I. Etiology

  1. Candida albicans

II. Risk Factors

  1. Skin maceration
  2. Immunosuppressed patients
    1. Advanced Human Immunodeficiency Virus (AIDS)
    2. Hematologic Malignancy
    3. Antibiotic use
    4. Corticosteroid use
    5. Pregnancy
    6. Diabetes Mellitus

III. Signs: Systemic involvement in immunocompromised patient

  1. Severe muscle tenderness

IV. Signs: Mucocutaneous Rash

  1. Character
    1. Erythematous Papules
    2. Pruritic, eroded areas
    3. Scaling and crusting of lesions
  2. Normal Distribution (Not Immunocompromised)
    1. Mouth
    2. Vagina
    3. Axillae
    4. Inguinal folds
    5. Interdigital surfaces

V. Signs: Specific Lesions

  1. Oral Thrush
    1. White Plaques firmly adhered to Oral Mucosa
  2. Cutaneous Candidiasis
    1. Red, macerated intertriginous areas
  3. Chronic mucocutaneous Candidiasis
    1. Circumscribed hyperkeratotic skin lesions
    2. Dystrophic Nails
    3. Partial Alopecia
    4. Oral and vaginal Thrush
    5. Endocrine organ hypofunction
      1. Hypoparathyroidism
      2. Hypothyroidism
      3. Adrenal Insufficiency
  4. Gastrointestinal
    1. Distal esophagus Ulcerations
  5. Hematogenous (Immunosuppressed)
    1. Fever
    2. Malaise
    3. Retinal abscess
    4. Pulmonary nodular infiltrate
    5. Endocarditis

VI. Labs

  1. Abscess drainage shows candida mycelia
  2. Candida Serology titers elevated
  3. KOH Preparation
    1. Pseudohyphae

VII. Management

  1. Cutaneous
    1. Nystatin
    2. Ciclopirox
    3. Imidazole cream
  2. Oral Thrush
    1. Clotrimazole
      1. One troche dissolve in mouth x5 qd for 7-14 days
    2. Nystatin suspension
      1. Swish and swallow 4-6 times per day for 7-14 days
    3. Fluconazole 100 mg PO qd for 7-14 days
  3. Esophageal
    1. Fluconazole 100-200 mg PO/IV qd for 14-21 days
    2. Amphotericin B 0.3 mg/kg/day for 5-10d
      1. Indicated for severe cases only
    3. Ketoconazole 200-400 mg orally daily for 14-21 days
      1. Indicated only for severe, refractory cases due to Ketoconazole hepatotoxicity
      2. If Ketoconazole is used, requires Liver Function Tests at baseline and again weekly
  4. Bladder
    1. Irrigate with Amphotericin B 50 mg in 1L x5 days
  5. Disseminated
    1. Empiric broad Candidiasis coverage or known resistant Candidiasis (Candida glabrata or Candida krusei)
      1. Caspofungin 70 mg IV load, then 50 mg IV every 24 hours or
      2. Micafungin 100 mg IV every 24 hours or
      3. Anidulafungin 200 mg IV load, then 100 mg IV every 24 hours
    2. Known Candida albicans or Candida parapsilosis or Candida tropicalis
      1. Fluconazole 800 mg (12 mg/kg) load then 400 mg IV or oral daily
    3. Alternative empiric protocols
      1. Amphotericin B 0.7 mg/kg IV daily (or lipid based Amphotericin B 3-5 mg/kg daily) or
      2. Fluconazole 800 mg (or 12 mg/kg) load then 400 mg IV or oral daily or
      3. Voriconazole 400 mg (or 6 mg/kg) IV twice daily for 2 doses, followed by 200 mg every 12 hours
    4. References
      1. Gilbert (2013) Sanford Antibiotic Guide

Images: Related links to external sites (from Google)

Ontology: Candidiasis (C0006840)

