infectious diseases
Candidiasis
Introduction
Candidiasis is infection byCandidaspecies (most oftenC. albicans), manifested by mucocutaneous lesions, fungemia, and sometimes focal infection of multiple sites. Symptoms depend on the site of infection and include dysphagia, skin and mucosal lesions, blindness, vulvovaginal symptoms (itching, burning, discharge), fever, shock, oliguria, renal shutdown, and disseminated intravascular coagulation. Diagnosis is confirmed by cultures from normally sterile sites. For candidemia and invasive candidiasis, initial treatment with an echinocandin and potential step-down tofluconazoleor another azole is recommended. (See also Overview of Fungal Infections , species are commensal organisms that inhabit the gastrointestinal (GI) tract and sometimes the skin (see Etiology ). Unlike other systemic mycoses, candidiasis results from endogenous organisms. Most infections are caused byC. albicans; however,Nakaseomyces glabrata(C. glabrata) and other non-albicans species are increasingly involved in fungemia, urinary tract infections, and, occasionally, other focal disease. Antimicrobial sensitivities vary acrossCandidaspecies: N. glabratais less susceptible tofluconazolethan other species. Pichia kudriavzevii(C. krusei) is inherently resistant tofluconazole; frequency of resistance tovoriconazoleandamphotericin Bvaries.P. kudriavzeviiis most frequently susceptible to echinocandins. C. aurisis an emerging, multidrug-resistant species that has caused outbreaks in hospitals. Candidaspecies are a major cause of systemic fungal infections and are the most common cause of fungal infections in patients who are immunocompromised. Candidal infections are one of the most common hospital-acquired infections. Because resistance and transmission ofC. aurisin health care facilities have become a concern,special infection control precautionshave been instituted for patients who are colonized or infected withC. auris. is a defining opportunistic infection in Human Immunodeficiency Virus (HIV) Infection . Although mucocutaneous candidiasis is frequently present in patients with AIDS, hematogenous dissemination is unusual unless other specific risk factors are present (see Oral candidiasis takes many forms, including angular cheilitis and pseudomembranous plaques on the oral mucosae, which can be associated with dentures, as in this image (top), or develop on the tongue (bottom) or pharynx. Images courtesy of Jonathan Ship, MD. This photo shows oral candidiasis manifesting as a white exudate overlying a beefy, red, and raw mucosal surface of the labial mucosa. © Springer Science+Business Media This photo shows fluffy white exudate on the tongue of a child with HIV infection. © Springer Science+Business Media 