Candida albicans: saprophyte or pathogen? A diagnostic guideline.

Isolation ofCandida albicansfrom a patient's stools, sputum, or urine tends to obfuscate rather than clarify the diagnosis. The clinician's uncertainty as to the significance ofCandidaor ganisms cultured from skin lesions or from blood, cerebrospinal fluid, and other internal foci has all too often delayed or prevented administration of specific therapy. Much of the confusion concerning the diagnostic interpretation ofC albicansisolated from clinical specimens stems from faulty concepts as to the saprophytic occurrence of the organism. Despite ample evidence to the contrary,1many textbooks and articles still perpetuate the thoughtless statement thatC albicansoccurs saprophytically on normal skin. As a result, aCandidaorganism cultured from blood and other visceral specimens is often shrugged off as a "skin contaminant," with usually tragic consequences for the patient. Failure to recognize the role ofC albicansin the etiology of skin lesions may lead to