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Last reviewed: 21 Apr 2025
Last updated: 23 Mar 2023

Summary

Definition

History and exam

Key diagnostic factors

  • fever
Full details

Other diagnostic factors

  • tachycardia
  • tachypnea
  • hypotension
  • poor capillary refill
  • acute mental confusion
  • decreased urine output
  • low oxygen saturation
  • rash
  • hepatosplenomegaly
  • hypothermia
Full details

Risk factors

  • use of central venous catheter
  • exposure to broad-spectrum antibiotics
  • hemodialysis
  • surgery
  • parenteral nutrition
  • immunosuppressants (e.g., chemotherapy, systemic corticosteroids, biologic and other immunosuppressants)
  • colonization at multiple sites
  • intravenous drug use
Full details

Diagnostic tests

1st tests to order

  • blood culture
  • CBC
  • ABG
  • lactate levels
  • coagulation studies
  • renal function tests
  • liver function test
  • serum glucose
Full details

Tests to consider

  • 1,3-beta-D-glucan
  • T2 magnetic resonance assay
  • tissue biopsy
Full details

Emerging tests

  • polymerase chain reaction
  • matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry
Full details

Treatment algorithm

INITIAL

suspected diagnosis

ACUTE

confirmed diagnosis: non-neutropenic patients (no complications)

confirmed diagnosis: neutropenic patients (no complications)

confirmed diagnosis: with complications

Contributors

Authors

Brenda L. Tesini, MD

Assistant Professor

Infectious Diseases

Departments of Medicine and Pediatrics

University of Rochester Medical Center

Rochester

NY

Disclosures

BLT has received honoraria from Merck for educational contributions unrelated to this topic.

Acknowledgements

Dr Brenda L. Tesini would like to gratefully acknowledge Dr Jack D. Sobel and Dr Sanjay G. Revankar, previous contributors to this topic.

Disclosures

JDS declares that he has no competing interests. SR has received grants for research from Astellas, Gilead, and Merck, and has been involved in clinical trials for Cidara and Astellas.

Peer reviewers

John Fisher, MD

Professor of Medicine

Department of Medicine

Medical College of Georgia

Augusta

GA

Disclosures

JF is an author of a number of references cited in this topic. JF is a member of the speaker's bureau for the following companies: Pfizer, Merck, and Astellas.

Jean-Michel Livrozet, MD

Praticien hospitalier

Service de medecine de la Transplantation et d'Immunologie clinique

Hopital Edouard Herriot

Lyon

France

Disclosures

JML has been invited by Astellas, the manufacturer of micafungin, to attend a symposium, and invited by Gilead Sciences, manufacturer of liposomal amphotericin B, to attend different HIV conferences, and has been paid by Gilead Sciences for running HIV educational programs.

Matthew Falagas, MD, MSc, DSc

Director

Alfa Institute of Biomedical Sciences

Marousi

Athens

Greece

Disclosures

MF declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Tsay SV, Mu Y, Williams S, et al. Burden of candidemia in the United States, 2017. Clin Infect Dis. 2020 Dec 3;71(9):e449-53.Full text  Abstract

Centers for Disease Control and Prevention. ​Candida auris: information for laboratorians and health professionals. Jul 2021 [internet publication].Full text

Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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