Systemic Candida: Understanding a Serious Fungal Infection

Systemic candida is a severe fungal infection that occurs when the yeast Candida spreads from its normal locations in the body to internal organs such as the bloodstream, heart, kidneys, or brain. While Candida naturally lives on our skin and inside our bodies without causing harm, certain conditions can allow it to grow out of control and become life-threatening.

Table of contents

• What is Systemic Candida?
• Other Names
• What Causes This Infection?
• Who is at Risk?
• Signs and Symptoms
• How is it Diagnosed?
• Treatment Options
• Prevention
• Outlook and Complications

What is Systemic Candida?

Systemic candida, also called invasive candidiasis, is a serious fungal infection that affects your internal organs^[1]. It happens when a type of yeast called Candida grows out of control and spreads from where it normally lives to vital organs throughout your body^[1].

Candida is a common yeast that naturally lives in small amounts on your skin and inside your body, including your mouth, throat, gut, and vagina^[4]. Under normal circumstances, it doesn’t cause any problems and is actually part of a healthy balance of microorganisms in your body. However, when certain conditions occur, this yeast can multiply rapidly and spread to places where it shouldn’t be^[1].

The most common form of systemic candida is candidemia, which occurs when the infection spreads throughout your bloodstream^[1]. This is one of the most common healthcare-associated infections in the United States. The infection can also affect specific organs such as your eyes, kidneys, heart, brain, bones, liver, and spleen^[2].

Without immediate treatment, systemic candida can lead to organ failure and death^[1]. This infection is considered a medical emergency that requires urgent attention^[1].

invasive candidiasis, acute disseminated candidiasis, candidemia, systemic candidiasis

Other Names

This condition is known by several different names in medical practice. Healthcare providers may refer to it as invasive candidiasis, systemic candidiasis, acute disseminated candidiasis, or candidemia^[1][2]. All of these terms describe the same serious condition where Candida yeast spreads beyond its normal locations to affect internal organs.

What Causes This Infection?

Systemic candida occurs when too much Candida yeast grows in your body and spreads to your internal organs^[1]. Several species of Candida can cause this infection, but about 90% of cases are caused by five main types: Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei^[7].

The infection most commonly spreads when a healthcare provider inserts a medical device through your skin and into your body^[1]. Examples include catheters that drain fluid from your body or intravenous lines that deliver nutrition or medication. When these devices are inserted, they can pick up Candida from your skin’s surface and carry it to your organs. Sometimes, the yeast can transfer from a healthcare provider’s hands to the medical device, contaminating it^[1].

Most infections arise from the Candida that naturally lives in your body. When your skin or mucous membranes are disrupted, or when other protective factors are weakened, the yeast can enter your bloodstream and spread to internal organs^[7].

An important note is that systemic candida is not contagious from one person to another through normal contact^[1]. However, Candida itself can transfer between people and onto surfaces in healthcare settings^[1].

Who is at Risk?

Systemic candida primarily affects people who are already sick or hospitalized, particularly those with weakened immune systems^[1]. Generally, healthy people are not at risk for this type of infection^[4].

People at higher risk include those who:^[1][2][7]

• Were born prematurely (premature babies)
• Have a weakened immune system from conditions like HIV/AIDS, cancer, or diabetes
• Are taking antibiotics, especially broad-spectrum antibiotics
• Use central venous catheters (tubes inserted into large veins)
• Need to be fed through a tube
• Are receiving chemotherapy or radiation therapy
• Take medications that suppress the immune system, such as corticosteroids
• Have had major surgery, especially abdominal surgery
• Are staying in an intensive care unit for a prolonged period
• Receive kidney dialysis
• Have had an organ or stem cell transplant
• Receive nutrition through an intravenous line (total parenteral nutrition)
• Have severe burns

The infection can also develop outside of the hospital if you are sent home with a central venous catheter that you manage yourself^[1].

Signs and Symptoms

The symptoms of systemic candida can be difficult to identify because most people who develop this infection are already ill or recovering from surgery^[1]. The signs can also be similar to other conditions, such as bacterial infections, making diagnosis challenging^[1].

Common symptoms of systemic candida include^[1][2]:

• Fever and chills that do not improve with antibiotic treatment
• Belly pain
• Muscle pain
• Skin rash
• Weakness or fatigue
• Rapid heart rate (tachycardia)
• Rapid breathing (tachypnea)
• Low blood pressure (hypotension)

Some symptoms are specific to where the infection has spread. For example, if systemic candida affects your eyes, you may experience^[1]:

• Blurred vision
• Sensitivity to light
• Vision changes

When the infection spreads to the bloodstream (candidemia), symptoms may include fever and chills along with confusion, low blood pressure, and decreased urine output^[1][2].

