Original communication| Volume 72, ISSUE 5, P730-736, November 1972

Disseminated candidiasis in the surgical patient

  • J.David Gaines
    From the Division of Allergy, Immunology, and Infectious Diseases, Palo Alto Medical Research Foundation, Palo Alto, Calif., USA

    From the Department of Medicine, Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, Calif., USA
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  • Jack S. Remington
    From the Division of Allergy, Immunology, and Infectious Diseases, Palo Alto Medical Research Foundation, Palo Alto, Calif., USA

    From the Department of Medicine, Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, Calif., USA
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  • Author Footnotes
    ∗ Recipient of a Postdoctoral Fellowship (Grant AM01006-05) from the National Institutes of Health, Bethesda, Md.
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      Of the 82 cases of systemic candidiasis diagnosed at the Stanford University Medical Center and Palo Alto Veterans Administration Hospital from 1960 through 1970, 40 (49 percent) occurred in patients who had experienced a major surgical procedure. Abdominal surgery was the most common procedure, and 25 patients underwent two or more operations. Each of the patients had received multiple antibiotic therapy, and 50 percent were also receiving either corticosteroids, cytotoxic agents, radiotherapy, or combinations of these. In this series, 85 percent of the surgical patients died and in approximately half of them, Candida infection was considered to be the cause of death or a major contributing factor. The diagnosis of candidiasis was suspected before death in only 18 patients, and 28 of the 34 patients (82 percent) who died either did not receive antifungal therapy or were moribund at the time it was initiated. A discussion of appropriate culture techniques and of the newer serologic procedures helpful in the diagnosis of systemic candidiasis is presented, as well as appropriate guidelines for the prevention and treatment of such infections in the surgical patient.
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        • Baker R.D.
        Leukopenia and therapy in leukemia as factors predisposing to fatal mycoses.
        Am. J. Clin. Pathol. 1962; 37: 358
        • Bodey G.P.
        Fungal infections complicating acute leukemia.
        J. Chronic Dis. 1966; 79: 667
        • Bodey G.P.
        • Nies B.A.
        • Mohberg N.R.
        • Freireich E.J.
        The effect of adrenal corticosteroid therapy on infection in acute leukemia.
        Am. J. Med. Sci. 1965; 250: 162
        • Bogen J.D.
        Local complications in 67 patients with indwelling venous catheters.
        Surg. Gynecol. Obstet. 1960; 110: 112
        • Boggs D.R.
        • Athens J.S.
        • Cartwright G.E.
        • Wintrobe M.M.
        The effects of adrenal glucocorticoids upon the cellular composition of the inflammatory exudates.
        Am. J. Path. 1964; 44: 763
        • Braude A.I.
        • Rock J.A.
        The syndrome of acute disseminated moniliasis in adults.
        Arch. Intern. Med. 1959; 104: 107
        • Crosby D.L.
        Fatal candidiasis following colonic sterilization with neomycin and bacitracin.
        Br. J. Urol. 1967; 39: 479
        • Curry C.R.
        • Quie P.G.
        Fungal septicemia in patients receiving parenteral hyperalimentation.
        N. Engl. J. Med. 1971; 285: 1221
        • Davies R.R.
        • Reeves D.S.
        5-fluorocytosine and urinary candidiasis.
        Br. Med. J. 1971; 1: 577
        • Drutz D.J.
        • Spickard A.
        • Koenig M.G.
        New approach to therapy with amphotericin B.
        in: Hobby G.L. Antimicrobial agents and chemotherapy, 1967, Proceedings of the Sixth Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Philadephia1967: 202-207
        • Duhig J.J.
        • Mead M.
        Systemic mycosis due to Monilia albicans.
        Med. J. Aust. 1951; 1: 179
        • Ellis C.A.
        • Spivack M.L.
        The significance of candidemia.
        Ann. Intern. Med. 1967; 67: 511
        • Fass R.J.
        • Perkins R.
        5-fluorocytosine in the treatment of cryptococcal and Candida mycoses.
        Ann. Intern. Med. 1971; 74: 535
        • Gordee R.S.
        • Simpson P.J.
        Relationships of x-irradiations to the enhancement of Candida albicans infections.
        J. Bacteriol. 1967; 94: 6
      1. Gaines, J. D., and Remington, J. S.: Diagnosis of deep infection with Candida—A prospective study of Candida precipitins. Submitted for publication.

