Severe candidal infections in neutropenic patients

The incidence of candidal infections in patients with cancer is increasing, and drug-resistant fungi are being isolated more frequently. Diagnosis of hematogenously disseminated candidiasis remains difficult. Characteristic clinical presentations, such as endophthalmitis and chronic hematogenously disseminated candidiasis, are inconstant and may not develop until after neutrophil recovery. Blood cultures are insensitive for detecting candidemia. Growth of Candida species in even one blood culture is strongly suggestive of hematogenously disseminated candidiasis. Serological tests to diagnose this disease remain experimental. Whenever feasible, central venous catheters should be removed from patients with candidemia. Amphotericin B is the treatment of choice for acute and chronic hematogenously disseminated candidiasis. The roles of azoles and liposomal amphotericin B in treating these diseases are currently undefined. Prophylactic use of antifungal agents decreases the incidence of documented fungal infections in neutropenic patients but does not improve overall survival and may increase the likelihood of infections by resistant fungi.