Description

• Heterogeneous group of mucocutaneous infections with commensal Candida species
• Characterized by superficial infection of the skin, mucous membranes, and nails
• >20 Candida species cause infection in humans. Candida albicans is responsible for 70% of fungal infections worldwide.
  • Candida auris is an emerging global pathogen with a high propensity to develop drug resistance (1).
• Candidiasis affects:
  • Aerodigestive system
    • Oropharyngeal candidiasis (thrush): mouth, pharynx
    • 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)
• Synonym(s): monilia; thrush; yeast; intertrigo

Pregnancy Considerations

• Vaginal candidiasis is common during pregnancy—extend treatment (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.

Epidemiology

• 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 (prepubertal through postmenopausal): yeast vaginitis

Incidence
Unknown—mucocutaneous candidiasis is common in immunocompetent patients. Complication rates are low.

Prevalence
Candida species are normal flora of oral cavity, GI tract that are present in >70% of the U.S. population.

Etiology and Pathophysiology

C. albicans (responsible for 80–92% vulvovaginal and >80% of oral isolates); altered cell–mediated immunity against Candida species (either transient or chronic) increases susceptibility to infection.

Genetics
Chronic mucocutaneous candidiasis is a heterogeneous, genetic syndrome that typically presents in infancy.

Risk Factors

• Immune suppression (antineoplastic treatments, transplant patients, cellular immune defects, HIV/AIDS)
• Malignant diseases
• Corticosteroid use
• Smoking and alcoholism
• Hyposalivation (Sjögren disease, drug-induced xerostomia, radiotherapy)
• Broad-spectrum antibiotic therapy
• Douches, chemical irritants, birth control pills, intrauterine devices, and concurrent vaginitides
• Denture wear, poor oral hygiene
• Endocrine alterations (diabetes mellitus, pregnancy, renal failure, hypothyroidism)
• Uncircumcised men at higher risk for balanitis

General Prevention

• Use antibiotics and steroids judiciously; rinse mouth after using inhaled steroids.
• Minimize perineal moisture (wear cotton underwear; frequent diaper changes; avoid douching).
• Clean dentures often; use well-fitting dentures and remove them during sleep.
• Optimize glycemic control in diabetics.
• Preventive regimens during cancer treatments, especially in patients with hematologic malignancies
• Treat with HAART in HIV-infected patients; antifungal prophylaxis is not recommended unless HIV-infected adults have frequent or severe recurrences.

Commonly Associated Conditions

HIV, diabetes mellitus, cancer, and other immunosuppressive conditions