Fungaemia and disseminated infection

Abstract

Invasive fungal disease can present without localization or obvious target organ involvement. These disseminated mycoses occur predominantly in patients who are immunocompromised, particularly from haematological malignancy and HIV. Candidiasis and aspergillosis are the commonest forms of disseminated fungal infection worldwide, but an increasing number of non-Candida yeasts and non-Aspergillus moulds have emerged as important causes of invasive disease in recent years. Endemic fungi such as Histoplasma capsulatum are important causes of invasive disease within limited geographic regions. Fever is the commonest manifestation of disseminated fungal infection, but other clinical features such as cutaneous manifestations may point to a specific diagnosis. Definitive diagnosis relies on the detection of fungi in tissue or blood, but serological tests can augment diagnosis in some infections. Mortality from disseminated fungal disease is high and prompt initiation of antifungal therapy—where invasive disease is suspected—is essential.