Fungal Infections

Disease name and synonyms

Candidaemia and invasive candidiasis (Candida bloodstream infection, disseminated candidiasis)

Fungi responsible (links to these)

Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Candida auris, and other species of Candida.

Disease description

Most cases (90%) of systemic candidiasis arise from the gastrointestinal tract and the remainder from venous catheters or other instrumentation. Candida bloodstream infections may be silent or associated with fever, reduced oxygenation, features of sepsis, and occasionally rash. If infection is silent, then organ involvement (usually liver, kidneys, spleen, occasionally brain, retina of the eye, bone or other organs) is usually not recognised unless a biopsy is taken, as clinical  features are not specific.  

Frequency and global burden

Candidaemia occurs at a population rate of 2-11/100,000, so ~350,000 cases are predicted worldwide every year. The numbers rose in the US by 52% between 2000 and 2005. Rates in India and Brazil are much higher, so the overall estimate could be greater. Blood cultures are insensitive, so the burden of invasive candidiasis is likely greater.

Underlying problems and at risk patients

Prematurity, especially extremely low birth weight infants, chemotherapy and neutropenia, critical care, pancreatitis(17.5% rate), major trauma, burns, multiple antibiotics, renal dialysis or dysfunction, central venous catheterisation.

Diagnostic testing

Blood culture. PCR testing more sensitive than blood culture for invasive candidiasis. Tissue biopsy. Candida antigen and antibody test (Review).

Detailed examination of the retina ( video with kind permission of Prof Liu et al, NEJM 2015)


Caspofungin, micafungin, anidulafungin, amphotericin B (including lipid formulations), fluconazole and voriconazole. Flucytosine may have a role in endocarditis and endophthalmitis as well as urinary tract infections. Antifungal resistance is especially a problem with fluconazole. Resistance to echinocandins is not frequent but case reports and small series have been described

IDSA clinical practice guidelines 2016

Outlook and prognosis

Candidaemia has a mortality of 30-55%. Invasive candidiasis is a serious problem with a high morbidity and mortality.

Review article


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