Candidiasis

GENERAL PRINCIPLES

• Candida species are the most common cause of invasive fungal infections in humans.

• Candida species are considered part of the normal microbiota of the gastrointestinal and genitourinary tract; however, infections ranging from uncomplicated mucocutaneous candidiasis to life-threatening invasive candidiasis affecting any organ can occur.

• Mucocutaneous disease may resolve after elimination of the causative condition (e.g., antibiotic therapy) or may persist and progress in the setting of deficiencies with cell-mediated immunity that occur in conditions such as AIDS.

• Invasive disease is often associated with concurrent antibiotic use, contraceptive use, neutropenia, cytotoxic therapy, and indwelling foreign bodies. In the US, Candida is the fourth most common cause of BSI overall, and the leading cause of nosocomial BSI. Serious complications of candidemia include skin lesions, ocular disease, endocarditis, and osteomyelitis.³³

DIAGNOSIS

• Any Candida species can be responsible for the syndromes above, but Candida albicans is the most common species. Diagnosis of mucocutaneous candidiasis is usually based on clinical findings but can be confirmed by a potassium hydroxide preparation of exudates.

• Identification of the Candida species is important because some species are more resistant to the azole antifungal agents than others. Cultures can be obtained in refractory cases or to diagnose invasive candidiasis by performing blood or tissue cultures.

TREATMENT

See Table 14-13.