Candidiasis, Mucocutaneous

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Basics

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
      • Folliculitis
      • Interdigital candidiasis: webs of the digits
      • Candidal diaper dermatitis and intertrigo (within skin folds)
  • Synonym(s): monilia; thrush; yeast; intertrigo
ALERT
Vaginal antifungal creams and suppositories can weaken condoms and diaphragms.

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 and 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) (2)
  • Broad-spectrum antibiotic therapy
  • Douches, chemical irritants, birth control pills, intrauterine devices, and concurrent vaginitides
  • Denture wear, poor oral hygiene (2)
  • 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.
  • Avoid douching.
  • 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, especially in patients with hematologic malignancies
  • Treat with HAART in HIV-infected patients; antifungal prophylaxis not recommended unless HIV-infected adults have frequent or severe recurrences

Commonly Associated Conditions

  • HIV
  • Diabetes mellitus
  • Cancer and other immunosuppressive conditions that cause leukopenia

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Basics

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
      • Folliculitis
      • Interdigital candidiasis: webs of the digits
      • Candidal diaper dermatitis and intertrigo (within skin folds)
  • Synonym(s): monilia; thrush; yeast; intertrigo
ALERT
Vaginal antifungal creams and suppositories can weaken condoms and diaphragms.

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 and 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) (2)
  • Broad-spectrum antibiotic therapy
  • Douches, chemical irritants, birth control pills, intrauterine devices, and concurrent vaginitides
  • Denture wear, poor oral hygiene (2)
  • 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.
  • Avoid douching.
  • 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, especially in patients with hematologic malignancies
  • Treat with HAART in HIV-infected patients; antifungal prophylaxis not recommended unless HIV-infected adults have frequent or severe recurrences

Commonly Associated Conditions

  • HIV
  • Diabetes mellitus
  • Cancer and other immunosuppressive conditions that cause leukopenia

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