Depending on the site of infection by Candida species (mostly Candida albicans), systemic candidiasis can be broadly classified into 2 entities: candidemia, a bloodstream candidial infection, or disseminated candidiasis, characterized by the infection of one or more organs.

Candidemia is mostly nosocomial in origin and manifests primarily as fever that is unresponsive to antibiotics [1] [2]. Risk factors lowering the immune defense of the individual are frequently present, such as prolonged intravenous catheterization, prosthetic valves, drug abuse, etc [3]. Some patients may also show associated deep-seated infections (disseminated candidiasis) or occasionally features of septic shock.

Disseminated candidiasis may present with fever originating from an unknown source and frequently involves one or more of the following organs: the eyes, central nervous system (CNS), kidneys, heart, musculoskeletal system, etc.

Candida endophthalmitis may arise either from an external source via iatrogenic/ accidental injury or as a consequence of candidemia. Patients may be asymptomatic or may present with pain or visual symptoms such as photophobia, floaters, or scotomas. Fundoscopy may reveal one or many off-white pinhead lesions in the vitreous, extending onto the retina.

The CNS manifestations of disseminated candidiasis vary widely, with meningitis, parenchymal infections, abscesses, mycotic aneurysms, and vasculitis being reported in patients. The usual presenting features include fever, confusion, coma, nuchal rigidity and different sensory/motor symptoms.

Patients may also present with abscesses in the myocardium or pericardium, frequently associated with candidemia. Hypotension, tachycardia, murmurs and rubs are common complaints seen.

Patients with renal candidiasis are mostly asymptomatic and the diagnosis includes a kidney biopsy.

Candidial musculoskeletal infections may involve the joints, muscles or bones, with the vertebral column and knees amongst the common sites affected. The sternum, ribs and lower limbs may also be frequently involved.

Other less common manifestations of systemic candidiasis include cholecystitis, hypersplenism, and peritonitis [4].

A positive fungal culture forms the mainstay of diagnosis for systemic candidiasis. However, cultures from non-sterile sites such as the mouth, vagina, stool, sputum or skin are not beneficial in establishing a diagnosis. They may, however, serve as an indication to begin empirical antifungal therapy in clinically susceptible patients.

A positive blood culture helps in the diagnosis but is only seen in 50-60 % of patients with systemic candidiasis [5] [6] [7]. Cultures from other sterile sites such as the pericardium or the cerebrospinal fluid are diagnostic of invasive disease and should be followed by a prompt initiation of appropriate therapy.

A nonculture assay measuring the serum β-glucan, a component of the fungal cell wall, shows a high specificity for systemic candidiasis [8]. A negative assay reduces the chances of the patient suffering from an invasive disease.

An ophthalmological examination is to be conducted in patients showing manifestations of candidial endophthalmitis as well as in all patients suffering from candidemia. Urinalysis and a subsequent kidney biopsy may help in establishing the diagnosis of renal candidiasis.

The primary treatment for systemic candidiasis is antifungal medication. Commonly used drugs include fluconazole, amphotericin B, and echinocandins like caspofungin. The choice of medication depends on the severity of the infection, the specific Candida species involved, and the patient's overall health. In some cases, surgical intervention may be required to remove infected tissue or drain abscesses.

The prognosis for systemic candidiasis varies based on several factors, including the patient's immune status, the promptness of diagnosis, and the effectiveness of treatment. While the condition can be life-threatening, early detection and appropriate antifungal therapy significantly improve outcomes. However, patients with severe immunosuppression or multiple organ involvement may have a poorer prognosis.

Systemic candidiasis is caused by the overgrowth of Candida species, which are normally harmless yeast found in the human body. Factors that can lead to systemic infection include a weakened immune system, prolonged use of broad-spectrum antibiotics, invasive medical procedures, and the presence of medical devices like catheters. These conditions allow Candida to enter the bloodstream and spread to internal organs.

Systemic candidiasis is a relatively rare condition but is more common in hospital settings, particularly in intensive care units. It is a leading cause of bloodstream infections in hospitalized patients. The incidence is higher in individuals with compromised immune systems, such as those with cancer, HIV/AIDS, or those who have undergone organ transplants.

Candida species are opportunistic pathogens that can transition from a harmless commensal organism to a virulent pathogen under certain conditions. In systemic candidiasis, the yeast form of Candida can invade the bloodstream and disseminate to various organs. The body's immune response to this invasion can lead to inflammation and tissue damage, contributing to the symptoms and complications of the disease.

Preventing systemic candidiasis involves minimizing risk factors, especially in hospital settings. This includes strict adherence to infection control practices, careful use of antibiotics, and prompt removal of unnecessary medical devices. In high-risk patients, prophylactic antifungal medications may be considered to prevent infection.

Systemic candidiasis is a serious fungal infection that can affect multiple organs and is most common in individuals with weakened immune systems. Early diagnosis and treatment with antifungal medications are crucial for improving outcomes. Preventive measures, particularly in healthcare settings, are essential to reduce the risk of infection.

If you or a loved one is at risk for systemic candidiasis, it's important to be aware of the symptoms and seek medical attention if they occur. Symptoms like persistent fever, chills, and fatigue should not be ignored, especially if you have a weakened immune system. Understanding the risk factors and working with healthcare providers to minimize them can help prevent this serious infection.

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