Severe Candidal Infections

doi:10.1059/0003-4819-89-1-91

Severe Candidal Infections

Clinical Perspective, Immune Defense Mechanisms, and Current Concepts of Therapy

Los Angeles, California

Abstract

Disseminated candidiasis has become an important infection, particularly in immunocompromised and postoperative patients. Although serologic tests may, in some settings, facilitate a premortem diagnosis, the disease is usually diagnosed by comprehensive clinical evaluation. Detection of the relatively newly recognized peripheral manifestations of candidemia may be vital to early diagnosis: endophthalmitis, osteomyelitis, arthritis, myocarditis, meningitis, and macronodular skin lesions. Studies in patients with chronic mucocutaneous candidiasis and in-vitro manipulations have begun to elucidate normal immune defense mechanisms against Candida, including serum factors, phagocytosis, intracellular killing mechanisms, and lymphocyte function (particularly T cell). The primary drugs for the treatment of disseminated candidiasis are still amphotericin B or amphotericin B plus 5-fluorocytosine; the mainstay of therapy for chronic mucocutaneous candidiasis is amphotericin B. Other antifungals and immune system-stimulating modalities (transfer factor, thymosin, thymus epithelial cell transplantation, and levamisol) may be useful for chronic mucocutaneous candidiasis in some settings and deserve further evaluation.

Article and Author Information

▸An edited transcription of an Interdepartmental Clinical Case Conference arranged by the Department of Medicine of the UCLA School of Medicine (University of California, Los Angeles); Los Angeles, California.
▸Authors who wish to cite a section of this conference and specifically indicate its author can use this example for the form of reference:

LEHRER RI: Host defense mechanisms against disseminated candidiasis, pp. 94-96 in EDWARDS JE JR (moderator): Severe candidal infections. Clinical perspective, immune defense mechanisms, and current concepts of therapy. Ann Intern Med 89:91-106, 1978
▸Requests for reprints should be addressed to J.E. Edwards, Jr., M.D.; Division of Infectious Diseases, Box 15, Department of Medicine, Harbor General Hospital; 1000 West Carson Street; Torrance, CA 90509.
- Received March 9, 1978.
- Accepted March 22, 1978.