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Invasive candidiasis

Nature Reviews Disease Primers volume 10, Article number: 20 (2024) Cite this article

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Abstract

Invasive candidiasis is an important fungal disease caused by Candida albicans and, increasingly, non-albicans Candida pathogens. Invasive Candida infections originate most frequently from endogenous human reservoirs and are triggered by impaired host defences. Signs and symptoms of invasive candidiasis are non-specific; candidaemia is the most diagnosed manifestation, with disseminated candidiasis affecting single or multiple organs. Diagnosis poses many challenges, and conventional culture techniques are frequently supplemented by non-culture-based assays. The attributable mortality from candidaemia and disseminated infections is ~30%. Fluconazole resistance is a concern for Nakaseomyces glabratus, Candida parapsilosis, and Candida auris and less so in Candida tropicalis infection; acquired echinocandin resistance remains uncommon. The epidemiology of invasive candidiasis varies in different geographical areas and within various patient populations. Risk factors include intensive care unit stay, central venous catheter use, broad-spectrum antibiotics use, abdominal surgery and immune suppression. Early antifungal treatment and central venous catheter removal form the cornerstones to decrease mortality. The landscape of novel therapeutics is growing; however, the application of new drugs requires careful selection of eligible patients as the spectrum of activity is limited to a few fungal species. Unanswered questions and knowledge gaps define future research priorities and a personalized approach to diagnosis and treatment of invasive candidiasis is of paramount importance.

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Fig. 1: Geographical variation in the distribution of Candida species and countries reporting the major species of concern.
Fig. 2: Virulence factors and immune evasion in Candida albicans.
Fig. 3: Phagocyte-led immune response to invasive candidiasis.
Fig. 4: Important receptors and signalling pathways against invasive candidiasis.
Fig. 5: Proposed pathomechanisms in the onset of an infection.

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Acknowledgements

The authors would like to thank L’Emir Wassim El Ayoubi for his contributions towards the creation of the figures related to the pathophysiology of invasive candidiasis.

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Authors and Affiliations

  1. Institute of Hygiene and Medical Microbiology, ECMM Excellence Centres of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria

    Cornelia Lass-Flörl & Miriam Alisa Govrins

  2. Infectious Diseases Division, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon

    Souha S. Kanj

  3. Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa

    Nelesh P. Govender

  4. MRC Centre for Medical Mycology, University of Exeter, Exeter, UK

    Nelesh P. Govender

  5. UC Davis Health Medical Center, Division of Infectious Diseases, Sacramento, CA, USA

    George R. Thompson III

  6. Department of Internal Medicine, McGovern Medical School, Houston, TX, USA

    Luis Ostrosky- Zeichner

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  1. Cornelia Lass-Flörl
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Contributions

Introduction (C.L.-F.); Epidemiology (M.A.G.); Mechanisms/pathophysiology (S.S.K.); Infections and manifestations (N.P.G.); Diagnosis, screening and prevention (C.L.-F.); Management (G.R.T.); Quality of life (L.O.-Z.); Outlook (C.L.-F.); overview of Primer (all authors). The authors contributed equally to this work and are listed alphabetically.

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Correspondence to Cornelia Lass-Flörl.

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Competing interests

C.L.-F. has received institutional grants from Gilead Sciences and Astellas Pharma, personal consulting fees from Gilead Sciences and Merck Sharp and Dohme, and payments or honoraria for lectures/presentations from Gilead Sciences, Merck Sharp and Dohme, Pfizer, BioMerieux, F2G, Immy and Shionogi. S.S.K. reports honoraria as speaker and for participating in advisory boards for Pfizer, MSD, Basilea, Gilead and Hikma. G.R.T. reports consulting and research support from Astellas, Cidara, F2G, Mundipharma, Melinta, Mayne and Scynexis. L.O.-Z. has received institutional research grants and/or personal consulting honoraria from Merck, Astellas, Pfizer, Cidara, Melinta, Gilead, Scynexis, GSK, Octapharma, Pulmocide, F2G and Eurofins Viracor. M.A.G. and N.P.G. declare no competing interests.

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Lass-Flörl, C., Kanj, S.S., Govender, N.P. et al. Invasive candidiasis. Nat Rev Dis Primers 10, 20 (2024). https://doi.org/10.1038/s41572-024-00503-3

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