnosis, treatment and prevention. Includes an informational video. [curlie.org]

Basic Information You can obtain information on this topic from the Centers for Disease Control and Prevention (CDC). [web.archive.org]

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.