Because most people who get invasive candidiasis are already sick, it can be very difficult to determine which symptoms are from the original condition and which are from the Candida infection^[7].

How is it Diagnosed?

Systemic candida is primarily diagnosed through blood cultures^[7]. A healthcare provider takes a sample of your blood and sends it to a laboratory where it is tested to see if Candida yeast is present.

However, blood cultures are only 70% to 80% sensitive in diagnosing this infection, meaning they may miss some cases^[2]. This is why doctors may order additional tests if they suspect systemic candida.

Other diagnostic tests that may be used include^[2][14]:

• Beta-D-glucan test: This blood test detects a substance produced by many fungi, including Candida. It can help support the diagnosis, though it is not specific to Candida alone
• T2 magnetic resonance assay: A newer test that can detect Candida in the blood more quickly than traditional cultures
• Complete blood count and other blood tests to check for signs of infection
• Imaging tests such as ultrasound, CT scan, or MRI to look for signs of infection in internal organs
• Tissue biopsy if infection of a specific organ is suspected

Determining which species of Candida is causing the infection is important because different species may respond differently to antifungal medications^[7]. Healthcare providers often need to test every day or every other day to monitor the infection and treatment response^[7].

Treatment Options

Treatment for systemic candida involves antifungal medications and often requires removing the source of infection^[1][2]. Treatment should be started within 24 hours of diagnosis to improve outcomes^[2].

Antifungal medications are the main treatment for systemic candida. The most commonly used medications are^[7][11]:

• Echinocandins (such as caspofungin, micafungin, or anidulafungin): These are the first-line or preferred choice for most adults with candidemia and invasive candidiasis. They are given through a vein (intravenously)
• Fluconazole: This medication may be used for patients who are not critically ill when resistance is unlikely. It can be given as a pill or through a vein
• Amphotericin B (lipid or liposomal formulations): This may be used in certain situations
• Voriconazole: Another option in specific circumstances

The type of antifungal medication, the dose, and the length of treatment depend on several factors, including the patient’s age, overall health, location and severity of infection, and which species of Candida is causing the infection^[11].

For bloodstream infections (candidemia), treatment typically continues for two weeks after signs and symptoms have resolved and Candida is no longer found in the bloodstream^[11]. Infections in other locations, such as bones, joints, heart, or the central nervous system, usually require longer treatment periods^[11].

Source control is an essential part of treatment^[2]. This may include:

• Removing central venous catheters or other medical devices
• Draining abscesses (collections of pus)
• Surgery in certain cases

An eye examination is generally recommended for patients with candidemia to check for spread of infection to the eyes^[2].

Prevention

Since systemic candida primarily occurs in hospitalized patients, most prevention measures focus on healthcare settings^[7][22].

Important prevention measures in hospitals include^[7][22]:

• Healthcare workers following proper hand hygiene practices
• Careful placement and maintenance of central venous catheters
• Using antibiotics only when necessary and as directed
• Following infection control practices to prevent the spread of Candida
• Removing catheters as soon as they are no longer needed

Some high-risk patients may benefit from antifungal prophylaxis, which means taking antifungal medications to prevent infection before it occurs^[7]. This is often recommended for:

• Some organ transplant recipients
• Certain patients in intensive care units
• Patients receiving chemotherapy with low white blood cell counts
• Stem cell transplant recipients with low white blood cell counts
• Very low birth weight infants in nurseries with high rates of invasive candidiasis

If you or a family member has a central venous catheter, it’s important to^[22]:

• Learn how to keep the catheter site clean and protected
• Tell your doctor immediately if the skin around the catheter becomes red or painful
• Wash hands frequently with soap and water or use alcohol-based hand sanitizer

Outlook and Complications

Systemic candida is a serious, life-threatening infection that can cause severe complications^[1]. The infection can spread to vital organs throughout your body, including your eyes, kidneys, heart, and brain^[1].

Possible complications include^[1][2]:

• Endocarditis: Inflammation and infection of the heart valves or inner lining of the heart
• Meningitis: Infection of the protective membranes covering the brain and spinal cord
• Endophthalmitis: Infection inside the eye that can lead to vision loss
• Osteomyelitis: Infection of the bones
• Arthritis: Infection of the joints
• Organ failure
• Death

The outcome depends on several factors, including how quickly treatment is started, the patient’s overall health and immune status, and whether the source of infection can be removed^[2]. Starting treatment within 24 hours of diagnosis significantly improves outcomes^[2].

People who are already critically ill or have weakened immune systems may have a more difficult recovery. However, with prompt and appropriate treatment, many patients can recover from systemic candida^[14].