Candidiasis, Mucocutaneous

Candidiasis, Mucocutaneous is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • 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)[A]
      • 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.
  • Topical treatment during pregnancy should be extended 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.

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 of childbearing age: vaginitis
    • Prepubertal or postmenopausal: yeast vaginitis
    • Predominant sex: female > male

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

Prevalence
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)[A].

Genetics
Chronic mucocutaneous candidiasis is a heterogeneous, genetic syndrome with infection of skin, nails, hair, and mucous membranes; typically presents in infancy

Risk Factors

  • Immune suppression (antineoplastic treatments, transplant patients, cellular immune defects) (2)[A]
  • Malignant diseases
  • AIDS or hematologic/immune disorders (neutropenia)
  • Corticosteroid use
  • Smoking and alcoholism
  • Hyposalivation (Sjögren disease, drug-induced xerostomia, radiotherapy) (2)[A]
  • 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

General Prevention

  • Use antibiotics and steroids judiciously; rinse mouth after inhaled steroid use (1)[A].
  • 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)[A]
  • 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)[A].

Commonly Associated Conditions

  • HIV
  • Leukopenia
  • Diabetes mellitus
  • Cancer and other immunosuppressive conditions

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Citation

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TY - ELEC T1 - Candidiasis, Mucocutaneous ID - 116100 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116100/all/Candidiasis__Mucocutaneous PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -