Revisiting the source of candidemia: skin or gut?

Nucci, Marcio; Anaissie, Elias

doi:10.1086/323759

Cited by 424Antifungal resistance and susceptibilityInfective Endocarditis Diagnosis and ManagementFungal Infections and Studies

Revisiting the source of candidemia: skin or gut?

Nucci, Marcio, Anaissie, Elias·2001·Clinical Infectious Diseases

DOI 10.1086/323759

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Abstract

The source of candidemia has been the subject of considerable debate, with some suggesting a origin in the gastrointestinal tract and others suggesting a skin origin. To evaluate the potential sources of candidemia, we performed a computerized search of the MEDLINE database for studies published from January 1966 through September 2000 and we identified relevant abstracts presented at national meetings. We reviewed the literature with special emphasis on studies that used appropriate definitions, evaluated both gut and skin as sources, and conducted molecular-relatedness studies. Among 203 candidemia studies published, we identified 21 that evaluated a specific source for candidemia and only 5 that performed molecular typing. Those studies and additional experimental, epidemiologic, and molecular-relatedness studies strongly suggested that the gut is an important source of candidemia, and studies that supported the skin as a source for this infection were surprisingly incomplete.

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Candidemia can occur after disruption of the body's skin and mucosal barriers, including in the intestines.
“Candidemia can occur after disruption of the body’s skin and mucosal barriers, including in the intestines (6).”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021 (2025) · cites this paper as [6]
The Discussion identifies the gastrointestinal tract as a likely source of candidemia and says infected burn wounds may increase its risk. The Experimental evidence section also describes entry through skin lesions, but the passages do not establish disruption of mucosal barriers, including the intestinal barrier, as the mechanism. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Extensive esophageal candidiasis can lead to gastric candidiasis.
“it has been reported previously that extensive esophageal candidiasis can lead to gastric candidiasis [28]”
From High iron-mediated increased oral fungal burden, oral-to-gut transmission, and changes to pathogenicity of Candida albicans in oropharyngeal candidiasis (2022) · cites this paper as [28]
In neutropenic patients, the gut is a source for disseminated candidiasis, evident from autopsy studies.
“In neutropenic patients, the role of the gut as a source for disseminated candidiasis is evident from autopsy studies”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [118]
In an individual patient, it is difficult to determine the relative contributions of the gut and a catheter as primary sources of fungemia.
“in an individual patient, it is difficult to determine the relative contributions of the gut and a catheter as primary sources of fungemia [107,108,118].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [118]

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Authors: Nucci, M., & Anaissie, E.
Affiliations: University of Arkansas for Medical Sciences (US)
Venue: Clinical Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 2001-12-15
Volume: 33
Issue: 12
Pages: 1959-1967
ISSN: 1058-4838 (ISSN-L)
1537-6591
DOI: 10.1086/323759
OpenAlex: W2145106986
Cited by: 424
References: 45
Citations by year: 2026: 11 · 2025: 25 · 2024: 23 · 2023: 12 · 2022: 15 · 2021: 20 · 2020: 31 · 2019: 20 · 2018: 18 · 2017: 19 · 2016: 22 · 2015: 27 · 2014: 26 · 2013: 14 · 2012: 17
FWCI: 6.35
Type: journal article
Language: en
Open access: closed
Locations: Clinical Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords: candidemia, infection source, gastrointestinal tract, skin, Candida albicans, molecular typing, fungemia
MeSH terms: Candidiasis, Cutaneous, Candidiasis, Oral, Hematologic Diseases, Humans, Meta-Analysis as Topic, Incidence, Databases, Factual

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Revisiting the source of candidemia: skin or gut?

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