Difference between revisions of "Candidiasis"

(Clinical Features)
(Clinical Features)
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*Vulva/vagina: [[Candida vulvovaginitis]] [[File:Candida vaginitis.JPG|thumb|Candida vaginitis]]
*Vulva/vagina: [[Candida vulvovaginitis]] [[File:Candida vaginitis.JPG|thumb|Candida vaginitis]]
*Skin lesions: '''[[Candida dermatitis]]''' [[File:Diaper dermatitis.png|thumb|Diaper Dermatitis]]
*Skin lesions: '''[[Candida dermatitis]]''' [[File:Diaper dermatitis.png|thumb|Diaper Dermatitis]]
*hematogenous, central line cathether, intravenous catheter, indwelling foley catheter: [[Invasive candidiasis]]
===[[Invasive candidiasis]]===
* Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley catheter, recent abdominal surgery with anastamotic leak
* Associated with candidemia with further hematogenous spread to visceral organs (heart, kidney, liver, spleen, eye, brain, skin, joints etc)
* Clinical Features
** presence of biofilms on catheter
** fever and chills unresponsive to antibiotics
** chorioretinitis
** muscle abscesses
** skin lesions with satellite pustules
* Diagnosis
** positive blood culture
** positive culture of blood, tissue, urine from normally sterile sites
** biopsy of skin lesions for gram staining
** beta-D-glutan assay can be a diagnostic adjunct to blood cultures and identify systemic fungal infections weeks before positive blood cultures
* Management <ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>
** vascular catheter removal
** 1st line: IV Echinocandins (Caspofungin, Anidulafungin, Micafungin)
** Step down therapy: as early as 5 days, can step down to oral if blood stream is clear and patient can tolerate oral regime
** 2nd line: Fluconazole, Voriconazole
** Alternative: Amphotericin B is acceptable but carries a higher toxicity and side-effect profile

Revision as of 13:28, 4 September 2016


  • 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


  • 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


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


  • 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


  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.