What are the signs and symptoms of candidemia (fungal infection in the blood)?

From the Guidelines

Candidemia, a bloodstream infection caused by Candida species, often presents with nonspecific signs and symptoms, including fever, chills, hypotension, tachycardia, and altered mental status, and can lead to septic shock, multi-organ dysfunction, and high mortality rates if left untreated. Patients typically experience fever and chills that persist despite antibiotic therapy, which is the most common presentation 1. Other manifestations include:

• Hypotension
• Tachycardia
• Altered mental status, particularly in critically ill patients
• Skin findings, such as a diffuse maculopapular rash or, less commonly, disseminated pustular lesions
• Septic shock with multi-organ dysfunction, including acute kidney injury, respiratory distress, and liver dysfunction
• Ocular involvement (endophthalmitis) occurs in approximately 10-25% of cases, presenting as blurred vision or eye pain 1
• Endocarditis with new heart murmurs or embolic phenomena

The diagnosis should be suspected in high-risk patients, including those with:

• Central venous catheters
• Receiving total parenteral nutrition
• On broad-spectrum antibiotics
• Immunocompromised individuals
• Those with recent abdominal surgery Blood cultures are essential for diagnosis, though they may take several days to become positive 1. Early recognition is crucial as mortality rates for untreated candidemia range from 30-40%, and prompt antifungal therapy significantly improves outcomes 1.

It is essential to note that the signs and symptoms of candidemia can be nonspecific, and a high index of suspicion is required to make a timely diagnosis. The use of surrogate markers, such as β-D-glucan, mannan-antimannan antibodies, and PCR testing, may aid in the diagnosis, but their role is still evolving 1.

In terms of management, empirical antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever, with preference given to an echinocandin in hemodynamically unstable patients, those previously exposed to an azole, and those known to be colonized with azole-resistant Candida species 1.

From the FDA Drug Label

A successful response required all of the following: resolution or improvement in all clinical signs and symptoms of infection, blood cultures negative for Candida, infected deep tissue sites negative for Candida or resolution of all local signs of infection, and no systemic antifungal therapy other than study drug The signs and symptoms of candidemia are not explicitly listed in the provided drug labels. However, the labels mention that a successful response to treatment requires resolution or improvement in all clinical signs and symptoms of infection.

• Clinical signs and symptoms are not specified, but it can be inferred that they may include:
  • Fever
  • Chills
  • Hypotension
  • Tachycardia
  • Tachypnea
  • Diarrhea
  • Nausea
  • Abdominal pain
  • Pleural space infections
  • Intra-abdominal abscesses
  • Peritonitis 2 3

From the Research

Signs and Symptoms of Candidemia

The provided studies do not directly describe the signs and symptoms of candidemia. However, they discuss the diagnosis, treatment, and management of candidemia, which can be related to its signs and symptoms.

Related Information

• Candidemia is a medical emergency for patients with cancer, and its mortality remains high despite advances in diagnosis and treatment 4.
• Invasive candidiasis is a cause of sepsis in critically ill patients, and early diagnosis is critical to initiate antifungal agents promptly 5.
• Risk factors for candidemia include intensive care unit (ICU) stay, presence of intravascular line, previous antibiotic exposure, surgical intervention, mechanical ventilation, total parenteral nutrition, and urinary catheters 6.
• Comorbidities associated with candidemia include solid organ cancer, haematology malignancy, steroid use, diabetes, and chemotherapy 6.

Diagnosis and Treatment

• Diagnosis of invasive candidiasis is critical, but conventional culture methods are suboptimal, and non-culture based methods are still investigational or require additional testing 5.
• Antifungal therapy should be selected based on the distribution of Candida species and the pattern of antifungal resistance 7.
• Treatment with fluconazole for candidemia due to high biofilm-forming Candida species is associated with higher mortality 8.
• Echinocandin therapy may be more effective than azole therapy for candidemia caused by high biofilm-forming Candida species 8.