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- Heterogeneous mucocutaneous disorder caused by infection with common commensal Candida species
- Characterized by superficial infection of the skin, mucous membranes, and nails
- >20 Candida species cause infection in humans. Candida albicans is most common, at 80% of isolates.
- Candidiasis affects:
- Aerodigestive system
- Oropharyngeal candidiasis (thrush): mouth, pharynx (1)
- Angular cheilitis: corner of the mouth
- Esophageal candidiasis
- Gastritis and/or ulcers, associated with thrush; alimental or perianal
- Other systems
- Candida vulvovaginitis: vaginal mucosa and/or vulvar skin
- Candidal balanitis: glans of the penis
- Candidal paronychia: nail bed or nail folds
- Interdigital candidiasis: webs of the digits
- Candidal diaper dermatitis and intertrigo (within skin folds)
- Aerodigestive system
- Synonym(s): monilia; thrush; yeast; intertrigo
Vaginal antifungal creams and suppositories can weaken condoms and diaphragms.
- Vaginal candidiasis is common during pregnancy.
- Extend topical treatment during pregnancy by several days (typically a full 7-day course).
- Vaginal yeast infection at birth increases the risk of newborn thrush but is of no overall harm to baby.
- Common in the United States; particularly with immunodeficiency and/or uncontrolled diabetes
- Age considerations
- Infants and seniors: thrush and cutaneous infections (infant diaper rash)
- Women of childbearing age: vaginitis
- Prepubertal or postmenopausal: yeast vaginitis
- Predominant sex: female > male
Unknown—mucocutaneous candidiasis is common in immunocompetent patients. Complication rates are low.
Candida species are normal flora of oral cavity, pharynx, esophagus, and GI tract that are present in >70% of the U.S. population.
Etiology and Pathophysiology
C. albicans (responsible for 80–92% vulvovaginal and 70–80% oral isolates). Altered cell–mediated immunity against Candida species (either transient or chronic) increases susceptibility to infection (2).
Chronic mucocutaneous candidiasis is a heterogeneous, genetic syndrome with infection of skin, nails, hair, and mucous membranes; typically presents in infancy
- Immune suppression (antineoplastic treatments, transplant patients, cellular immune defects) (2)
- Malignant diseases
- AIDS or hematologic/immune disorders (neutropenia)
- Corticosteroid use
- Smoking and alcoholism
- Hyposalivation (Sjögren disease, drug-induced xerostomia, radiotherapy) (2)
- Broad-spectrum antibiotic therapy
- Douches, chemical irritants, and concurrent vaginitides alter vaginal pH and predispose patients to candidal vaginitis.
- Denture wear, poor oral hygiene
- Birth control pills, intrauterine devices
- Endocrine alterations (DM, pregnancy, renal failure, hypothyroidism)
- Uncircumcised men at higher risk for balanitis
- Use antibiotics and steroids judiciously; rinse mouth after inhaled steroid use (1).
- Avoid douching.
- Treat other vaginal infections.
- Minimize perineal moisture (wear cotton underwear; frequent diaper changes).
- Clean dentures often; use well-fitting dentures and remove during sleep.
- Optimize glycemic control in diabetics.
- Preventive regimens during cancer treatments (2)
- Treat with HAART in HIV-infected patients.
- Antifungal prophylaxis against oral candidiasis is not recommended in HIV-infected adults unless patients have frequent or severe recurrences (2).
Commonly Associated Conditions
- Diabetes mellitus
- Cancer and other immunosuppressive conditions