JOHN E. EDWARDS Jr., M.D.; ROBERT I. LEHRER, M.D.; E. RICHARD STIEHM, M.D.; THOMAS J. FISCHER, M.D.; LOWELL S. YOUNG, M.D., F.A.C.P.
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.
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EDWARDS JE, LEHRER RI, STIEHM ER, FISCHER TJ, YOUNG LS. Severe Candidal Infections: Clinical Perspective, Immune Defense Mechanisms, and Current Concepts of Therapy. Ann Intern Med. 1978;89:91–106. doi: 10.7326/0003-4819-89-1-91
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Published: Ann Intern Med. 1978;89(1):91-106.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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