Candidemia and systemic candidiasis.

The growing problem of candidemia and systemic candidiasis reflects the enormous increase in the pool of patients at risk as well as the increased opportunity that exists for Candida sp to invade tissues normally resistant to invasion. Candida sp, as truly opportunistic pathogens, exploit recent technological advances to gain access to the circulation and deep tissues. The increased prevalence of local and systemic disease caused by Candida organisms has resulted in new clinical syndromes, the expression of which depends upon the immune status of the host. These new syndromes include the focal hepatosplenic candidiasis, Candida peritonitis and systemic candidiasis. Management of serious and life-threatening invasive candidiasis remains severely hampered by the lack of reliable diagnostic methods that would allow early detection of both fungemia and tissue invasion by Candida organisms. Amphotericin B remains the cornerstone of effective antifungal therapy in systemic candidiasis. Over the last decade, new principles have emerged, including shorter and lower dosage regimens for catheter-related candidemia. The newer oral azoles may play a useful role in the management of invasive candidiasis.