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Systemic candidiasis

Last reviewed: 4 Sep 2023
Last updated: 23 Mar 2023



History and exam

Key diagnostic factors

  • fever
More key diagnostic factors

Other diagnostic factors

  • tachycardia
  • tachypnea
  • hypotension
  • poor capillary refill
  • acute mental confusion
  • decreased urine output
  • low oxygen saturation
  • rash
  • hepatosplenomegaly
  • hypothermia
Other diagnostic factors

Risk factors

  • use of central venous catheter
  • exposure to broad-spectrum antibiotics
  • hemodialysis
  • surgery
  • parenteral nutrition
  • immunosuppressants (e.g., chemotherapy, systemic corticosteroids, biologic and other immunosuppressants)
  • colonization at multiple sites
  • intravenous drug use
More risk factors

Diagnostic investigations

1st investigations to order

  • blood culture
  • CBC
  • ABG
  • lactate levels
  • coagulation studies
  • renal function tests
  • liver function test
  • serum glucose
More 1st investigations to order

Investigations to consider

  • 1,3-beta-D-glucan
  • T2 magnetic resonance assay
  • tissue biopsy
More investigations to consider

Emerging tests

  • polymerase chain reaction
  • matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry

Treatment algorithm


suspected diagnosis


confirmed diagnosis: non-neutropenic patients (no complications)

confirmed diagnosis: neutropenic patients (no complications)

confirmed diagnosis: with complications



Brenda L. Tesini, MD

Assistant Professor

Infectious Diseases

Departments of Medicine and Pediatrics

University of Rochester Medical Center




BLT has received honoraria from Merck for educational contributions unrelated to this topic.


Dr Brenda L. Tesini would like to gratefully acknowledge Dr Jack D. Sobel and Dr Sanjay G. Revankar, previous contributors to this topic.


JDS declares that he has no competing interests. SR has received grants for research from Astellas, Gilead, and Merck, and has been involved in clinical trials for Cidara and Astellas.

Peer reviewers

John Fisher, MD

Professor of Medicine

Department of Medicine

Medical College of Georgia




JF is an author of a number of references cited in this topic. JF is a member of the speaker's bureau for the following companies: Pfizer, Merck, and Astellas.

Jean-Michel Livrozet, MD

Praticien hospitalier

Service de medecine de la Transplantation et d'Immunologie clinique

Hopital Edouard Herriot




JML has been invited by Astellas, the manufacturer of micafungin, to attend a symposium, and invited by Gilead Sciences, manufacturer of liposomal amphotericin B, to attend different HIV conferences, and has been paid by Gilead Sciences for running HIV educational programs.

Matthew Falagas, MD, MSc, DSc


Alfa Institute of Biomedical Sciences





MF declares that he has no competing interests.

  • Differentials

    • Bacterial sepsis
    • Drug-induced fever
    • Pulmonary embolism
    More Differentials
  • Guidelines

    • Revision and update of the consensus definitions of invasive fungal disease
    • Clinical practice guideline for the management of candidiasis
    More Guidelines
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