Complications
Occurs early during period of candidemia. Indistinguishable from septic shock due to bacterial causes. Characterized by hypotension, florid sepsis, and multiorgan failure. Requires immediate administration of broad-spectrum antifungals (not fluconazole), removal of potential source (e.g., intravascular catheter), abscess drainage, or relief of obstruction in presence of urosepsis. Any Candida species possible. More common with neutropenia.
Reported occurrence has ranged from 0% to 45% of patients with candidemia in published literature.[64][65]
Typically seen in association with candidemia; can be asymptomatic. Chorioretinitis varies from asymptomatic lesions to blindness. All patients with candidemia should undergo a thorough routine ophthalmologic evaluation.
For lesions that do not threaten vision, treatment of candidemia with antifungal usually suffices, although duration of systemic therapy should be extended for 4 to 6 weeks with frequent follow-up ophthalmologic exam.
For vision-threatening disease, systemic treatment with amphotericin-B or fluconazole is effective (little data for echinocandins), and intravitreal injection of amphotericin-B and vitrectomy.
Occurs in 10% to 20% of cases of candidemia.[8]
Additionally, blood cultures may only be positive in 20% to 70% of invasive candidiasis cases.[66]
Metastatic sites may require therapeutic drainage (e.g., joint or muscle abscess).
Central nervous system infection is seen in association with candidemia, particularly in neonates, or related to neurosurgical procedures.
Osteomyelitis can be seen in association with candidemia, as a complication following surgery, or in persons who inject drugs. May present with pain and fever and require diagnostic aspiration.
Hematogenous renal candidiasis frequently complicates candidemia and is suggested by concomitant decrease in glomerular filtration rate and candiduria.
Antifungal selection depends upon Candida species involved as well as metastatic site. Experience with using echinocandins for disseminated sites is limited, and cerebrospinal fluid penetration is poor.
Skin infection manifests as localized or disseminated erythematous or macular/papular rash.
Hepatosplenic invasion is usually indicated by abnormal liver function tests and computed tomography imaging.
Rare complication of candidemia; persons who inject drugs may be at higher risk.
Previously thought to be incurable with medical therapy (antifungals) only, and valve replacement was required for cure. Antifungals alone have been reported to cure occasional cases of native but not prosthetic valve endocarditis. However, optimal therapy remains a combination of drugs and surgery. Drug therapy is selected upon basis of Candida species responsible for persistent and recurrent candidemia; select most active cidal agent. This entity represents one of the few indications for antifungal combination therapy.
Given the frequency of nosocomial candiduria, especially in intensive care units and accompanying bladder catheter use, ascending Candida infections are surprisingly uncommon and tend to occur in the presence of urinary obstructions and nephrostomy.
Rarely, pyelonephritis or fungus balls may occur. Removal of a fungus ball is essential to control urosepsis. C glabrata is a frequent uropathogen. Asymptomatic patients with Candida detected in a urine specimen usually do not require treatment.
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