Association of infection due to Candida albicans with intravenous hyperalimentation

Systemic candidiasis is frequently unrecognized before death of the patient because of lack of specific clinical signs, insensitive laboratory tests, and difficulties in culturing Candida albicans from the blood. Recent attention has been focused on the use of serologic testing and ocular signs to increase the rate of diagnosis of candidiasis. Because of the association between hyperalimentation fluids and disseminated candidiasis, a preliminary prospective study was carried out to determine more accurately the incidence in patients receiving hyperalimentation fluids of inapparent candida infection, candida endophthalmitis, or positive candida precipitins. Five of 23 patients developed small, white eye lesions consistent with candida endophthalmitis. Three of the five patients with eye lesions had blood cultures positive for C. albicans, and no patients without eye lesions had positive blood cultures. Candida precipitins were positive in three of the five patients with eye lesions. The results of this study suggest that unrecognized systemic candida infection may be more frequent in patients receiving hyperalimentation than previously suspected.