Severe candidal infections: clinical perspective, immune defense mechanisms, and current concepts of therapy

Ann Intern Med. 1978 Jul;89(1):91-106. doi: 10.7326/0003-4819-89-1-91.

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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Amphotericin B / therapeutic use
  • Animals
  • Antifungal Agents / therapeutic use
  • Arthritis / etiology
  • Brain Diseases / etiology
  • Candidiasis* / complications
  • Candidiasis* / drug therapy
  • Candidiasis* / immunology
  • Candidiasis, Cutaneous / diagnosis
  • Candidiasis, Cutaneous / immunology
  • Candidiasis, Cutaneous / therapy
  • Drug Therapy, Combination
  • Endophthalmitis / etiology
  • Humans
  • Immunotherapy
  • Leukocytes / immunology
  • Lymphocytes / immunology
  • Macrophages / immunology
  • Myocarditis / etiology
  • Osteomyelitis / etiology
  • Phagocytosis
  • Skin Diseases / etiology

Substances

  • Antifungal Agents
  • Amphotericin B