Candidiasis: Difference between revisions

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==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 <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>
* ''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
*''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 <ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>
* Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis  
*Invasive candida infections: Fungal UTI, Meningitis, Endocarditis, Empyema, Mediastinitis, Pericarditis  


==General Risk Factors==
===Risk Factors=== 
* Skin maceration
*Skin maceration
* Immunosuppression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators
*Immunosuppression: HIV/AIDS, Corticosteroid use, Chemotherapy, Immunomodulators <ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>
* Broad spectrum antibiotic use
*Broad spectrum antibiotic use
* Diabetes Mellitus
*[[Diabetes mellitus]]
* Oral Contraceptive use
*Oral Contraceptive use
* Hematologic Malignancy
*Hematologic Malignancy
* Central Venous Catheters use
*Central Venous Catheters use
* Total Parenteral nutrition use
*Total Parenteral nutrition use
* Neutropenia
*[[Neutropenia]]


==Local Candida Infections==
==Clinical Features==
'''Oropharyngeal Candidiasis (thrush)''' [[File:Oral candidiasis.jpg|thumb|Oral Candidiasis, Wikipedia]]
===Local Candida Infections===
* Most commonly seen in infants, immunocompromised, older adults with dentures
*Mouth: [[Oropharyngeal candidiasis]] (thrush)  
* Clinical features
*Esophagus: [[Esophageal candidiasis]]  
** cotton sensation in mouth
*Vulva/vagina: [[Candida vulvovaginitis]]
** angular cheilitis
*Skin lesions: [[Candida dermatitis]]
** 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''' [[File:Oral Candidiasis.jpg|thumb|Esophageal Candidiasis, OPENi-An]]
===Systemic===
* Most commonly seen in HIV patients (AIDS-defining illness) or chronic inhaled glucocorticoid use
*hematogenous, central line cathether, intravenous catheter, [[Candiduria|indwelling foley catheter]]: [[Invasive candidiasis]]
* 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''' [[File:Candida vaginitis.JPG|thumb|Candida vaginitis, Wikipedia]]
<gallery mode="packed">
* Most commonly seen in females in high estrogen states: pregnancy, oral contraceptive use, obesity
File:Oral candidiasis.jpg|[[Oral candidiasis]]
* Clinical Features
File:Oral Candidiasis.jpg|[[Esophageal candidiasis]]
** intense vulvovaginal pruritis or burning
File:Candida vaginitis.JPG|[[Candida vaginitis]]
** dyspareunia
File:Diaper dermatitis.png|[[Diaper dermatitis]]
** dysuria
</gallery>
* 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''' [[File:Diaper dermatitis.png|thumb|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


==Differential Diagnosis==
===Esophageal candidiasis===
*CMV esophagitis
*HSV esophagitis
*[[Diphtheria]] (C. diptheriae)
*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==
==Evaluation==
* Candidiasis is primarily diagnosed clinically
*Local candidiasis is primarily clinically diagnosed based on lesion characteristics and appearance
* Confirmatory tests available by KOH preparation of lesion scrapings, vaginal wet mount, culture, or endoscopic biopsy revealing budding yeast with pseudohyphae  
*Confirmatory tests: KOH preparation of lesion scrapings, vaginal wet mount, culture, or endoscopic biopsy reveal budding yeast with pseudohyphae  


==Management==
==Management==
*Local: Topical anti-fungal (Nystatin, azoles) or oral azole (eg [[fluconazole]])
*Invasive: Intravenous Echinocandins (Caspofungin, Micafungin)


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


==See Also==
==See Also==
*[[Candiduria]]


==External Links==
==External Links==
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==References==
==References==
<references/>
<references/>
[[Category:ID]]

Latest revision as of 02:51, 23 September 2021

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
  • Diphtheria (C. diptheriae)
  • 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 (eg fluconazole)
  • 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.
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