- 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)
- 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 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.
- 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
Unknown—mucocutaneous candidiasis is common in immunocompetent patients. Complication rates are low.
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.
Chronic mucocutaneous candidiasis is a heterogeneous, genetic syndrome that typically presents in infancy.
- 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
- 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
- Diabetes mellitus
- Cancer and other immunosuppressive conditions that cause leukopenia
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