Candida Infections in Immunocompetent Hosts: Pathogenesis and Diagnosis

Abstract

Candida is a common commensal of the human skin and gastrointestinal tract causing infections in immunocompromised hosts. However, Candida has a variety of virulence factors and fitness attribute which make it capable of infecting even persons with otherwise intact immune system, especially those in critical care settings and with underlying co-morbidities. In this review, we describe the mechanisms behind the pathogenesis and diagnosis of Candida infections in such hosts. Both noninvasive and invasive infections can be seen especially in critically ill, hospitalized patients. The gold standard for diagnosis, despite low sensitivity, is blood and sterile body fluid culture. Combining clinical scores, fungal biomarkers, and nucleic acid amplification–based tests is necessary to guide early antifungal therapy. Understanding of the pathogenesis of infections in critically ill non-neutropenic individuals can help in identifying potential diagnostic and therapeutic targets. Future studies in specific patient groups can help in stratifying patients needing antifungals.