Severe candidal infections: clinical perspective, immune defense mechanisms, and current concepts of therapy.
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| Abstract |
Disseminated candidiasis has become an important infection, particularly in immunocompromised and postoperative patients. Although serologic tests may, in some settings, facilitate a premortem diagnosis, the disease is usually diagnosed by comprehensive clinical evaluation. Detection of the relatively newly recognized peripheral manifestations of candidemia may be vital to early diagnosis: endophthalmitis, osteomyelitis, arthritis, myocarditis, meningitis, and macronodular skin lesions. Studies in patients with chronic mucocutaneous candidiasis and in-vitro manipulations have begun to elucidate normal immune defense mechanisms against Candida, including serum factors, phagocytosis, intracellular killing mechanisms, and lymphocyte function (particularly T cell). The primary drugs for the treatment of disseminated candidiasis are still amphotericin B or amphotericin B plus 5-fluorocytosine; the mainstay of therapy for chronic mucocutaneous candidiasis is amphotericin B. Other antifungals and immune system-stimulating modalities (transfer factor, thymosin, thymus epithelial cell transplantation, and levamisol) may be useful for chronic mucocutaneous candidiasis in some settings and deserve further evaluation.
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| Authors | J E Edwards Jr, R I Lehrer, E R Stiehm, T J Fischer, L S Young |
| Journal | Annals of internal medicine (Ann Intern Med) Vol. 89 Issue 1 Pg. 91-106 (Jul 1978) ISSN: 0003-4819 [Print] United States |
| PMID | 352220 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S., Review) |
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