Candidiasis
Also known as candidosis and moniliasis, this usually mild, superficial fungal infection can lead to severe disseminated infections and fungemia in an immunocompromised patient. In most cases, the causative fungi infect the nails (paronychia), skin (diaper rash), or mucous membranes, especially the oropharynx (thrush), vagina (vaginitis), esophagus, and GI tract.
These fungi may enter the bloodstream and invade the kidneys, lungs, endocardium, brain, or other structures, causing serious systemic infection. Such systemic infection predominates among drug abusers and hospitalized patients (particularly diabetic and immunosuppressed patients).
The prognosis varies, depending on the patient’s resistance. The incidence of candidiasis continues to rise because of increasing use of I.V. antibiotic therapy and increasing numbers of immunocompromised patients in the acute care setting.
Causes
Most cases of candidiasis result from infection with Candida albicans or Candida tropicalis, although eight other potentially disease-causing strains exist among the more than 150 species of Candida. One of the normal flora of the GI tract, mouth, vagina, and skin, C. albicans causes infection when some change in the body permits its sudden proliferation. The changes may be triggered by rising blood glucose levels from diabetes mellitus, lowered resistance from diseases such as cancer, immunosuppressant drug therapy, radiation, aging, or irritation from dentures.
The infecting organism may enter the body because of I.V. or urinary catheterization, drug abuse, total parenteral nutrition, or surgery. The most common precipitator is the use of broad-spectrum antibiotics such as tetracycline. These agents decrease the number of normal bacterial flora and permit the number of fungi, including candidal organisms, to increase.
A mother with vaginitis can transmit the organism (as oral thrush) to the neonate during vaginal delivery.
Complications
The most common complications include Candida dissemination with organ failure of the kidneys, brain, GI tract, eyes, lungs, and heart.
Assessment
The patient’s history may reveal an underlying illness, such as cancer, diabetes, or human immunodeficiency virus infection, a recent course of antibiotic or antineoplastic therapy, or drug abuse.
Depending on the infection site, superficial infection may cause the following signs and symptoms:
Skin—scaly, erythematous, papular rash, possibly covered with exudate and erupting in breast folds, between fingers, and at the axillae, groin, and umbilicus (in diaper rash, papules appear at the edges of the rash)
Nails—red, swollen, darkened nail beds; occasionally, purulent discharge; sometimes, separation of the nail from the nail bed
Esophageal mucosa—occasionally, scales in the mouth and throat
Vaginal mucosa—white or yellow discharge, with local excoriation; white or gray raised patches on vaginal walls, with local inflammation
Oropharyngeal mucosa—cream-colored or bluish white lacelike patches of exudate on the tongue, mouth, or pharynx that reveal bloody engorgement when scraped; pain and a burning sensation in the mouth and throat may occur.
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