Difference between revisions of "Candidiasis"

Line 21: Line 21:
 
* Clinical features  
 
* Clinical features  
 
** cotton sensation in mouth
 
** cotton sensation in mouth
**loss of taste
+
** angular cheilitis
 +
** loss of taste
 
*Diagnosis
 
*Diagnosis
 
** pseudomembrane white plaques adhered to oral mucosa, tongue, palate, or oropharynx
 
** pseudomembrane white plaques adhered to oral mucosa, tongue, palate, or oropharynx
Line 32: Line 33:
 
** dysphagia
 
** dysphagia
 
** retrosternal pain
 
** retrosternal pain
** nausea/vomting
+
** nausea/vomiting
 
* Diagnosis
 
* Diagnosis
 
** thick, white, linear esophageal plaques on endoscopy  
 
** thick, white, linear esophageal plaques on endoscopy  
 
*Differential Diagnosis
 
*Differential Diagnosis
** Cytomegalovirus, Herpes Simplex, Eosinophilic Esophagitis, Medication-induced Esophagitis
+
** Cytomegalovirus Esophagitis
 +
** Herpes Simplex Esophagitis
 +
** Eosinophilic Esophagitis
 +
** Medication-induced Esophagitis
  
 
'''Candida Vulvovaginitis'''
 
'''Candida Vulvovaginitis'''
 
* Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity
 
* Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity
 
* Clinical Features  
 
* Clinical Features  
** intense vulvovaginal pruritis or burning, dyspareunia, dysuria
+
** intense vulvovaginal pruritis or burning
 +
** dyspareunia
 +
** dysuria
 
* Diagnosis
 
* Diagnosis
 
** although other candida infections are clinically diagnosed, laboratory methods should be pursued to confirm diagnosis of candida vulvovaginitis
 
** 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   
+
** cotton cheese curd-like non-odorous vaginal discharge on pelvic exam   
 
** vaginal pH < 4.5
 
** vaginal pH < 4.5
 
** vaginal wet mount
 
** vaginal wet mount
 
* Differential Diagnosis
 
* Differential Diagnosis
** Bacterial vagininosis, Trichomoniasis, Chlamydia/Gonorrheal infection  
+
** Bacterial vagininosis
 +
** Trichomoniasis
 +
** Chlamydia/Gonorrheal infection  
 
*Management
 
*Management
 
**Pregnant: Topical Imidazole  
 
**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  
+
* Most commonly seen in infants (diaper dermatitis) or intertriginous areas
 
* Clinical Features
 
* Clinical Features
 
* Diagnosis
 
* Diagnosis
 
** erythematous, macerated, intertriginous plaques with satellite pustules
 
** erythematous, macerated, intertriginous plaques with satellite pustules
 +
** KOH prep of skin scrapings
  
  

Revision as of 21:46, 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
    • angular cheilitis
    • 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/vomiting
  • Diagnosis
    • thick, white, linear esophageal plaques on endoscopy
  • Differential Diagnosis
    • Cytomegalovirus Esophagitis
    • Herpes Simplex Esophagitis
    • 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 curd-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
  • Most commonly seen in infants (diaper dermatitis) or intertriginous areas
  • Clinical Features
  • Diagnosis
    • erythematous, macerated, intertriginous plaques with satellite pustules
    • KOH prep of skin scrapings


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