Candida Infection of the Bloodstream–

Candidemia
Fungal Disease Series #4
Candida is the single most important cause of fungal
infections worldwide. In the U.S., Candida is the 4th
most common cause of bloodstream infection that
can develop while you are in a hospital (also called
“nosocomial” infection or hospital acquired infection).
There are 17 different species of Candida. Of these,
Candida albicans (C. albicans), C. glabrata, C. parapsilosis
and C. tropicalis are the most common species.
Where in my body can I get a How can I get Candidemia?
Candida infection? In the hospital, 40% of bloodstream infections
Candida infection can happen in almost any are caused by the fungus Candida. Most often,
part of your body. Usually it develops on mucous Candidemia develops within a week of being
membranes (in the mouth, genitals etc.) but the admitted to an intensive care unit (ICU) if
infection can also be in your bloodstream. When you also have a central venous catheter, get
Candida is in your blood stream, the condition is kidney dialysis, have major surgery, have a low
called Candidemia. Candida infection can spread white blood count, or if you are getting broad
from your blood stream to other parts of your spectrum antibiotics, intravenous steroids or
body (such as your eyes, kidney, liver and brain). medications to depress your immune system.
If this happens, it is called Invasive Candidemia. You can also get Candidemia outside of the
People who are healthy do not usually get hospital if you are sent home from the hospital
Candidemia. Healthy people however, may get a with a central venous catheter or if you are on
Candida infection in their mouth (called thrush) cancer chemotherapy. Chemotherapy weakens
from certain drugs such as inhaled corticosteroids your immune system and can put you at risk for
used to treat asthma and COPD. If you are common infections, like the cold or flu, or less
very ill or have a weakened immune system common infections, like Candidemia or other
(for example from chemotherapy or an organ fungal infections. Candida species can also enter
transplant), are diabetic, receive corticosteroids, the bloodstream alongside a catheter in your vein
or artery, at the area where the catheter enters
broad spectrum antibiotics or have a central
through the skin. Although Candida infections of
venous catheter in place, you are predisposed to
the mucosal surfaces (mouth and esophagus) are
develop Candidemia. A central venous catheter is
usually easy to treat, treatment of Candidemia
a tube that is inserted in one of the major blood
can be challenging, especially when the infection
vessels leading to the heart and is used to give
has spread to other organs (eye, brain or kidneys)
you medications, chemotherapy, or nutritional
and if there is a central venous catheter in place.
supplements. (see ATS Patient Series at http://
patients.thoracic.org/information-series/en/resources/ What are the signs and symptoms of
central-venous-catheter.pdf for information on Candidemia?
central venous catheters). Signs and symptoms of Candida infection

Am J Respir Crit Care Med Vol. 185, P3-4, 2012 • Online Version Updated October 2013 www.thoracic.org
ATS Patient Education Series © 2012 American Thoracic Society
depend upon the site of infection. However, if are at risk for getting Candidemia, you may be
you have Candidemia, you may have one or more treated with an antifungal medication to prevent
of the following: you from getting the infection. This is called
• fever, chills “prophylactic” treatment. Prophylactic treatment
• skin rash with antifungal medication does not work for
• generalized weakness or fatigue everyone. The decision to treat you is based on
• low blood pressure the likely benefits of preventing an infection
• muscle aches compared to the risk of making you sick from the
• vision changes or signs of an eye infection medications themselves.
• headaches and neurological deficits What puts me at risk for developing
• abdominal pain Candidemia?
How is Candidemia diagnosed? You are at risk for developing Candidemia if you:
Candidemia is diagnosed by taking a blood • are hospitalized, especially in the intensive
sample and finding Candida in your blood. In care unit (ICU) for several days
many cases, the species found is Candida albicans, • have a central venous catheter (whether you
however, other species of Candida, Candida are in the hospital or at home)
tropicalis, C. glabrata and C. parapsilosis can be • have a weak immune system, either from drugs
found in your blood. Candida parapsilosis is most or from being extremely ill
commonly found in children. The diagnosis can • have had abdominal surgery,
also be made by detecting antigens of Candida in • have severe burns,
the blood stream • inject yourself with drugs,
• are being treated with antibiotics for bacterial
How is Candidemia treated?
infection,
Because Candidemia can cause a serious, life
• have kidney disease needing dialysis
threatening illness, treatment is usually begun
Infants who are very underweight at birth are also
when an infection is suspected. Treatment
at risk for developing Candidemia.
includes finding the source of the infection
and if possible, removing it (for example Author: Ernestine Kotthoff-Burrell PhD, ANP
the central venous catheter) and beginning Reviewers: Bonnie Fahy RN, MN; Suzanne Lareau RN, MS;
Chadi Hage MD
treatment with medication. There are a number
of medications that can be used to treat Candida Resources
infections. The medications include: fluconazole, Centers for Disease Control (CDC)
an amphotericin B drug, a drug from the http://www.cdc.gov/nczved/divisions/dfbmd/diseases/
candidiasis/index.html
echinocandin group (such as anidulafungin,
caspofungin or micagungin) or voriconazole. The
type of drug used will depend on how sick you
are or the species of Candida most likely causing
your infection. Action Steps
What can be done to prevent Call your health care provider if you have two or more
getting Candidemia? of any of the above risk factors and develop a fever, or
any other signs and symptoms of infection (for example,
Your health care team (physician, nurse, redness, warmth or drainage from the catheter site).
pharmacist etc) know that Candidemia can Doctor’s Office Telephone:
develop from not using good hand washing and
not checking your central venous catheter for
signs of infection. Therefore, they will check your
catheter and wash their hands regularly. If you

The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing
in this series is for educational purposes only and should not be used as a substitute for the medical advice one one’s personal health care
provider. For further information about this series, contact J.Corn at [email protected].
www.thoracic.org