Invasive Candidiasis

Candidiasis

Microorganisms such as bacteria, viruses and fungi can cause infection in people.¹ Examples of fungi that cause infection include aspergillus (which can affect the lungs) and cryptococcus (which can cause meningitis).² Candidiasis is a fungal infection caused by a fungus called Candida.² Candida can live on skin and inside the body, such as in the mouth and vagina, without causing problems.³ Candida can cause infections if it grows out of control or if it enters deep into the body. For example, it can cause infections in the bloodstream or internal organs like the kidney, heart, or brain.^1,3

Invasive candidiasis

Unlike Candida infections in the mouth and throat (also called “thrush”) or vaginal “yeast infections,” invasive candidiasis is a serious infection that can affect the blood, heart, brain, eyes, bones, and other parts of the body.⁴ Invasive candidiasis tends to occur in patients who are at risk such as those hospitalized with cancer, bone marrow or organ transplants.⁵ Half of all candidemia infections occur in patients in intensive care.⁶ It often results in long hospital stays.⁷ While Invasive candidiasis is rare (affecting approximately 2000 people per year in the UK)^8-9 sadly, an estimated 40% of those affected die.¹⁰

Risk Factors

Certain people are more likely to get invasive candidiasis; these include:

• People who are critically ill with weakened immune systems (immunocompromised), such as those with cancer or those undergoing bone marrow or solid organ transplant.¹¹
• People with kidney disease.
• People who are unconscious with a machine helping them to breathe.
• People with a cannula administering medicines or fluids directly into a large vein (e.g. through the neck).
• People requiring hospitalisation due to infection.
• People being fed by a tube directly into a vein.
• People who have used broad-spectrum antibiotics
• Older people.
• People who have had recent abdominal surgery.^12-14

Clinical Features

Disease symptoms can vary based on the affected organs (e.g. if in the heart it may cause chest pain) and the species of Candida causing the infection.¹⁵ Fever and chills are common.¹⁶

Diagnosis and treatment

Blood tests and imaging (e.g. Xrays) may be used to determine if a person has invasive candidiasis or other invasive fungal infections.^17-18 Antifungal medications are the primary treatment, often administered via a tube directly into a vein.¹⁹

If you suspect invasive candidiasis, seek medical attention promptly for appropriate diagnosis and management.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK27114/#:~:text=The%20agents%20that%20cause%20disease,are%20the%20subject%20of%20microbiology [Accessed February 2024]. 

2. https://www.niaid.nih.gov/diseases-conditions/fungal-disease-specific-research [Accessed February 2024]. 

3. https://www.cdc.gov/fungal/diseases/candidiasis/index.html#:~:text=Candidiasis%20is%20a%20fungal%20infection,and%20vagina%2C%20without%20causing%20problems [Accessed

February 2024].  

4. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/index.html#:~:text=Invasive%20candidiasis%20is%20an%20infection,other%20parts%20of%20the%20body [Accessed 

February 2024]. 

5. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/risk-prevention.html [Accessed February 2024]. 

6. Pappas PG et al. Nat Rev Dis Primers. 2018;4:18026.

7. Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, et al. Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance external icon. Infect Control Hosp Epidemiol 2005 Jun;26(6):540-7. [Accessed February 2024].

8. https://www.worldometers.info/world-population/uk-population/ [Accessed February 2024] 

9. https://www.gov.uk/government/publications/candidaemia-annual-data-from-voluntary-surveillance/bloodstream-infection-due-to-candida-and-species-formerly-part-of-the-candida-genus-in-england-2022#:~:text=In%202022%2C%20the%20rate%20of,included%20within%20the%20data%20tables). [Accessed February 2024].  

10. Harrison D, Muskett H, Harvey S, et al. NIHR Journals Library; 2013 (Health Technology Assessment, No. 17.3.)

11. Kullberg BJ and Arendrup MC. N Engl J Med. 2015;373:1445–1456.

12. WHO fungal priority pathogens list to guide research, development and public health action. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240060241. [Accessed February 2024].

13. Hoenigl M et al. Lancet Infect Dis. 2023;23:751–761.

14. Bongomin F et al. J Fungi (Basel). 2017;3:57.

15. https://www.usu.edu/herbarium/education/fun-facts-about-fungi/endocarditis#:~:text=The%20symptoms%20can%20include%20fever,blood%20vessels%20under%20the%20nails [Accessed February 2024].

16. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/symptoms.html [Accessed February 2024]. 

17. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/diagnosis.html#:~:text=Diagnosis%20and%20testing%20for%20Invasive%20Candidiasis&text=The%20most%20common%20way%20that,grow%20Candida%20in%20a%20culture [Accessed February 2024]. 

18. Alexander BD, Lamoth F, Heussel CP, Prokop CS, Desai SR, Morrissey CO, Baddley JW. Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clin Infect Dis. 2021 Mar 12;72(Suppl 2):S79-S88. doi: 10.1093/cid/ciaa1855. PMID: 33709131.

19. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/treatment.html [Accessed February 2024].