        • Hart P.D.
        • Russell Jr., E.
        • Remington J.S.
        The compromised host and infection. II. Deep fungal infection.
        J. Infect. Dis. 1969; 120: 169
        • Hughes J.M.
        • Remington J.S.
        Systemic candidiasis: A diagnostic challenge.
        Calif. Med. 1972; 116: 8
        • Kozinn P.J.
        • Taschdjian C.L.
        Candida albicans: Saprophyte or pathogen? A diagnostic guideline.
        J. A. M. A. 1966; 198: 170
        • Louria D.B.
        • Stiff D.P.
        • Bennett B.
        Disseminated moniliasis in the adult.
        Medicine. 1962; 41: 307
        • Medoff G.
        • Dismukes W.E.
        • Meade III, R.H.
        • Moses J.
        Therapeutic program for Candida infection.
        in: Hobby G.L. Antimicrobial agents and chemotherapy, Proceedings of the Tenth Interscience Conference on Antimicrobial agents and Chemotherapy. American Society for Microbiology, Philadelphia, Pa1970: 286-290
        • Masterson J.G.
        • Nelson J.H.
        • Valenti C.
        Acute monilial infection as a cause of death.
        Am. J. Obstet. Gynecol. 1962; 84: 1799
        • Miller D.G.
        Patterns of immunological deficiency in lymphomas and leukemias.
        Ann. Intern. Med. 1962; 57: 703
        • Murray I.G.
        • Buckley H.R.
        • Turner G.C.
        Serological evidence of Candida infection after open-heart surgery.
        J. Med. Microbiol. 1969; 2: 463
        • Portnoy J.
        • Wolf P.L.
        • Webb M.
        • Remington J.S.
        Candida blastospores and pseudohyphae in blood smears.
        N. Engl. J. Med. 1971; 285: 1010
        • Preisler H.D.
        • Hasenclever H.
        • Henderson E.S.
        Anti-candida antibodies in patients with acute leukemia.
        Am. J. Med. 1971; 51: 352
        • Preisler H.D.
        • Hasenclever H.F.
        • Levitan A.A.
        • Henderson E.S.
        Serologic diagnosis of disseminated candidiasis in patients with acute leukemia.
        Ann. Intern. Med. 1969; 70: 19
        • Record C.O.
        • Skinner J.M.
        • Sleight P.
        • Speller D.C.E.
        Candida endocarditis treated with 5-fluorocytosine.
        Br. Med. J. 1971; 1: 262
        • Rifkind D.
        • Marchioro T.L.
        • Schneck S.A.
        • Hill R.B.
        Systemic fungal infections complicating renal transplantation and immunosuppressive therapy. Clinical, microbiologie, neurologic, and pathologic features.
        Am. J. Med. 1967; 43: 28
        • Rosner F.
        • Gabriel F.D.
        • Taschdjian C.L.
        • Cuesta M.B.
        • Kozinn P.J.
        Serologic diagnosis of systemic candidiasis in patients with acute leukemia.
        Am. J. Med. 1971; 51: 54
        • Seelig M.S.
        The role of antibiotics in the pathogenesis of Candida infections.
        Am. J. Med. 1966; 40: 887
        • Seelig M.S.
        Mechanisms by which antibiotics increase the incidence and severity of candidiasis and alter the immunological defenses.
        Bacteriol. Rev. 1966; 30: 442
        • Shadomy S.
        In vitro studies with 5-fluorocytosine.
        Appl. Microbiol. 1969; 17: 871
        • Shadomy S.
        Further in vitro studies with 5-fluorocytosine.
        Infect. Immunity. 1970; 2: 484
        • Smits B.J.
        • Prior A.P.
        • Arblaster P.G.
        Incidence of Candida in hospital inpatients and the effects of antibiotic therapy.
        Br. Med. J. 1966; 1: 208
        • Taschdjian C.L.
        • Kozinn P.J.
        • Fink H.
        • Cuesta M.B.
        • Caroline L.
        • Kantrowitz A.B.
        Postmortem studies of systemic candidiasis. I. Diagnostic validity of precipitin reaction and probable origin of sensitization to cytoplasmic candidal antigens.
        Sabouraudia. 1969; 7: 110
        • Taschdjian C.L.
        • Kozinn P.J.
        • Toni E.F.
        Opportunistic yeast infections, with special reference to candidiasis.
        Ann. N. Y. Acad. Sci. 1970; 174: 606
        • Toala P.
        • Schroeder S.A.
        • Daly K.A.
        • Finland M.
        Candida at Boston City Hospital.
        Arch. Intern. Med. 1970; 126: 983
        • Torack R.M.
        Fungus infections associated with antibiotic and steroid therapy.
        Am. J. Med. 1957; 22: 872
        • Vic-Dupont V.
        • Cartier F.
        • Margairaz A.
        • Monsallier J.F.
        • Pocidalo J.J.
        • Couland J.P.
        Les septicemies. Complications des catheterismes veineux de perfusion.
        Bull. Soc. Mem. Hosp. Paris. 1966; 117: 89
        • Winn W.A.
        The use of amphotericin B in the treatment of coccidioidal disease.
        Am. J. Med. 1959; 27: 617