Candidiasis

CASES/YEAR

300,000 (US); 6,000,000 (Global)

CATEGORY

Sapronoses

AGENT TYPE

Fungi (Pathogenic Yeasts)

OTHER NAMES

Fungal infections caused by Candida species;

ACUITY

Subacute/Chronic

INCUBATION

Varies; Thrush in infants: 3-5 days; [CCDM, p. 85]

INITIAL SYMPTOMS

Cutaneous (diaper rash, intertrigo, balanitis, vulvitis, & paronychia); Stomatitis (thrush); Vaginitis; Esophageal (common with advanced HIV infection); Invasive (blindness, fever, shock, renal shutdown, DIC); [Merck Manual, p. 1031-2, 1569]

PRECAUTIONS

Standard; "As colonizers, Candida species do not cause infection unless there is a defect in host defense mechanisms or unless exogenous factors, such as antibiotic use or cutaneous disruption and/or maceration, have upset the ecology of the normal microbiota." [Cecil, p. 2048]

COMMENTS

Candidiasis includes mucocutaneous and invasive infections. "Chronic mucocutaneous candidiasis is a heterogeneous infection of hair, nails, skin, and mucous membranes that persists despite therapy and is associated with a dysfunctional immune system." [Harrisons, p. 593] Central venous catheters and immunosuppression are risk factors for candidemia. ". . . isolation from sputum, bronchial washings, stools, urine, mucosal surfaces, skin or wounds is not proof of a causal relationship to the disease." [CCDM, p. 98-101] Microabscesses in organs (brain, chorioretina, heart, kidneys, liver, and spleen) are the most serious consequences of candidemia. Candida granulomas (dermal exophytic growths) are characteristic of chronic mucocutaneous candidiasis. [Harrison ID, p. 1010-1] Satellite lesions are characteristic of cutaneous candidiasis but not of tinea cruris or corporis. AIDS should be suspected in cases of thrush with no known risk factors. [Cecil, p. 2048-9] Folliculitis is sometimes caused by Candida. Vesicles may be present in balanitis. Vesicles and pustules are seen in disseminated and congenital candidiasis. Hematogenous Candida endophthalmitis causing blindness has been reported after tattooing, childbirth, abortion, HIV treatment, and IV therapy with contaminated dextrose solution. [PPID, p. 1286, 3096-7, 814] Candida albicans most commonly causes oral pharyngeal candidiasis or thrush. Deep organ infections include meningitis, encephalitis, myocarditis, endocarditis, and pneumonia (very rare). [Cohen, p. 1684] Risk factors for Candida empyema include abdominal disease, GI perforation, and lung transplantation. Hepatosplenic candidiasis is another complication in the immunocompromised. [PPID, p. 922, 3096] Hepatosplenomegaly is typical in chronic disseminated disease, a condition of neutropenic patients. Pancreatitis is associated with pancreatic abscesses. Pyuria and colony counts of >10,000/mL of urine suggest infection. Severe edema and ulcerations may occur in candidal balanitis. [Guerrant, p. 593-5] Papulonodular skin lesions are seen in neutropenic patients. [Merck Manual, p. 1569] See "Candida paronychia" and "Onychomycosis."

DIAGNOSTIC

Clinical + KOH wet preps for mucocutaneous forms; Culture from normally sterile site; Recovery from sputum, urine, or peritoneal catheters may indicate colonization, not deep infection; Antigen test (beta-D-glucan); [Harrisons, p. 593]

SCOPE

Global

SIGNS & SYMPTOMS

• >fever
• E dysphagia
• E nasal ulcers
• E pharyngitis
• E stomatitis
• G abdominal pain
• G hepatomegaly
• G liver function test, abnormal
• G nausea, vomiting
• H splenomegaly
• N headache
• N stiff neck
• O conjunctivitis, acute
• R chest pain
• S papules or plaques
• S pustule
• S skin blister or vesicles
• S skin or subcutaneous nodule
• S ulcer of skin
• S warty growth of the skin
• U hematuria
• U pyuria
• X lung infiltrates
• X pleural effusions
• *acute renal failure
• *arthritis
• *bleeding tendency
• *blindness
• *brain abscess or lesion
• *cranial neuropathy
• *encephalitis
• *endocarditis
• *glomerulonephritis
• *meningitis
• *myocarditis
• *osteomyelitis
• *pancreatitis
• *pericarditis
• *pneumonia
• *sepsis
• *shock
• *uveitis

ANTIMICROBIC

Yes

VACCINE

No

ENTRY

SOURCE

Person-to-Person

RESERVOIR

Human

RISK FACTORS

• AIDS patients
• Cancer patients
• Injection drug users

DRUG LINK

Merck Manual: Candidiasis (Mucocutaneous)

REFERENCES FOR CASES/YEAR

1. (US) Incidence of mucocutaneous = 50/100,000; Incidence of invasive: 30/100,000 adult cases/year & 43/100,000 pediatric cases/year; [5MCC-2015] Candida causes up to 9% of bloodstream infections in US; [Gorbach, p. 112] Assume 100/100,000 cases per year = 1/1000; 1/1000 X 300 million = 300,000 cases/year in US;
2. (Global) Normally inhabit humans (GI tract,, genital tract, and skin), but has become one of the most common nosocomial pathogens since the introduction of antimicrobial therapy over the last 100 years; "The non-albicans species now account for approximately half of all cases of candidemia and hematogenously disseminated candidiasis." [Harrison ID, p. 1010] The most common opportunistic fungal infection; [Cecil, p. 2048] Estimate global cases/yr at 20 X US cases/yr;