Candidemia

Overview

Candidemia is the presence of Candida yeast in the bloodstream. It is the most common type of invasive candidiasis and one of the more frequent bloodstream infections acquired in hospitals. Candida normally lives harmlessly on the skin and in the gut, but in seriously ill people it can enter the blood, often through a medical catheter, and cause a dangerous infection.

Once in the bloodstream, Candida can travel to organs such as the heart, eyes, brain, and bones. Candidemia is a serious condition that requires prompt antifungal treatment, removal of the likely source, and close monitoring. Early recognition greatly improves the outcome.

Symptoms

The symptoms of candidemia are often nonspecific and resemble other serious bloodstream infections. A characteristic warning sign is fever that does not respond to antibiotics. Symptoms may include:

• Fever and chills that persist despite antibiotic treatment
• Feeling very unwell, weak, or exhausted
• A rapid heartbeat and rapid breathing
• Low blood pressure in severe cases
• Confusion in seriously ill or older patients

If Candida spreads to the eyes, it can cause pain or vision changes; if it reaches the heart valves, it can cause a serious infection. Candidemia can progress to sepsis and organ failure, so any unexplained persistent fever in a high-risk patient needs urgent evaluation.

Causes

Candidemia develops when Candida gains access to the bloodstream, usually because a natural barrier has been breached or the immune system is weakened.

• Central venous catheters: The most common route, as Candida can grow on the line and enter the blood.
• Recent surgery, especially abdominal surgery.
• Prolonged intensive care stays.
• Broad-spectrum antibiotics that disturb the body's normal microbes.
• Weakened immunity from chemotherapy, transplants, or other causes.
• Tube feeding through a vein (total parenteral nutrition).

Risk Factors

• A central venous catheter or other indwelling line
• A prolonged stay in intensive care
• Recent major or abdominal surgery
• Long courses of broad-spectrum antibiotics
• A weakened immune system
• Diabetes and kidney failure requiring dialysis
• Premature birth in newborns

Diagnosis

Doctors confirm candidemia mainly through blood testing and look for spread to other organs:

• Blood cultures: The standard test to grow and identify Candida from the blood.
• Identifying the species: Knowing which Candida species is present helps choose the right antifungal.
• Eye examination: Often recommended to check whether the infection has spread to the eyes.
• Echocardiogram and imaging: To look for involvement of the heart or other organs in selected patients.

Because blood cultures can take time and miss some cases, doctors may start treatment in high-risk patients before results return.

Treatment

Candidemia is treated urgently with antifungal medication and removal of the likely source.

• Antifungal medication: Echinocandins are commonly used first, with fluconazole or other agents chosen based on the species and the patient's condition.
• Removing the catheter: Infected central lines are usually taken out, as they can keep seeding the blood.
• Treating organ involvement: Longer or specialized treatment if the eyes, heart, or other organs are affected.
• Supportive care: Intensive care support for severely ill patients.

Treatment generally continues for at least two weeks after blood cultures become negative, and longer if organs are involved. Repeat blood cultures help confirm the infection has cleared.

Prevention

• Strict sterile technique when placing and caring for catheters
• Removing central lines as soon as they are no longer needed
• Using antibiotics only when necessary
• Preventive antifungal medication for selected very high-risk patients
• Good hand hygiene and infection control in hospitals

When to See a Doctor

Candidemia occurs in people who are already seriously ill, usually in the hospital, where it is detected and treated. Urgent attention is needed for any seriously ill or hospitalized person with:

• Fever and chills that do not improve with antibiotics
• Signs of sepsis, such as low blood pressure, confusion, and a racing heartbeat
• New eye pain or vision changes during a serious infection
• Rapid deterioration in someone with risk factors

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). Invasive candidiasis.
2. National Institute of Allergy and Infectious Diseases (NIAID). Fungal diseases.
3. Infectious Diseases Society of America (IDSA). Candidiasis guidance.
4. MedlinePlus, U.S. National Library of Medicine. Candida infection.