Difference between revisions of "Candidiasis"

(Updated Background, Clinical Features, and Evaluation (still in progress))
 
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==Background==
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==Background==  
* Candidiasis encompasses a wide array of local and invasive infections which vary extensively in clinical presentation and affect more than 250,000 patients worldwide per year
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*Candidiasis encompasses a wide array of local or invasive fungal infections caused by the ''Candida'' genus and infect more than 250,000 patients worldwide per year <ref>Candidiasis. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/fungal/diseases/candidiasis/. Published June 12, 2015. Accessed August 25, 2016.</ref>
* Local mucocutanoues infections include: oropharyngeal candidiasis, esophagitis, vulvovaginitis, balanitis, chronic mucocutaneous candidiasis, and mastitis  
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*''Candida'' yeasts (most commonly ''Candida albicans'') are normal flora that live on the skin and mucous membranes, but may cause infection with overgrowth and vary in clinical presentation depending on the infected area
* Invasive infections include: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis  
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*Local mucocutaneous candida infections: oropharyngeal candidiasis, esophagitis, vulvovaginitis, balanitis, chronic mucocutaneous candidiasis, and mastitis <ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>
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*Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis  
  
==Risk Factors==
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===Risk Factors==
* Skin maceration
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*Skin maceration
* Immunosupression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators
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*Immunosuppression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators <ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>
* Broad spectrum antibiotic use
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*Broad spectrum antibiotic use
* Diabetes Mellitus
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*[[Diabetes mellitus]]
* Hematologic Malignancy
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*Oral Contraceptive use
* Central Venous Catheters use
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*Hematologic Malignancy
* Total Parenteral nutrition use
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*Central Venous Catheters use
* Neutropenia
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*Total Parenteral nutrition use
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*[[Neutropenia]]
  
 
==Clinical Features==
 
==Clinical Features==
* Oropharyngeal Candidiasis: psuedomembrane white plaques adhered to oral mucosa, tongue, or phaynx
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===Local Candida Infections===
* Esophageal Candidiasis: AIDS definining illness, odynophagia, white esophageal plaques
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*Mouth: [[Oropharyngeal candidiasis]] (thrush)
* Cutaneous Candidiasis: erythematous, macerated, intertriginous plaques with pustules
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*Esophagus: [[Esophageal candidiasis]]
* Chronic mucocutaneous Candidiasis
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*Vulva/vagina: [[Candida vulvovaginitis]]
* Candida Vulvovaginitis
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*Skin lesions: [[Candida dermatitis]]
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===Systemic===
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*hematogenous, central line cathether, intravenous catheter, [[Candiduria|indwelling foley catheter]]: [[Invasive candidiasis]]
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<gallery mode="packed">
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File:Oral candidiasis.jpg|[[Oral candidiasis]]
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File:Oral Candidiasis.jpg|[[Esophageal candidiasis]]
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File:Candida vaginitis.JPG|[[Candida vaginitis]]
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File:Diaper dermatitis.png|[[Diaper dermatitis]]
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</gallery>
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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===Esophageal candidiasis===
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*CMV esophagitis
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*HSV esophagitis
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*Diptheria
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*Pill esophagitis (bisphosphonates, NSAIDs, potassium chloride, iron supplements)
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*Post-radiation esophagutis
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*Mallory Weiss tear or Boerhaave syndrome
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*Cardiac pain (ACS, pericarditis, myocarditis, dissection, etc.)
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*[[Zenker's diverticulum]]
  
 
==Evaluation==
 
==Evaluation==
* Candidiasis is primarily diagnosed clinically
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*Local candidiasis is primarily clinically diagnosed based on lesion characteristics and appearance
* Confirmatory tests available by KOH preparation of skin scrapings revealing budding yeasts with pseudohyphae  
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*Confirmatory tests: KOH preparation of lesion scrapings, vaginal wet mount, culture, or endoscopic biopsy reveal budding yeast with pseudohyphae  
  
 
==Management==
 
==Management==
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*Local: Topical anti-fungal (Nystatin, azoles) or oral azole
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*Invasive: Intravenous Echinocandins (Caspofungin, Micafungin)
  
 
==Disposition==
 
==Disposition==
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*Local infections can be managed on an outpatient basis
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*Invasive infection will be managed with IV antibiotics and requires prolonged hospitalization
  
 
==See Also==
 
==See Also==
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*[[Candiduria]]
  
 
==External Links==
 
==External Links==
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==References==
 
==References==
 
<references/>
 
<references/>
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[[Category:ID]]

Latest revision as of 18:04, 27 October 2016

Background

  • Candidiasis encompasses a wide array of local or invasive fungal infections caused by the Candida genus and infect more than 250,000 patients worldwide per year [1]
  • Candida yeasts (most commonly Candida albicans) are normal flora that live on the skin and mucous membranes, but may cause infection with overgrowth and vary in clinical presentation depending on the infected area
  • Local mucocutaneous candida infections: oropharyngeal candidiasis, esophagitis, vulvovaginitis, balanitis, chronic mucocutaneous candidiasis, and mastitis [2]
  • Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis

Risk Factors

  • Skin maceration
  • Immunosuppression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators [2]
  • Broad spectrum antibiotic use
  • Diabetes mellitus
  • Oral Contraceptive use
  • Hematologic Malignancy
  • Central Venous Catheters use
  • Total Parenteral nutrition use
  • Neutropenia

Clinical Features

Local Candida Infections

Systemic

Differential Diagnosis

Esophageal candidiasis

  • CMV esophagitis
  • HSV esophagitis
  • Diptheria
  • Pill esophagitis (bisphosphonates, NSAIDs, potassium chloride, iron supplements)
  • Post-radiation esophagutis
  • Mallory Weiss tear or Boerhaave syndrome
  • Cardiac pain (ACS, pericarditis, myocarditis, dissection, etc.)
  • Zenker's diverticulum

Evaluation

  • Local candidiasis is primarily clinically diagnosed based on lesion characteristics and appearance
  • Confirmatory tests: KOH preparation of lesion scrapings, vaginal wet mount, culture, or endoscopic biopsy reveal budding yeast with pseudohyphae

Management

  • Local: Topical anti-fungal (Nystatin, azoles) or oral azole
  • Invasive: Intravenous Echinocandins (Caspofungin, Micafungin)

Disposition

  • Local infections can be managed on an outpatient basis
  • Invasive infection will be managed with IV antibiotics and requires prolonged hospitalization

See Also

External Links

References

  1. Candidiasis. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/fungal/diseases/candidiasis/. Published June 12, 2015. Accessed August 25, 2016.
  2. 2.0 2.1 Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.