Candidiasis- treatment, symptoms and cause of Candidiasis

Candidiasis is a fungal infection caused by a related group of yeasts, whose manifestations may be localized to the skin, or rarely, may be systemic and life-threatening. The causative organism is usually Candida albicans, but may also be C. tropicalis, C. parapsilosis, or C. krusei. These organisms are normal saprophytic inhabitants of the gastrointestinal tract but may overgrow (usually due to broad-spectrum antibiotic therapy) and cause disease at a number of cutaneous sites. Other predisposing factors include diabetes mellitus, chronic intertrigo, oral contraceptive use, and cellular immune deficiency.

Candidiasis is a very common infection in HIV-infected individuals. The oral cavity is commonly involved. Lesions may occur on the tongue or buccal mucosa (thrush) and appear as white plaques. Microscopic examination of scrapings demonstrate both pseudohyphae and yeast forms. Fissured, macerated lesions at the corners of the mouth (perleche) are often seen in individuals with poorly fitting dentures and may also be associated with candidal infection.

Additionally, candidal infections have an affinity for sites that are chronically wet and macerated and may occur around nails (onycholysis and paronychia) and in intertriginous areas. Intertriginous lesions are characteristically edematous, erythematous, and scaly, with scattered "satellite pustules." In males, there is often involvement of the penis and scrotum as well as the inner aspect of the thighs.

In contrast to dermatophyte infections, candidal infections are frequently accompanied by a marked inflammatory response. Diagnosis of candidal infection is based upon the clinical pattern and demonstration of yeast on KOH preparation, or culture.

Treatment of Candidiasis

Treatment routinely involves removing any predisposing factors such as antibiotic therapy or chronic wetness and the use of appropriate topical or systemic antifungal therapy. Effective topical agents include nystatin or topical azoles (miconazole, clotrimazole, econazole, or ketoconazole). These agents are generally effective in clearing mucous membrane or glabrous skin involvement in nonimmunosuppressed patients.

The associated inflammatory response that often accompanies candidal infection on glabrous skin should be treated with a mild glucocorticoid lotion or cream (2.5% hydrocortisone). Systemic therapy is generally reserved for immunosuppressed patients or individuals with chronic or recurrent disease who fail to respond to or tolerate appropriate topical therapy.

Vulvovaginal candidiasis may respond to treatment with a single dose of fluconazole (150 mg). Chronic recurrent oral or vaginal candidiasis may be treated with weekly to monthly oral fluconazole (150 to 200 mg) in conjunction with topical therapy.