Major risk factors are use of central venous catheters, exposure to broad-spectrum antibiotics, and neutropenia.
Blood cultures are only 70% to 80% sensitive in diagnosis.
Treatment should be started within 24 hours of diagnosis to improve outcome. Echinocandins or fluconazole are first-line choices.
Central venous catheters should be removed in non-neutropenic patients.
Ophthalmological examination is required in all patients with candidaemia.
Systemic candidiasis (acute disseminated candidiasis) is an infection of blood or other normally sterile sites (e.g., pleural and peritoneal fluid) with Candida species, usually in association with fever, hypotension, and/or leukocytosis. Candida organisms may be disseminated to multiple sites, notably retina, kidney, liver and spleen, bones, and the central nervous system. Chronic disseminated candidiasis usually implies involvement of liver and/or spleen in association with recovery from chemotherapy-induced neutropenia.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- poor capillary refill
- acute mental confusion
- decreased urine output
- low oxygen saturation
- use of central venous catheter
- exposure to broad-spectrum antibiotics
- colonisation at multiple sites
- parenteral nutrition
- immunosuppressants (e.g., chemotherapy, systemic corticosteroids)
- intravenous drug use
1st investigations to order
- blood culture
- lactate levels
- coagulation studies
- renal function tests
- liver function test
- serum glucose
Investigations to consider
- beta 1,3 glucan
- T2 magnetic resonance assay
- tissue biopsy
- polymerase chain reaction
- matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry
confirmed diagnosis: non-neutropenic patients (no complications)
confirmed diagnosis: neutropenic patients (no complications)
confirmed diagnosis: with complications
- Bacterial sepsis
- Drug-induced fever
- Pulmonary embolism
- ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients
- Clinical practice guideline for the management of candidiasis
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