The spectrum of systemic candidiasis at Auckland Hospital

Systemic candidiasis is uncommon. We reviewed our experience with this disease from the infectious disease unit, Auckland Hospital, between 1982 and 1988, because many of these patients are referred to us. We then selected 11 of them to highlight particular presentations, diagnostic or management issues. We included both compromised and noncompromised patients from medical and surgical services. Candida albicans was the most common cause, but we also saw patients infected with C glabrata, C parapsilosis, and C tropicalis and present them to exemplify their different clinical presentations. Demonstrable fungaemia is uncommon in patients with systemic candidiasis, serological techniques are both insensitive and nonspecific and patients are often too ill from underlying disease to allow for invasive diagnostic procedures. Thus diagnosis is often difficult. Parenteral amphotericin B with or without 5-fluorocytosine is still the main antifungal treatment. Triazole antifungals may change that in the future. Systemic candidiasis retains a high mortality: careful individualised management of patients may improve mortality and morbidity.