2.3.2 Candidiasis

Moniliasis; candidosis; yeast infection; thrush.

Found very commonly; it occurs at least once during the lifetime of every individual. 

Candidiasis is a harmless comensal colonisation with yeast of the genus Candida (normal flora of the gastrointestinal tract, upper respiratory tract, female genitalia) which in the presence of predisposing factors can develop into an infection. Main species is Candida albicans; other less common Candida (C.) species are: C. tropicalis, C. stellatoidea, C. parapsilosis and C. glabrata.

Predisposing factors in generating infection are: very old, very young, very ill. Pre-existing diseases of skin and mucous membranes, use of topical corticosteroids, chronic maceration, intertrigo, increased sweating, in -dwelling plastic lines or implants that can serve as entry sites,; diabetes mellitus, obesity, pregnancy, severe illness, malnutrition, antibiotic therapy and immunosuppression ( autoimmune disease, transplant patients, HIV). The disease is caused by the growth of sporophytic yeasts (skin, GI tract) or by infection (birth canal, sexual contact).

Candida infections can involve skin and mucous membranes, but in immunocompromised patients can be also systemic. Manifestions: intertriginous and anogenital candidasis, onychomycosis, paronychia, oral candidiasis, intestinal candidiasis, systemic candidiasis, mucocutaneous candidasis. Candidal intertrigo is the most common complication of intertrigo with macerations and fissures and scattered outbreaks (satellite lesions) in the surrounding area. In candidal paronychia and candidal nail infection, there may be a red, swollen nail wall with suppuration. Candida folliculitis can lead to small follicular pustules, particularly in the beard area of adult males. In chronic mucocutaneous and vulvovaginal candidiasis, pregnancy, oral contraceptives and mechanical stress are predisposing factors. Vaginal involvement: whitish discharge forming a removable coat on the vaginal wall. Candida balanitis: circumscribed redness, grey-whitish coating or erosions with overlying exudate on the foreskin (balanoposthitis), predisposing factors are: wet-warm environments in the prepucial space, bad hygiene, specifically insufficient drying after washing or sexual intercourse with a partner that has candida vulvovaginitis. There is a risk of phimosis when the inflammation is chronic.

Mainly in moist areas (intertriginous regions, mucosa). 

See Symptoms. 

KOH examination of mycology scrapings. Culture over the course of 1 to 4 days; white or cream colonies with a dull surface and without air mycelium; differentiation by means of micromorphology on rice agar (chlamydospores in C. albicans) or biochemical/PCR.

PAS stain shows hyphae and spores and neutrophilic inflammatory infiltrate sometimes with pustular accumulation in the stratum corneum. 

Generally good. Outlook poor in candidal sepsis, depending on underlying disease.

Predisposition to bacterial superinfection. 

Clinical features, laboratory findings.

Depends on location: lichen planus, leukoplakia, food remnants, secondary syphilis , flexural psoriasis, bacterial infections, other fungi.

Stop predisposing factors (often opportunistic infections). Topical and, where appropriate, systemic antifungal therapy. Polyenes (nystatin, amphotericin B) and azoles are effective in treating these fungal infections. Griseofulvin is not effective for some yeasts, depending on localization: creams and ointments (trunk and extremities), pastes (intertrigines), lacquer paint (nails), suppositories/vaginal tablets (vaginal), lozenges and suspensions (oral mucosa). Systemic therapy of a severe local candidiasis (fluconazole, itraconazole, posaconazole). For invasive candidiasis: amphotericin, echinocandine and intravenous flucytosine.

None.