Candidiasis

What is Candidiasis

Candidiasis is a fungal infection caused by a realted group of yeasts, whose manifestations may be loaclized to the skin, or rarely, may be systemic and life threatening. The causitive organism is usually Candida albicans, but may also be C.tropicalis. These organisms are normal saprophytic inhabitants of the pastrointestinal tract but may overgrow and cause Candidiasis ata number of cutaneous sites. Mucocutaneous candidiasis occurs on the vulva, anus, breast or groin folds. Superficial denuded beefy red areas with or without scattered satellite vesicopustules with marginal scaling.

Candidiasis is very common infection in HIV-infected people. Candidasis in skin folds is more common in warm climates and in those with frequently wet hands such as gardeners and housewives. The oral cavity is normal involved. lesions may occur on the tounge and appear as white plaques.

Additionally, Candidal infections have an affinity for sites that are chronically wet and macerated and may occur around nails and in other areas. In contrast to dermatophyte infections, candidal infections are frequently accompanied bya marked inflammatory response. Diagnosis of Candidiasis is based upon the clinical pattern and demostration of yeast.

Treatment of Candidiasis

Treatment routinely involves removing any predisposing factors such as antibiotic therapy or chronic wetness and the use of appropriate topical or systemic antifungal therapy. Choice of therapy for other forms of candidiasis is based on case series and anecdotal reports. In general, amphotericin B-based preparations, the azole antifungal agents, and the echinocandin antifungal agents play a role in treatment.

Effective topical agents include nystatin or topical azoles (miconazole, clotrimazole, econazole, or ketoconazole). These agents are generally effective in clearing mucous membrane or glabrous skin involvement in nonimmunosuppressed patients. The associated inflammatory response that often accompanies candidal infection on glabrous skin should be treated with a mild glucocorticoid lotion or cream (2.5% hydrocortisone).

Systemic therapy is generally reserved for immunosuppressed patients or individuals with chronic or recurrent disease who fail to respond to or tolerate appropriate topical therapy. Vulvovaginal candidiasis may respond to treatment with a single dose of fluconazole (150 mg). Chronic recurrent oral or vaginal candidiasis may be treated with weekly to monthly oral fluconazole (150 to 200 mg) in conjunction with topical therapy.