Disseminated Candidiasis: Changes in Incidence, Underlying Diseases, and Pathology

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Abstract
Thirty-nine patients who had disseminated candidiasis were studied at autopsy between 1963 and June 1975. The number of cases at autopsy increased from 1.1 to 6.8 cases per year during the last four and a half years, due primarily to the occurrence of candidiasis in patients with acute leukemia. The recent high incidence of disseminated candidiasis complicating acute leukemia correlated with the use of modern chemotherapy, which results in prolonged granulocytopenia during the induction of remission. All recent leukemic patients had gastrointestinal candidiasis, and many had hepatic (75%) and splenic (94%) involvement by unusually large macroscopic lesions. Candida stellatoidea (eight cases), Candida albicans (six cases), and Candida tropicalis (six cases) were the most frequently identified species. Clinical and laboratory detection of disseminated candidiasis was often impossible. A comparison of recent leukemic patients with and without candidiasis revealed that only positive blood (7/16 vs. 1/17) and urine (8/16 vs. 3/17) cultures had predictive diagnostic value, but these cultures were frequently negative. The best approach toward reducing the incidence of disseminated candidiasis in acute leukemia appears to be prevention of gastrointestinal infection.