Systemic Disease or Invasive Focal Infection
Cultures of the Blood, Urine & CSF Multiple or repeat blood cultures should be performed to increase the likelihood of detecting candidemia as the sensitivity of a single blood culture is low in detecting disseminated candidiasis. Blood cultures can be negative in up to 50% of autopsy-proven cases of deep-seated candidiasis or may only become positive late in the infection.[66,83,84] If a central venous catheter is present, cultures should be obtained through the catheter and a peripheral vessel to distinguish between disseminated infection and catheter-related candidiasis. A drawback of all blood culture systems as the primary means of establishing the diagnosis of candidemia is that 1–4 days are required for growth of the organism. Molecular diagnostic methods based on amplification of fungal ribosomal DNA in blood samples are under evaluation. The diagnosis of a Candida infection of any one organ system should prompt a thorough examination and evaluation to detect candidemia and other organ involvement. Other options are as follows:
Cranial imaging by head ultrasound, CT or MRI is recommended in systemic candidiasis;
Dilated eye examination;
Echocardiogram to determine whether there are any cardiac thrombi or vegetations;
Diagnostic imaging of the liver, spleen and kidney;
Skin biopsy to confirm invasive fungal dermatitis.
Expert Rev Anti Infect Ther. 2013;11(7):709-721. © 2013 Expert Reviews Ltd.