Candidiasis in Emergency Medicine Differential Diagnoses

Updated: Oct 05, 2021
  • Author: Ivan L Yue, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print

Diagnostic Considerations

A 2019 retrospective review of data in Spain Emergency departments showed that of patients who came through the emergency department and were diagnosed with candidemia, all patients had several risk factors for candida infection.  The authors concluded that it is important for emergency departments to evaluate risk factors and underlying conditions when deciding to treat non-hospitalized patients empirically for candidemia. [24]

Due to diagnosis requiring cultures or other lab work that requires time that generally extends beyond pratical emergency department stays, the diagnosis is probably not made until after the patient has left the emergency department, particularly with invasive candidiasis.  Emergency physicians ought to maintain a high index of suspicion whenever encountering patients with risk factors for candidal infections.

Risk Factors for candidiasis include "immunocompromised status (neutropenia, chemotherapy, transplant, diabetes mellitus, chronic liver failure, chronic renal failure), prolonged invasive vascular devices (hemodialysis catheters, central venous catheters), total parenteral nutrition, necrotizing pancreatitis, recent major surgery (particularly abdominal), prolonged administration of broad-spectrum antibiotics, prolonged hospital/ICU admission, recent fungal infection, and multisite colonization", per surviving sepsis guidelines.  [25]

A 2017 meta-analysis and systematic review of nineteen trials containing over 2,500 patients concluded that in immunocompetent adults in the ICU, antifungal prophylaxis for systemic candidiasis did not reduce mortality. [26]   Although this was a study conducted in the ICU setting, there does not appear to be strong data or guidelines supporting starting empiric treatment for candidiasis unless there are risk factors present.

Differential Diagnoses