Contents
Cutaneous, mucosal and deep-seated organ infections caused by fungi of the Candida genus, which can occur at any age and usually occur in the setting of easily identifiable risk factors for infection.
Microbiology
Candida:
Candida spp. are common commensal organisms in the skin and gut microbiota, and disruptions in the cutaneous and gastrointestinal barriers (for example, owing to gastrointestinal perforation) promote invasive disease.
Major pathogenic species:
At least 15 distinct Candida spp. can cause human disease, but the majority of invasive infections are caused by 5 pathogens:
- C. albicans
- C. tropicalis
- C. parapsilosis
- C. krusei
- C. glabrata
Risk factors:
Candida spp. are commensal yeasts that are part of the normal human skin and gut microbiota, and they are detectable in up to 60% of healthy individuals; thus, invasive disease is usually a consequence of increased or abnormal colonization together with a local or generalized defect in host defences.
- Prolonged intensive care stay
- Broad-spectrum antibiotic therapy
- Renal failure
- Very low birthweight (VLBW)
- Immunosuppressive therapies
- Total parenteral nutrition
- Especially intralipids
- Neutropenia
- Central venous catheters
Clinical features
The spectrum of disease of invasive candidiasis ranges from minimally symptomatic candidaemia to fulminant sepsis with an associated mortality exceeding 70%.
Superficial infections
- Thrush, vaginitis, paronychia, etc
Invasive infections:
Bloodstream infections with Candida spp. (that is, candidaemia) and deep-seated infection
- Intra-abdominal abscess
- Peritonitis
- Osteomyelitis
- Candidaemia (candidal sepsis)

Diagnosis
Blood culture:
GOLD STANDARD for diagnosis of invasive candidiasis that enables species identification and susceptibility testing.
Antigen detection:
- Mannan antigen and antimannan antibody.
- β-D-glucan: Pan-fungal marker of invasive fungal infection
- C. albicans germ tube antigen (CAGTA) test: Candida spp.-specific antibody test
Management
It is important to differentiate colonization from true infection to avoid overtreatment
- Fluconazole (Drug of choice)
- Fluconazole-resistant Candida: Amphotericin B, echinocandins, newer azoles (voriconazole)

Summary:
