Difference between revisions of "Candidiasis"

Line 1: Line 1:
 
==Background==
 
==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
 
* 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
* ''Candida'' yeasts (most commonly ''Candida albicans'') are normal flora that live on the skin and mucous membranes, but cause infection with overgrowth and vary in clinical presentation depending on the area infected
+
* ''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  
 
* Local mucocutaneous candida infections: oropharyngeal candidiasis, esophagitis, vulvovaginitis, balanitis, chronic mucocutaneous candidiasis, and mastitis  
 
* Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis  
 
* Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis  
Line 7: Line 7:
 
==General Risk Factors==
 
==General Risk Factors==
 
* Skin maceration
 
* Skin maceration
* Immunosupression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators
+
* Immunosuppression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators
 
* Broad spectrum antibiotic use
 
* Broad spectrum antibiotic use
 
* Diabetes Mellitus
 
* Diabetes Mellitus
Line 23: Line 23:
 
*Diagnosis
 
*Diagnosis
 
** pseudomembrane white plaques adhered to oral mucosa, tongue, palate, or oropharynx
 
** pseudomembrane white plaques adhered to oral mucosa, tongue, palate, or oropharynx
** Budding yeast on KOH prep of skin scrapings using a tongue depressor   
+
** KOH prep of skin scrapings using a tongue depressor   
  
 
'''Esophageal Candidiasis''' [[File:Oral Candidiasis.jpg|thumb|Esophageal Candidiasis, OPENi-An]]
 
'''Esophageal Candidiasis''' [[File:Oral Candidiasis.jpg|thumb|Esophageal Candidiasis, OPENi-An]]
* Most commonly seen in HIV patients (AIDS-defining illness)
+
* Most commonly seen in HIV patients (AIDS-defining illness) or chronic inhaled glucocorticoid use
 
* Clinical Features
 
* Clinical Features
** odynophagia
+
** odynophagia, dysphagia, retrosternal pain, nausea/vomting
 
* Diagnosis
 
* Diagnosis
 
** thick, white, linear esophageal plaques on endoscopy  
 
** thick, white, linear esophageal plaques on endoscopy  
 
+
*Differential Diagnosis
'''Cutaneous Candidiasis'''
+
** Cytomegalovirus, Herpes Simplex, Eosinophilic Esophagitis, Medication-induced Esophagitis
** erythematous, macerated, intertriginous plaques with pustules
 
 
 
'''Chronic Mucocutaneous Candidiasis'''
 
  
 
'''Candida Vulvovaginitis'''
 
'''Candida Vulvovaginitis'''
* Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use
+
* Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity
 
* Clinical Features  
 
* Clinical Features  
** vulvar pruritis, dyspareunia, dysuria
+
** intense vulvovaginal pruritis or burning, dyspareunia, dysuria
 
* Diagnosis
 
* Diagnosis
**cotton cheese-like non-odorous discharge
+
** although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis
 +
** cotton cheese-like non-odorous vaginal discharge on pelvic exam 
 +
** vaginal pH < 4.5
 +
** vaginal wet mount
 +
* Differential Diagnosis
 +
** Bacterial vagininosis, Trichomoniasis, Chlamydia/Gonorrheal infection
 +
*Management
 +
**Pregnant: Topical Imidazole
  
 
'''Candida Dermatitis''' [[File:Diaper dermatitis.png|thumb|Diaper Dermatitis, OPENi-An]]
 
'''Candida Dermatitis''' [[File:Diaper dermatitis.png|thumb|Diaper Dermatitis, OPENi-An]]
 +
* Seen in
 +
* Clinical Features
 +
* Diagnosis
 +
** erythematous, macerated, intertriginous plaques with satellite pustules
  
  
 
==Evaluation==
 
==Evaluation==
 
* Candidiasis is primarily diagnosed clinically  
 
* Candidiasis is primarily diagnosed clinically  
* Confirmatory tests available by KOH preparation of skin scrapings revealing budding yeasts with pseudohyphae  
+
* Confirmatory tests available by KOH preparation of lesion scrapings, vaginal wet mount, culture, or endoscopic biopsy revealing budding yeast with pseudohyphae  
  
 
==Management==
 
==Management==

Revision as of 21:38, 25 August 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
  • 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
  • Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis

General Risk Factors

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

Local Candida Infections

Oropharyngeal Candidiasis (thrush)

Oral Candidiasis, Wikipedia
  • Most commonly seen in infants, immunocompromised, older adults with dentures
  • Clinical features
    • cotton sensation in mouth, loss of taste
  • Diagnosis
    • pseudomembrane white plaques adhered to oral mucosa, tongue, palate, or oropharynx
    • KOH prep of skin scrapings using a tongue depressor

Esophageal Candidiasis

Esophageal Candidiasis, OPENi-An
  • Most commonly seen in HIV patients (AIDS-defining illness) or chronic inhaled glucocorticoid use
  • Clinical Features
    • odynophagia, dysphagia, retrosternal pain, nausea/vomting
  • Diagnosis
    • thick, white, linear esophageal plaques on endoscopy
  • Differential Diagnosis
    • Cytomegalovirus, Herpes Simplex, Eosinophilic Esophagitis, Medication-induced Esophagitis

Candida Vulvovaginitis

  • Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity
  • Clinical Features
    • intense vulvovaginal pruritis or burning, dyspareunia, dysuria
  • Diagnosis
    • although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis
    • cotton cheese-like non-odorous vaginal discharge on pelvic exam
    • vaginal pH < 4.5
    • vaginal wet mount
  • Differential Diagnosis
    • Bacterial vagininosis, Trichomoniasis, Chlamydia/Gonorrheal infection
  • Management
    • Pregnant: Topical Imidazole

Candida Dermatitis

Diaper Dermatitis, OPENi-An
  • Seen in
  • Clinical Features
  • Diagnosis
    • erythematous, macerated, intertriginous plaques with satellite pustules


Evaluation

  • Candidiasis is primarily diagnosed clinically
  • Confirmatory tests available by KOH preparation of lesion scrapings, vaginal wet mount, culture, or endoscopic biopsy revealing budding yeast with pseudohyphae

Management

Disposition

See Also

External Links

References