Candidiasis
Revision as of 10:14, 8 September 2016 by Rossdonaldson1 (talk | contribs) (→Differential Diagnosis)
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
- Mouth: Oropharyngeal candidiasis (thrush)
- Esophagus: Esophageal candidiasis
- Vulva/vagina: Candida vulvovaginitis
- Skin lesions: Candida dermatitis
Systemic
- hematogenous, central line cathether, intravenous catheter, indwelling foley catheter: Invasive candidiasis
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
- ↑ Candidiasis. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/fungal/diseases/candidiasis/. Published June 12, 2015. Accessed August 25, 2016.
- ↑ 2.0 2.1 Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.