title: Severe candidal infections: clinical perspective, immune defense mechanisms, and current concepts of therapy.
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.
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use; D001168:Arthritis / Q000209:etiology; D001927:Brain Diseases / Q000209:etiology; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D002179:Candidiasis, Cutaneous / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000209:etiology; D006801:Humans; D007167:Immunotherapy; D007962:Leukocytes / Q000276:immunology; D008214:Lymphocytes / Q000276:immunology; D008264:Macrophages / Q000276:immunology; D009205:Myocarditis / Q000209:etiology; D010019:Osteomyelitis / Q000209:etiology; D010587:Phagocytosis; D012871:Skin Diseases / Q000209:etiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B