SYNDROMES OF SYSTEMIC CANDIDIASIS

ACUTE DISSEMINATED CANDIDIASIS: - THIS usually presents as candidaemia (isolation of Candida spp. from the blood). The main predisposing factor is the presence of a central venous catheter. Other major factors include recent abdominal surgery, total parenteral nutrition (TPN), recent antibiotic therapy and localised Candida colonisation. Up to 40% of cases will have ophthalmic involvement, with characteristic retinal ‘cotton wool’ exudates. As this is a sight-threatening condition, candidaemic patients should be assessed by detailed ophthalmoscopy. Skin lesions (non-tender pink/red nodules) may be seen. Although predomi[1]nantly a disease of intensive care and surgical patients, acute disseminated candidiasis and/or Candida endoph[1]thalmitis is seen occasionally in injection drug-users, thought to be due to candidal contamination of citric acid or lemon juice used to dissolve heroin.

CHRONIC DISSEMINATED CANDIDIASIS:- (hepatosplenic candidiasis) In this condition, a neutropenic patient has a persistent fever, despite antibacterial therapy. The fever persists, even though there is neutrophil recovery, and is associ[1]ated with the development of abdominal pain, raised alkaline phosphatase and multiple lesions in abdominal organs (e.g. liver, spleen and/or kidneys) on radiologi[1]cal imaging. Chronic disseminated candidiasis is a form of immune reconstitution syndrome in patients recovering from neutropenia and usually lasts for several months, despite appropriate therapy.

OTHER MANIFESTATIONS: -

Renal tract candidiasis, osteomyelitis, septic arthritis, peritonitis, meningitis and endocarditis are all well rec[1]ognised, and are usually sequelae of acute disseminated disease.

Diagnosis and treatment of these conditions require specialist mycological advice.

HOMEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are:-

• Thuja
• Acid nitric
• Sepia
• Calcarea carb
• Pulsatilla