Candidiasis (invasive)

[Magaret]

Candidiasis is infection by Candida species (most often C. albicans), manifested by mucocutaneous lesions, fungemia, and sometimes focal infection of multiple sites. Symptoms depend on the site of infection and include dysphagia, skin and mucosal lesions, blindness, vaginal symptoms (itching, burning, discharge), fever, shock, oliguria, renal shutdown, and disseminated intravascular coagulation. Diagnosis is confirmed by histopathology and cultures from normally sterile sites. Treatment is with amphotericin B, fluconazole , echinocandins, voriconazole , or posaconazole .
(See also Overview of Fungal Infections, Candidiasis, Candidal Vaginitis, and Chronic Mucocutaneous Candidiasis.)
Candida species are commensal organisms that inhabit the gastrointestinal (GI) tract and sometimes the skin (see etiology of mucocutaneous candidiasis). Unlike other systemic mycoses, candidiasis results from endogenous organisms. Most infections are caused by C. albicans; however, C. glabrata (formerly Torulopsis glabrata) and other non-albicans species are increasingly involved in fungemia, urinary tract infections, and, occasionally, other focal disease. C. glabrata is frequently less susceptible to fluconazole than other species; C. krusei is inherently resistant to fluconazole ; frequency of resistance to voriconazole and amphotericin varies. C. krusei is most frequently susceptible to echinocandins. C. auris is an emerging, multidrug-resistant species that has caused recent outbreaks in hospitals and is challenging to identify and treat.
Candida species account for about 80% of major systemic fungal infections and are the most common cause of fungal infections in immunocompromised patients. Candidal infections are one of the most common hospital-acquired infections. Because resistance and transmission of C. auris in health care facilities have become a concern, special infection control precautions have been instituted for patients who are colonized or infected with C. auris.
Candidiasis of the esophagus is a defining opportunistic infection in AIDS. Although mucocutaneous candidiasis is frequently present in HIV-infected patients, hematogenous dissemination is unusual unless other specific risk factors are present (see below).