[Systemic candidiasis]. 1992

P Lelarge, and J Mariot
Département d'Urgence et de Réanimation, Hôpital Central, Nancy.

Candida proliferate within the body of patients with deficient cellular immunity either by the haematogenous route or by adjacency. This condition is often found in hospital patients. It explains the increasing incidence of disseminated candidiasis. They are preferentially found in patients who have had complicated surgery, mostly of the gastrointestinal tract and the heart, or transplant surgery (except for kidney transplants), or who have had prolonged intensive care. Other patients concerned are neonates with a low birth weight, haemato-oncology patients, heroin addicts and AIDS patients. Clinical signs are usually unspecific. When there is widespread involvement, clinical signs can be defined by the secondary locations, especially within the kidneys, lung, endocardium and brain in surgical patients, and liver and spleen in haemato-oncology patients. Eye, skin, gastrointestinal tract, and indeed, muscle lesions which are easily accessible, should be looked for routinely. This helps to ascertain the diagnosis, by showing the presence of Candida in the tissues. Moreover, isolating Candida from places which are normally sterile confirms deep-seated candidiasis. However, the presence of Candida in urine, bronchi, or drainage fluids is only the witness of saprophytism. This underlines the usefulness of immunological tests, which should soon benefit from the availability of new kits for the detection of cytoplasmic antigens. Indeed, the search for antibodies or circulating metabolites do not provide, at present, significantly different results in patients who have only been colonised and in those who have a systemic candidiasis. Interesting results are only obtained by showing the presence of mannans, in research laboratories. For treatment, amphotericin B remains the standard antifungal agent, and the association of amphotericin B with flucytosine the recommended association. However, drugs such as the new triazoles, among which fluconazole is particularly well tolerated and efficient, may considerably alter the principles of treatment. Finally, combining a fungal decontamination of the gut should help reduce the very high death rate of systemic candidiasis.

UI MeSH Term Description Entries
D007654 Ketoconazole Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. Nizoral,R-41400,R41,400,R41400,R 41400
D008297 Male Males
D008825 Miconazole An imidazole antifungal agent that is used topically and by intravenous infusion. Brentan,Dactarin,Miconasil Nitrate,Miconazole Nitrate,Monistat,R-14,889,Nitrate, Miconasil,Nitrate, Miconazole,R 14,889,R14,889
D002175 Candida A genus of yeast-like mitosporic Saccharomycetales fungi characterized by producing yeast cells, mycelia, pseudomycelia, and blastophores. It is commonly part of the normal flora of the skin, mouth, intestinal tract, and vagina, but can cause a variety of infections, including CANDIDIASIS; ONYCHOMYCOSIS; VULVOVAGINAL CANDIDIASIS; and CANDIDIASIS, ORAL (THRUSH). Candida guilliermondii var. nitratophila,Candida utilis,Cyberlindnera jadinii,Hansenula jadinii,Lindnera jadinii,Monilia,Pichia jadinii,Saccharomyces jadinii,Torula utilis,Torulopsis utilis,Monilias
D002177 Candidiasis Infection with a fungus of the genus CANDIDA. It is usually a superficial infection of the moist areas of the body and is generally caused by CANDIDA ALBICANS. (Dorland, 27th ed) Candida Infection,Moniliasis,Candida Infections,Candidiases,Infection, Candida,Moniliases
D003666 Decontamination The removal of contaminating material, such as radioactive materials, biological materials, or CHEMICAL WARFARE AGENTS, from a person or object.
D004359 Drug Therapy, Combination Therapy with two or more separate preparations given for a combined effect. Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D005260 Female Females
D005437 Flucytosine A fluorinated cytosine analog that is used as an antifungal agent. 5-Fluorocytosine,Alcobon,Ancobon,Ancotil
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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