Definition (NCI) A condition in which Candida albicans, a type of yeast, grows out of control in moist skin areas of the body. It is usually a result of a weakened immune system, but can be a side effect of chemotherapy or treatment with antibiotics. Thrush usually affects the mouth (oral thrush); however, rarely, it spreads throughout the entire body.
Definition (MSH) Infection with a fungus of the genus CANDIDA. It is usually a superficial infection of the moist areas of the body and is generally caused by CANDIDA ALBICANS. (Dorland, 27th ed)
Definition (CSP) infection with a fungus of the genus Candida; usually a superficial infection of the moist areas of the body and is generally caused by Candida albicans; includes chronic mucocutaneous candidiasis, cutaneous candidiasis, oral candidiasis (thrush), and monilial vaginitis.
Concepts Disease or Syndrome (T047)
MSH D002177
ICD9 112.9, 112
ICD10 B37 , B37.9
SnomedCT 187005005, 154403005, 187478002, 187024008, 78048006
English Candidiases, Candidiasis, Moniliases, Moniliasis, Candidiasis of unspecified site, CANDIDIASIS, MONILIASIS, Candidiasis, NOS, Candidosis, NOS, Moniliasis, NOS, Candidiasis NOS, Candidiasis, unspecified, [X]Candidiasis, unspecified, MONILIASIS MONILIA, candidiasis, candidiasis (diagnosis), muguet, E-410 CANDIDIASIS, Candida NOS, Candida infections, Monilial infection, Monilia NOS, Moniliasis monilia, Moniliasis NOS, [X]Candidiasis, unspecified (disorder), Candidiasis site NOS, Candidiasis NOS (disorder), candidosis, Candidiasis [Disease/Finding], candidal infection, candidal infections, monilial infection, candida infections, candidiases, candida infection, monilia infection, thrush, Candidal infection NOS, Candidosis, Infection by Candida species, Candida infection, Monilia infection, Candidiasis (disorder), moniliasis, candida; infection, Muguet, infection; candidal, infection; monilia, monilia; infection
French CANDIDOSE, MONILIASE, Infection candidosique, Moniliase SAI, Infection à Candida SAI, Candidose SAI, Moniliase à Candida, Candidiase SAI, Candida SAI, Candidose de site non précisé, Candidoses, Candidiase, Candidose, Moniliase, Moniliose
Portuguese CANDIDIASE, MONILIASE, Candidíase de local NE, Candida NE, Candidíase NE, Monilíase NE, Monilia NE, Infecção por monilia, Monilia de monilíase, Infecção por cândida NE, Candidiase, Infecções a Candida, Candidíase, Monilíase
Spanish CANDIDIASIS, MONILIASIS, Moniliasis NEOM, Cándida NEOM, Infección por Candida NEOM, Monilia NEOM, Candidiasis NEOM, Candidiasis de localización no especificada, Infección monilial, Candidiasis, Moniliasis, Candidosis, Candida infection, Monilia infection, [X]candidiasis, no especificada (trastorno), [X]candidiasis, no especificada, candidiasis (trastorno), candidiasis, SAI (trastorno), candidiasis, SAI, candidiasis, candidosis, infección por especies de Candida, moliniasis, SAI, moniliasis, Infecciones por cándida
Italian Candidiasi, Infezioni da candida, Candidiasi / Candida, Infezione da Candida, Candidiasi NAS, Infezione da Candida NAS, Candida NAS, Candidiasi di sede non specificata, Moniliasi, Candidosi
Dutch Candida NAO, candidiasis op niet-gespecificeerde plaats, candidiasis NAO, Monilia-infectie, moniliasis NAO, moniliasis, moniliasis Monilia, Candida-infectie NAO, Monilia NAO, Monilia; infectie, candida; infectie, infectie; Monilia, infectie; candida, Candidiasis, niet gespecificeerd, Candida-infecties, candidiasis, Candidiasis, Moniliasis
German Candida NNB, Candidainfektion NNB, Moniliasis NNB, Moniliasis durch Monilia, Candidiasis NNB, Monilioseinfektion, Candidiasis unspezifischer Stelle, CANDIDIASIS, Kandidose, nicht naeher bezeichnet, MONILIASIS, Candida-Infektionen, Candida-Mykosen, Candidose, Kandidose, Moniliasis, Soor, Candidiasis
Japanese カンジダ感染, モニリア感染, カンジダNOS, 部位不明のカンジダ症, モニリアNOS, モニリア症NOS, カンジダ症NOS, カンジダ感染NOS, モニリアショウ, カンジダカンセンNOS, カンジダNOS, カンジダショウ, ブイフメイノカンジダショウ, モニリアNOS, モニリアカンセン, モニリアショウNOS, カンジダカンセン, カンジダショウNOS, カンジダ症, カンジダ感染症, モニリア症
Swedish Kandidos
Czech kandidóza, Kandidová infekce, Kandidová infekce NOS, Kandidové infekce, Moniliáza NOS, Kandidóza, Moniliáza, Kandidóza na blíže neurčeném místě, Kandidy NOS, Kandida NOS, Kandidóza NOS
Finnish Kandidiaasi
Korean 상세불명의 칸디다증, 칸디다증
Polish Kandidiaza, Zakażenie Candida albicans, Moniliaza, Oidiomikoza, Bielnica, Kandydoza
Hungarian Moniliasis monilia, Candida fertőzések, candidiasis k.m.n., candidiasis, Moniliazisos fertőzés, Candida k.m.n., moniliasis, Candidás fertőzés k.m.n., moniliasis k.m.n., Nem meghatározott elhelyezkedésű candidiasis, Monilia k.m.n.