Diagnosis and therapy of systemic candidiasis

Systemic candidiasis is becoming a major obstacle in the care of debilitated patients, particularly those with primary or iatrogenically induced immune deficiencies. Successful management of this infection requires anticipatory surveillance of the potential victim, and correct interpretation of diagnostically significant signs and symptoms. Predisposing factors as well as clinical, mycological and serological findings that facilitate diagnosis are discussed in the light of 33 cases of systemic candidiasis observed by the authors. It is shown that timely treatment of candidemia raises the chances for survival from 20 to 80%. Toxic side and after effects of amphotericin B can be significantly minimized by holding the dosage to the minimum required to establish and maintain fungistatic serum levels of the drug and by judicious administration and spacing of the intravenous infusions. Guidelines for achieving these aims are presented.