Definition
- Fungal infections caused by Candida species
- Clinical presentations include:
- Mucocutaneous infections
- Oral thrush
- Vulvovaginal thrush
- Cutaneous candidiasis
- Esophageal candidiasis
- Invasive infections
Epidemiology
- Candidemia
- ~50% of cases are due to Candida albicans.
- Fourth most common cause of nosocomial bloodstream infections
- 4–8 cases per 100,000 persons in the general population
- 0.5 cases per 1000 patient-days in tertiary care hospitals
- 1 case per 1000 patient-days in surgical intensive care units
- Esophageal candidiasis
- Indicator condition for AIDS in 16% of patients with HIV infection
Risk Factors
- General
- Conditions causing a compromised host defense
- Neutropenia
- Glucocorticoid therapy
- Malnutrition
- Oropharyngeal thrush
- Diabetes mellitus
- HIV infection
- Common in acute HIV infection
- Increasingly common late in disease as the CD4+ cell count falls
- Dentures
- Inhaled or oral glucocorticoids
- Neonatal period
- Iron deficiency
- Vulvovaginal candidiasis
- Third trimester of pregnancy
- Antibiotic use
- Cutaneous candidiasis
- Macerated skin
- Diapered area of infants
- Under pendulous breasts or pannus
- Hands constantly in water
- Hands covered by occlusive gloves
- Esophageal candidiasis
- HIV infection
- Uncommon until CD4+ counts fall below 50/μL
- Invasive candidiasis
- Use of broad-spectrum antibiotic therapy
- Indwelling central venous catheter
- Total parenteral nutrition
- Perforation of the GI tract through trauma, surgery, or peptic ulceration
- Mucosal damage due to cytotoxic agents used for cancer chemotherapy
- Contamination of the hub or skin site of a catheter in an umbilical or central vein with secretions from the mouth, rectum, or vagina or with drainage from surgical wounds or tracheostomy sites
- Intravenous drug abuse
- Third-degree burns
- Very low birth weight (in neonates)
- Neutropenia
- Glucocorticoid therapy
Etiology
- Candida species
- Mucosal candidiasis
- C. albicans most common cause
- Candidemia
- C. albicans is responsible for about half of all cases in hospitalized patients.
- Other half are accounted for by:
- C. dubliniensis (previously identified as C. albicans)
- C. tropicalis
- C. parapsilosis
- C. guilliermondii
- C. glabrata (formerly Torulopsis glabrata)
- C. krusei
- A few other Candida species
- Transmission and pathogenesis
- All Candida species pathogenic for humans are also encountered as commensals of humans, particularly in the:
- Invasive candidiasis is often preceded by increased colonization of the mouth, GI tract, and vagina with Candida as a result of broad-spectrum antibiotic therapy.
- Colonizing organisms pass into deep tissues when mucosal or skin integrity is violated.
- Candidemia
- The majority of non-albicans species enter the bloodstream through intravascular catheters.
Associated Conditions
- Oral candidiasis
- Esophageal candidiasis
- Invasive candidiasis
- Chronic mucocutaneous candidiasis (CMC) (candidal granuloma)
- Major component of the immune polyendocrinopathy syndrome
- Can begin in childhood
- As an autosomal dominant disorder
- As an autosomal recessive disorder
- In association with Job’s syndrome
- Can occur in adults
- In association with thymoma
- Systemic infection is very rare.
- Candida endophthalmitis and purulent folliculitis, sometimes accompanied by vertebral osteomyelitis
- Clinical syndrome caused by injection of impure brown heroin
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