Description

• A mucocutaneous disorder caused by infection with various Candida spp.
• >20 Candida species cause infection in humans, most common is Candida albicans.
• Areas include:
  • GI:
    • Oropharyngeal candidiasis: Mouth, pharynx
    • Angular cheilitis: Fissures at mouth corners
    • Candida esophagitis: Esophagus
    • GI candidiasis: Gastritis and/or ulcers, associated with thrush; in tract or perianal
  • Non-GI:
    • Candida vulvovaginitis: Vaginal mucosa and/or cutaneous aspects of the vulva
    • Candidal balanitis: Glans penis
    • Candidal paronychia: Nail bed of a digit
    • Folliculitis: Hair follicles
    • Interdigital candidiasis: Webs of the digits
• System(s) affected: Oropharynx; GI; Skin/Exocrine; Genitourinary
• Synonym(s): Monilia; Thrush; Yeast

ALERT
Vaginal antifungal creams and suppositories can weaken condoms and diaphragms.

Pregnancy Considerations
No known fetal complications of maternal Candida

Epidemiology

• Common in the US; very common with immunodeficiency and/or uncontrolled diabetes
• Predominant age: None:
  • Infants and seniors: Thrush and cutaneous infections (infant diaper rash)
  • Women of childbearing age: Vaginitis
  • Prepubertal or postmenopausal: Yeast vaginitis uncommon
  • Predominant sex: Female > Male

Incidence
Not well studied, estimate 50/100,000 annually

Prevalence
Candida species are normal inhabitants of the oral cavity, pharynx, esophagus, and rest of the GI tract; present in >50% of US population.

Risk Factors

• Immunosuppression, including HIV
• Hormonal fluctuations in women
• Antibacterial therapy, especially broad-spectrum antibiotics
• Douches, chemical irritants, and other vaginitides can predispose to yeast vaginitis.
• Dentures
• Birth control pills
• Hyperglycemia; diabetes

Genetics
Chronic mucocutaneous candidiasis is a heterogeneous, genetic syndrome with infection of the skin, nails, hair, and mucous membranes; presents in infancy or childhood, onset over age 30 is rare. Uncertain mode of inheritance

General Prevention

• Minimize antibiotic use.
• Minimize inhaled and systemic steroid use; rinse mouth after inhaled steroid use (1)[A].
• Avoid douching.
• Treat other vaginitides.
• Minimize moist environments (e.g., wear cotton underwear).
• Clean dentures often; use well-fitting dentures.
• Control diabetes (if present).
• Fluconazole prophylaxis against oral candidiasis in HIV-infected adults (2)[A].

Etiology

C. albicans predominant (responsible for 80–92% vulvovaginal and 70–80% oral isolates)

Commonly Associated Conditions

• HIV and other leukopenias
• Diabetes mellitus
• Cancer and other immunosuppressive disorders
• Disorders requiring corticosteroids or other immunosuppressive chemotherapy