Disseminated Candidiasis: Acute vs Chronic

Over the past few decades, there has been a significant increase in the prevalence of disseminated candidiasis. Fortunately, a number of novel antifungal medications have been developed recently to treat these infections.

Patients can be divided into two groups for therapy consideration based on their neutropenia. Unless an azole-resistant species infection is detected, fluconazole is the preferred empirical treatment for disseminated candidiasis in nonneutropenic, hemodynamically stable individuals. Agents with a wider species coverage are recommended for the empirical therapy of candidemia in individuals who are hemodynamically unstable or neutropenic.

Candida organisms can be disseminated to multiple sites, including the kidney, liver, spleen, retina, bones, and central nervous system. It's critical to differentiate between the two types of disseminated candidiasis since they differ significantly in terms of prognosis and clinical presentation. Diagnosis of chronic disseminated candidiasis is challenging and high index of suspicion is required as standard culture workup is often negative, however acute disseminated candidiasis is easy to establish when blood cultures are positive. 

Antifungal therapy should be given to all patients with disseminated candidiasis, if possible. Here are some key aspects to help with the diagnosis, management and better understanding of this condition.

References

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