[Deep Candida and related yeast infections]

Abstract

Yeast-like fungi that are commonly found on the skin and in the digestive tract of healthy people may be responsible for deep infections as well as for cutaneous and mucosal diseases. Such deep infections have long been known in the case of Candida spp.; they are facilitated by immunosuppression or by factors that enable this opportunistic organism to proliferate in the gut, skin or mucosae and to penetrate into deep tissues. In addition to such well-known clinical manifestations as septicaemia and endocarditis and to pulmonary, neuromeningeal, osteo-articular and ophthalmic lesions (to be systematically searched for), and apart from the special case of chronic granulomatosis, new syndromes have been described in heroin-addicts, including syndromes with deep cranial nodules and folliculitis. The difficult diagnosis often justifies and empirical treatment in neutropenic patients. In patients with AIDS, buccal and oesophageal candidiasis is common and sometimes reveals the syndrome, but other localizations are rarely encountered. Deep manifestations in the newborn are very seldom due to contamination by the mother; they are usually iatrogenic, so that their transmission can be prevented. More recently, deep mycoses caused by other fungi beside cryptococci have been described in fragile patients. Torulopsis glabrata, Trichosporon cutaneum or even Rhodotorula spp. may penetrate through catheters or drains and cause fungaemia and septicaemia. Malassezia furfur has been found in contaminated catheters and drains and causes pulmonary infections almost exclusively in premature infants under prolonged parenteral lipid diet.