ABSTRACT
INTRODUCTION Fungal infections of the urinary tract encompass a broad variety of fungi including the endemic mycosis, Cryptococcus species, and opportunistic pathogens such as Aspergillus species (1-3). However, the overwhelming majority of fungal infections of the urinary tract are caused by Candida spp. The escalating use of broad-spectrum antimicrobial agents, corticosteroids, and immunosuppressive and cytotoxic drugs with the frequent use of indwelling urinary catheters have been implicated as risk factors for Candida urinary tract infections (UTI) (4). The presence of candiduria may signal diverse pathological states, including invasive renal parenchymal disease, fungal balls in obstructed ureters, superficial lower urinary tract infection, and lower urinary tract candidal colonization associated with urinary catheterization. Accordingly, the spectrums of clinical disease embrace asymptomatic candiduria, cystitis, pyelonephritis, and renal candidiasis.Candida spp. have thepropensity to cause renal disease by either thehematogenous or the ascending route, which is the most common route of Candida UTI generally occurring in the setting of bladder instrumentation. Candiduria has always posed a diagnostic and therapeutic challenge as its presence does not always mean infection, and, therefore, may not require treatment. Unfortunately, there are no established diagnostic tests that reliably distinguish infection from colonization. Guidelines for the treatment of candiduria, based almost entirely on anecdotal reports and experts’ opinion rather than on controlled clinical trials, have been suggested by the Infectious Diseases Society of America (IDSA) and the Mycoses Study Group (5).
