Acute disseminated (septicæmic) moniliasis in adults and children

Abstract

Forty-eight proven cases of acute disseminated (septicaemic) moniliasis are reviewed and three further presumptive cases are described. The disease is an acute, usually fatal, complication of acute or chronic debilitating illness which has been treated with multiple antibiotics, and sometimes steroids and intravenous therapy. Males and females are equally affected and the disease occurs at all ages, although the prognosis is better in childhood. The presenting symptoms are those of a septicLmia with the oral or cutaneous manifestations of thrush and often a state of diminshed response to external stimuli. The disease may complicate recovery from major surgery, usually intestinal, and has been recorded after tooth extraction. The commonest group of debilitating diseases complicated by the systemic mycosis, excluding surgical conditions, is the blood dyscrasias. The diagnosis is established from the clinical state and culture of organisms of the genus Candida from the bloodstream. Treatment is by withdrawal of antibacterial antibiotics and other medicaments and *the intravenous administration of amphotericin B. I am grateful to Dr. D. Dexter, Reader in Morbid Anatomy, St. George's Hospital Medical School, for permission to study and publish Cases 2 and 3, and to Dr. G. A. Gresham, Lecturer in Pathology, University of Cambridge, for permission to study and publish Case 1, and for the post mortem report on the case by Dr. D. R. Ryrie. I thank the late Mr. K. W. Iles, Charing Cross Hospital Medical School, for the photographs, and the RegistrarGeneral for permission to publish figures pertaining to fatal fungus infections in England and Wales since 1940.