Among the elements contributing to causation of septicemia by Candida, prolonged therapy with broad spectrum antibiotics and the use of intravenous catheters under poor conditions of asepsis are the most important. The area in which these infections settle is usually one already damaged by some malign process or debilitating disease. The infection is rarely found in previously healthy subjects, although a high proportion of them are carriers of the organisms, generally at one or other extreme of the digestive tract. Except in cases of operative contamination, entry of the organisms into the systemic circulation seems to be via the digestive mucosa or peripheral veins (injection or catheterization), but in most published cases there is no conclusive proof of this. The role of substances used in parenteral nutrition has recently been suggested, but its mechanism is not yet clear. Evaluation of positive hemoculture by Candida has not been clarified, since this was frequently observed where no pathogenic action had occurred. Probably a difference in response to the organism depends not only on host idiosyncrasy but also on the virulence of the organism. Serological tests help little in the diagnosis owing to the frequency of false positives: the same applies of intradermal tests. Apparently the finding of mycelian forms in the blood smear implies marked pathogenic possibilities in the isolated organism. For a sound diagnosis it is absolutely necessary to combine hemoculture with a corresponding case history, to exclude the possibility of a mere transient fungemia.
|Publication status||Published - 1 Jan 1974|