Candidiasis

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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

Candida vaginitis, Wikipedia
  • 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
    • pruritus and erythematous changes in high risk locations: inguinal folds, axilla, scrotum, intergluteal/inframammary/abdominal folds
  • Diagnosis
    • erythematous, macerated, intertriginous plaques with satellite pustules or papules
    • KOH prep or culture of skin scrapings
  • Differential Diagnosis
    • Tinea cruris
    • Atopic Dermatitis
    • Contact Dermatitis
  • Management
    • Topical nystatin, ketoconazole, or clotrimazole applied twice per day until resolution


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