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

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Ontology: Candidiasis (C0006840)

Definition (NCI_NCI-GLOSS) 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, 187024008, 187478002, 154403005, 370520002, 78048006
English Candidiases, Candidiasis, Moniliases, Moniliasis, CANDIDIASIS, MONILIASIS, Candidiasis, unspecified, [X]Candidiasis, unspecified, candidiasis, candidiasis (diagnosis), Candida infections, Candidiasis site NOS, candidosis, Candidiasis [Disease/Finding], candidal infection, candidal infections, monilial infection, thrush, candida infections, candidiases, candida infection, muguet, monilia infection, Candidiasis NOS (disorder), [X]Candidiasis, unspecified (disorder), Candida NOS, Monilial infection, Moniliasis monilia, Moniliasis NOS, Candidiasis of unspecified site, Monilia NOS, Candidal infection NOS, Candidiasis NOS, Thrush, Candidosis, Infection by Candida species, Candida infection, Monilia infection, Candidiasis (disorder), moniliasis, candida; infection, Muguet, infection; candidal, infection; monilia, monilia; infection, Candidiasis, NOS, Candidosis, NOS, Moniliasis, NOS
French CANDIDOSE, MONILIASE, Infection candidosique, Infection à Candida, Candidiase SAI, Candidose SAI, Candida SAI, Infection à Candida SAI, Moniliase SAI, Candidose de site non précisé, Moniliase à Candida, Candidoses, Candidiase, Candidose, Moniliase, Moniliose
Portuguese CANDIDIASE, MONILIASE, Candidíase NE, Candidiase, Monilia NE, Candida NE, Monilia de monilíase, Infecção por Candida, Infecção por cândida NE, Candidíase de local NE, Infecção por monilia, Monilíase NE, Infecções a Candida, Candidíase, Monilíase
Spanish CANDIDIASIS, MONILIASIS, [X]candidiasis, no especificada (trastorno), moliniasis, SAI, candidiasis, SAI, candidiasis, SAI (trastorno), [X]candidiasis, no especificada, Infección por Candida NEOM, Infección por Cándida, Cándida NEOM, Candidiasis NEOM, Moniliasis NEOM, Candidiasis de localización no especificada, Monilia NEOM, Infección monilial, candidiasis (trastorno), candidiasis, candidosis, infección por especies de Candida, moniliasis, Infecciones por cándida, Candidiasis, Moniliasis
Italian Infezioni da candida, Moniliasi, Infezione da Candida, Candidiasi / Candida, Candidiasi NAS, Candida NAS, Candidiasi, Candidiasi di sede non specificata, Infezione da Candida NAS, Candidosi
Swedish Kandidos
Czech kandidóza, Kandidové infekce, moniliáza, Kandidy NOS, Kandidóza, Moniliáza, Kandidóza na blíže neurčeném místě, Kandidová infekce, Kandidová infekce NOS, Infekce způsobená Candida, Kandida NOS, Kandidóza NOS, Moniliáza NOS
Finnish Kandidiaasi
Russian KANDIDOZ, MONILIAZ, КАНДИДОЗ, МОНИЛИАЗ
German CANDIDIASIS, Kandidose, nicht naeher bezeichnet, MONILIASIS, Candidiasis unspezifischer Stelle, Candida NNB, Moniliasis NNB, Candidainfektion NNB, Candida-Infektion, Candidiasis NNB, Monilioseinfektion, Moniliasis durch Monilia, Candida-Infektionen, Candida-Mykosen, Candidose, Kandidose, Moniliasis, Soor, Candidiasis
Korean 상세불명의 칸디다증, 칸디다증
Croatian KANDIDIJAZA
Polish Kandidiaza, Zakażenie Candida albicans, Moniliaza, Oidiomikoza, Bielnica, Kandydoza
Hungarian Candida fertőzések, moniliasis k.m.n., Moniliazisos fertőzés, candidiasis, moniliasis, Moniliasis monilia, candidiasis k.m.n., Candida k.m.n., Nem meghatározott elhelyezkedésű candidiasis, Candida fertőzés, Monilia k.m.n., Candidás fertőzés k.m.n.
Japanese カンジダ症, カンジダ感染症, カンジダカンセン, カンジダショウ, カンジダショウNOS, モニリアNOS, カンジダ感染, カンジダ症NOS, モニリア感染, カンジダNOS, ブイフメイノカンジダショウ, カンジダ感染NOS, モニリアカンセン, カンジダNOS, モニリアNOS, カンジダカンセンNOS, モニリアショウ, 部位不明のカンジダ症, モニリア症NOS, モニリアショウNOS, モニリア症
Norwegian Candidainfeksjoner, Candidose, Kandidose, Candidiasis, Moniliase, Moniliasis
Dutch Monilia NAO, candidiasis NAO, moniliasis Monilia, moniliasis NAO, Candida-infectie NAO, candidiasis op niet-gespecificeerde plaats, Monilia-infectie, moniliasis, Candida-infectie, candidiasis, Candida NAO, Monilia; infectie, candida; infectie, infectie; Monilia, infectie; candida, Candidiasis, niet gespecificeerd, Candida-infecties, Candidiasis, Moniliasis