Acquired Systemic Candidiasis - Causes, Symptoms, Diagnosis and Treatment

What Is a Candidal Infection?

A fungal infection caused by a yeast called Candida albicans is candidiasis. Candida albicans is one of the species of Candida. It usually lives on the skin and inside the mouth, throat, gut, and vagina without causing any problems. When the Candida grows out of control or when entered deep into the body like the bloodstream or internal organs like the kidney, heart, or brain, it can result in systemic candidiasis infections.

Among the 200 species of Candida, five different species of them can cause 90 % of systemic candidiasis infections. Candidemia, a bloodstream infection with Candida, is a common and invasive infection in hospitalized patients. Candidemia may show fever and chills, which do not resolve on antibiotics. The other symptoms may be caused based on the organ which is infected.

Who Are the People at the Risk of Getting Systemic Candidiasis?

• Diabetic population.

• Intensive care unit (ICU) patients.

• People who have a weakened immune system.

• People having a central venous catheter.

• Underweight in infancy.

• Intravenous drug users.

• People taking broad-spectrum antibiotics.

• People with a very low neutrophil count (neutropenia).

• People who underwent surgery, especially gastrointestinal surgery.

• People with kidney failure or people who undergo hemodialysis.

• People who receive total parenteral nutrition.

What Are the Symptoms of Acquired Systemic Candidiasis?

Common symptoms of candidemia include fever and chills. These do not improve with antibiotics. Systemic candidiasis can also affect other body parts like the central nervous system (brain and spinal cord), covering of the brain and spinal cord (meninges), heart, kidneys, liver, sleep, abdomen, bones, muscles, joints, and eyes.

The septic shock caused by candidemia may include symptoms like fast heart rate, low blood pressure, and rapid breathing. The signs and symptoms of systemic candidiasis may occur depending on the organ or system infected. Symptoms of eye candidiasis may include blurred vision with photophobia (sensitivity to light).

The symptoms of Candida endocarditis (infection of the inner lining of the heart) may include:

• Fever.

• Shortness of breath.

• Fluid buildup in the arms or legs.

• Tiny red spots on the skin.

• Weight loss.

Since many people affected by systemic candidiasis are already sick, it is very difficult to know whether the symptoms are from Candida infection or complications of other medical conditions.

What Are the Causes of Systemic Candidiasis?

Candida will usually be present in small amounts in the mouth, intestines, and skin. The fungus will not cause any problem at normal levels, but it can cause an infection known as candidiasis when it grows uncontrollably. Candida is the most common cause of fungal infections in humans.

Systemic candidiasis is caused by Candida yeast. Almost 200 species of Candida exist till now, but the five most common species of Candida to cause systemic infections include:

1. C. albicans.

2. C. glabrata.

3. C. parapsilosis.

4. C. tropicalis.

5. C. krusei.

Candida is a type of yeast that will be present in every human, at least in a small quantity. It will not cause any problem at a normal level, but when they overgrow, it will enter the bloodstream and cause the problem. The overgrowth of Candida may also spread to various parts of the body. Candida species can also be introduced into the body iatrogenically (ill effect by medical activity) into the CNS (central nervous system) and induce meningitis after a lumbar puncture or neurosurgical procedures.

How to Diagnose Systemic Candidiasis?

Blood cultures (cerebrospinal fluid) can diagnose the presence of yeast in the blood. When systemic candidiasis is present in other parts of the body (sometimes 40 % to 50 % of cases), the blood culture may show negative results. In this condition, further testing may be required depending on the organ(s) or body system which is infected. Medical researchers trust T2 magnetic resonance testing to detect all forms of systemic candidiasis more accurately and easily.

How to Treat Systemic Candidiasis?

Systemic candidiasis is commonly treated with oral or intravenous (IV) antifungal medications, which include:

1. Echinocandin (Caspofungin, Micafungin, or Anidulafungin).

2. Fluconazole.

3. Amphotericin B.

The type of medication and its duration usually depends on the factors like:

1. Location of the infection.

2. The severity of the infection.

3. Age of the patient.

4. The health of the infected person.

Antifungal medications may be given to certain high-risk people to prevent the development of systemic candidiasis.

For candidemia, the treatment should be continued for the next two weeks after signs and symptoms have resolved and even if Candida yeasts are no longer in the bloodstream. Invasive candidiasis infections in other parts like the bones, joints, heart, or central nervous system should also be treated for a longer time.

What Is the Prognosis of Systemic Candidiasis?

The long-term prognosis for people with systemic candidiasis depends on various factors like the severity and location of the infection, the general health of the patient, and the timing of diagnosis and treatment. Since the people with systemic candidiasis are already sick, it is very hard to assess how many die from systemic candidiasis. between 45 % to 50 % and the mortality rate for candidemia ranges from 19 % to 30 %.

How to Prevent Systemic Candidiasis?

Invasive candidiasis cannot be transmitted directly from person to person. However, a few fungal species can live on the skin, and it can be passed from one person to another and cause an infection in someone at high risk.

The methods to prevent systemic candidiasis are:

• Antifungal Prophylaxis: If a person is at high risk for developing invasive candidiasis, their healthcare provider may suggest taking antifungal medication to prevent the infection. This antifungal prophylaxis is typically recommended for:

• Organ transplant patients.

• Patients in the intensive care unit (ICU).

• Patients undergoing certain types of chemotherapy.

• Patients having low white blood cell counts (neutropenia).

• The central venous catheter (central line) should be removed if the skin around the catheter becomes red or painful.

• Keeping the hands clean by washing hands can prevent the spread of infection.

• Patients having a stem cell or bone marrow transplant.

• Very low birth weight infants (less than 2.2 pounds).

Conclusion

Systemic candidiasis is a spectrum of yeast infections that can be disseminated into many body parts like blood, heart, liver, spleen, kidney, brain, eyes, bones, and central nervous system. The mortality rate in critically ill people who acquire systemic candidiasis is between 45 % to 50 % and the mortality rate for patients with infection in the blood range from 19 % to 30 %.