What are the symptoms of a systemic Candida glabrata infection?

Symptoms of Systemic Candida glabrata Infection

Systemic Candida glabrata infection presents with highly nonspecific symptoms that cannot be clinically distinguished from bacterial bloodstream infections, making laboratory confirmation essential for diagnosis. 1

Primary Clinical Manifestations

The hallmark presentation includes:

• Persistent fever despite broad-spectrum antibiotics or recurring febrile episodes after initial defervescence, which is the most common presenting symptom in immunocompromised patients 1
• Antibiotic-refractory fever in patients with prolonged granulocytopenia, particularly in hematology and oncology settings 1

Organ-Specific Symptoms

Hepatosplenic Involvement

• Persistent fever with hepatosplenomegaly and elevated alkaline phosphatase, typically developing after neutrophil recovery 1
• These signs emerge characteristically post-recovery from neutropenia, distinguishing them from acute presentation 1

Ocular Manifestations

• Fungal endophthalmitis presenting as posterior uveitis with characteristic "cotton wool spots" on fundoscopic examination 1
• This manifestation also typically develops after neutrophil recovery 1

Hematogenous Dissemination

Systemic Candida infections can affect multiple organs through bloodstream spread, including:

• Brain involvement (though less common than mold infections in hematologic malignancies) 1
• Cardiac involvement (endocarditis) 1
• Renal involvement (pyelonephritis, fungus balls) 1
• Bone involvement (osteomyelitis with vertebral involvement reported) 2

Cutaneous Manifestations

• Skin infiltrations during pancytopenia that may be misinterpreted as thrombocytopenic purpura 1, 3
• Cutaneous lesions can mimic other fungal infections histologically 3

Gastrointestinal Involvement

• Fungal esophagitis causing dysphagia and retrosternal burning, though these symptoms cannot definitively diagnose candidiasis without endoscopic confirmation 1
• Oral candidiasis may be indistinguishable from chemotherapy-induced mucositis 1

Critical Diagnostic Considerations

The symptoms of invasive fungal disease are fundamentally nonspecific, particularly in early stages, and bacterial versus fungal bloodstream infections cannot be differentiated clinically. 1

Key Clinical Pitfalls:

• Do not rely on clinical symptoms alone for diagnosis—histological and/or cultural evidence from tissue biopsies or positive cultures from sterile body fluids are required for definitive diagnosis 1
• Pulmonary infiltrates during antibiotic treatment may suggest fungal infection but require imaging (HRCT preferred) and microbiological confirmation 1
• C. glabrata exhibits innate resistance to azole antifungals, with approximately 10% of clinical isolates showing co-resistance to both azoles and echinocandins 4
• Mortality rates are particularly high in immunocompromised patients with C. glabrata infection, making rapid identification essential 3

Risk Context:

• C. glabrata ranks as the second or third most common cause of systemic candidal infections, particularly in nosocomial settings 5
• The organism is increasingly prevalent in immunocompromised populations, including HIV-infected individuals and those receiving immunosuppressive therapy 5
• Recent data shows C. glabrata is designated as a high-priority fungal pathogen by the WHO due to increasing antifungal resistance 4