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candidiasis

Infection or disease caused by Candida, usually Candida albicans. Etiology: 1) Candida species - Candida albicans (50-60%) - Candida tropicalis - Candida parapsilosis - Candida glabrata - Candida krusei 2) risk factors [3] - central venous catheters - broad-spectrum antimicrobial agents - SGLT2 inhibitors (flozins) -> vulvovaginal candidiasis - neutropenia - ICU stay > 3 days - total parenteral nutrition - general surgery, especially GI surgery - burns - trauma - mechanical ventilation > 3 days - organ transplantation, bone marrow transplantation - hemodialysis catheters - severe acute pancreatitis [3] Epidemiology: - most common fungal infection in HIV+ patients - Candida isolated from urinary tract or respiratory tract usually represents colonization [3] Pathology: 1) abscess formation a) kidney b) hepatic abscess c) brain abscess 2) meningitis a) infants b) neurosurgery 3) candidemia 4) pulmonary candidiasis rare [3] 5) urinary candidiasis uncommon [3] Clinical manifestations: - urinary tract infections - catheter-related infections - cutaneous candidiasis -> vulvovaginal candidiasis - peritonitis - osteomyelitis - infectious arthrtitis - endophthalmitis - CNS infections [3] - candida esophagitis - thrush - does not cause colitis [3] * images [7] Laboratory: 1) abscesses contain mycelia resembling yeast 2) serology 3) blood culture or culture from a normally sterile site is the gold standard for diagnosis - candida is part of normal bowel flora, thus positive stool culture not indicative of systemic disease [3] - 40-60% of patients with positive blood cultures [3] - T2 magnetic resonance assay of whole blood may provide rapid diagonsis of blood-culture negative candidiasis [3] 4) cerebrospinal fluid (CSF) a) hypoglycorrhachia (low glucose in CSF) b) leukocytosis with neutrophil predominance 5) antifungal drug susceptibility a) may not be correlated with clinical success b) susceptible organisms have MIC (fluconazole) < 8 ug/mL 6) Candida isolated from the respiratory tract or the urinary tract usually represent colonization [3] Special laboratory: - ophthalmoscopy: white exudates may be seen on retina [3] Management: 1) invasive candidiasis should be treated with echinocandin [3] - remove catheters if possible 2) central nervous system infection: - amphotericin B plus flucytosine 3) oral thrush a) nystatin swish & swallow b) fluconazole c) amphotericin B mouthwash d) liquid formula itraconazole 4) candida esophagitis - fluconazole 100 mg PO QD for 7 days - unresponsive disease: amphotericin B 0.3-0.5 mg/kg/day IV 5) Candida prophylaxis in neutropenic cancer patients - fluconazole may be useful - limited effectiveness against other fungal infections [3]

Related

amphotericin B (Fungisone, Ambisone, Amphotec, Fungilin, LAMB, AmBisome) Candida fluconazole (Diflucan) flucytosine; 5-fluorocytosine (Ancobin, 5-FC)

Specific

candidemia candiduria cutaneous candidiasis esophageal candidiasis familial candidiasis moniliasis mucocutaneous candidiasis (includes vulvovaginal candidiasis) oropharyngeal candidiasis (thrush)

General

mycosis; fungal infection

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 871
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Pappas PG, Kauffman CA, Andes D, Benjamin DK et al Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1;48(5):503-35. PMID: 19191635
  5. Kullberg BJ, Arendrup MC Invasive Candidiasis N Engl J Med 2015; 373:1445-1456. October 8, 2015 PMID: 26444731 http://www.nejm.org/doi/full/10.1056/NEJMra1315399
  6. Pappas PG, Kauffman CA, Andes DR et al Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. (2015) Dec 16 PMID: 26679628 http://cid.oxfordjournals.org/content/early/2015/12/15/cid.civ933#aff-3
  7. Hidalgo JA, Bronze MS (images) Medscape: Candidiasis http://emedicine.medscape.com/article/213853-overview
  8. Cornely OA, Bassetti M, Calandra T et al ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012 Dec;18 Suppl 7:19-37. PMID: 23137135 Free Article
  9. Pappas PG, Kauffman CA, Andes DR et al Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):409-17. Review. PMID: 26810419
  10. Centers for Disease Control & Prevention (CDC) Candidiasis. http://www.cdc.gov/fungal/diseases/candidiasis/