ACUTE DISSEMINATED CANDIDIASIS: - THIS usually presents as candidaemia (isolation of Candida spp. from the blood). The main predisposing factor is the presence of a central venous catheter. Other major factors include recent abdominal surgery, total parenteral nutrition (TPN), recent antibiotic therapy and localised Candida colonisation. Up to 40% of cases will have ophthalmic involvement, with characteristic retinal ‘cotton wool’ exudates. As this is a sight-threatening condition, candidaemic patients should be assessed by detailed ophthalmoscopy. Skin lesions (non-tender pink/red nodules) may be seen. Although predominantly a disease of intensive care and surgical patients, acute disseminated candidiasis and/or Candida endophthalmitis is seen occasionally in injection drug-users, thought to be due to candidal contamination of citric acid or lemon juice used to dissolve heroin.
CHRONIC DISSEMINATED CANDIDIASIS:- (hepatosplenic candidiasis) In this condition, a neutropenic patient has a persistent fever, despite antibacterial therapy. The fever persists, even though there is neutrophil recovery, and is associated with the development of abdominal pain, raised alkaline phosphatase and multiple lesions in abdominal organs (e.g. liver, spleen and/or kidneys) on radiological imaging. Chronic disseminated candidiasis is a form of immune reconstitution syndrome in patients recovering from neutropenia and usually lasts for several months, despite appropriate therapy.
Renal tract candidiasis, osteomyelitis, septic arthritis, peritonitis, meningitis and endocarditis are all well recognised, and are usually sequelae of acute disseminated disease.
Diagnosis and treatment of these conditions require specialist mycological advice.
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