Fungal Sepsis

Fungal sepsis, most commonly caused by Candida species (candidemia), occurs when fungi enter the bloodstream, typically in immunocompromised, critically ill patients with risk factors including broad-spectrum antibiotic use, central venous catheters, total parenteral nutrition, abdominal surgery, and neutropenia. Candida albicans forms biofilm on indwelling catheters, providing a protected reservoir for continuous seeding into the bloodstream. The innate immune response to fungal cell wall components (beta-glucan, mannan) involves pattern recognition by dectin-1 and mannose receptors on macrophages and neutrophils, but the inflammatory response is often less robust than in bacterial sepsis, leading to delayed diagnosis. Serum beta-D-glucan and blood cultures (which have only 50% sensitivity for candidemia) guide diagnosis. The nurse monitors for signs of disseminated candidiasis (new skin lesions, endophthalmitis, hepatosplenic candidiasis), administers prescribed antifungal therapy (echinocandins as first-line, fluconazole for susceptible species), ensures removal of central venous catheters (source control), monitors hepatic and renal function during antifungal therapy, and obtains repeat blood cultures to document clearance.