Invasive candidiasis happens when Candida yeast enters the bloodstream or deep organs, most often in hospitalized patients with central lines, recent surgery, broad-spectrum antibiotics or a weak immune system. It can look just like bacterial sepsis and carries a high death rate when treatment is delayed.
Key symptoms
- Fever or chills that continue despite antibiotics
- Feeling very unwell, weak or confused
- Abdominal pain after recent abdominal surgery
- New blurry vision or floaters (eye involvement)
- Painless skin nodules in some patients
What you find on exam
- Fever, fast heart rate and low blood pressure
- Central line site: redness, tenderness or pus
- Dilated eye exam to look for Candida endophthalmitis
- Abdominal tenderness or signs of peritonitis
- Risk factors: central lines, IV nutrition, low neutrophil count
Tests
- Blood cultures, ideally two sets, before antifungals
- Beta-D-glucan as a supporting blood test
- Blood count, kidney and liver function, lactate
- Echocardiogram and imaging to look for deep spread, such as endocarditis or abscess
Treatment basics
- Start an echinocandin such as micafungin or caspofungin
- Remove or replace the central line when possible
- Step down to fluconazole once the patient is stable and the species is susceptible
- Treat for at least 2 weeks after the first negative blood culture
- Drain abscesses and support blood pressure as in sepsis
Red flags
- Low blood pressure or signs of septic shock
- Blood cultures that stay positive
- New vision loss or eye pain
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.