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c
  or  is a fungal infection (mycosis) of any of the c




species, of which
c





 is the most common1]2] Candidiasis encompasses infections that range from
superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening
diseases c



infections of the latter category are also referred to as candidemia and are
usually confined to severely immunocompromised persons, such as cancer, transplant, and AIDS
patients

Superficial infections of skin and mucosal membranes by c




causing local inflammation
and discomfort are however common in many human populations2] ]4] While clearly
attributable to the presence of the opportunistic pathogens of the genus c



, candidiasis
describes a number of different disease syndromes that often differ in their causes and
outcomes2] ] Commonly referred to as a  
 
, it is also technically known as

, 
 , and  5]: 08
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OY 1 Classification
OY 2 Signs and symptoms
OY Causes
OY 4 Diagnosis
OY 5 Treatment
OY 6 History
OY
Society and culture
OY 8 References
OY 9 External links

Ñ  c  


08- 11
Candidiasis may be divided into the following types:5]:

OY ‰ral candidiasis (Thrush)

OY ëerlèche (Angular cheilitis)
OY Candidal vulvovaginitis
OY Candidal intertrigo
OY Diaper candidiasis
OY Congenital cutaneous candidiasis
OY ëerianal candidiasis
OY Candidal paronychia
OY Erosio interdigitalis blastomycetica
OY Chronic mucocutaneous candidiasis
OY Systemic candidiasis
OY Candidid
OY Antibiotic candidiasis (Iatrogenic candidiasis)

Ñ  !

  

Most candidial infections are treatable and result in minimal complications such as redness,
itching and discomfort, though complication may be severe or fatal if left untreated in certain
populations In immunocompetent persons, candidiasis is usually a very localized infection of the
skin or mucosal membranes, including the oral cavity (thrush), the pharynx or esophagus, the
gastrointestinal tract, the urinary bladder, or the genitalia (vagina, penis)1]

Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the
male genitals In immunocompromised patients, c



infections can affect the esophagus
with the potential of becoming systemic, causing a much more serious condition, a fungemia
called candidemia ]4]
Children, mostly between the ages of three and nine years of age, can be affected by chronic
mouth yeast infections, normally seen around the mouth as white patches However, this is not a
common condition
 

]

Symptoms of candidiasis may vary depending on the area affected Infection of the vagina or
vulva may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray
cottage cheese-like discharge, often with a curd-like appearance These symptoms are also
present in the more common bacterial vaginosis
 

] In a 2002 study published in the
 
  

 , ] only percent of women who were self-treating
for a yeast infection actually had a yeast infection, while most had either bacterial vaginosis or a
mixed-type infection Symptoms of infection of the male genitalia include red patchy sores near
the head of the penis or on the foreskin, severe itching, or a burning sensation Candidiasis of the
penis can also have a white discharge, although uncommon
 

] However, having no
symptoms at all is common, and a more severe form of the symptoms may emerge later



]

Ñ  c  
See also: Candida albicans

c



yeasts are commonly present in humans, and their growth is normally limited by the
human immune system and by other microorganisms, such as bacteria occupying the same
locations (niches) in the human body6]

In a study of 1009 women in New Zealand, c

 was isolated from the vaginas of 19% of
apparently healthy women, ie, those that experienced few or no symptoms of infection External
use of detergents or douches or internal disturbances (hormonal or physiological) can perturb the
normal vaginal flora, consisting of lactic acid bacteria, such as lactobacilli, and result in an
overgrowth of c



cells causing symptoms of infection, such as local inflammation
]
ëregnancy and the use of oral contraceptives have been reported as risk factors,8] while the roles
of engaging in vaginal sex immediately and without cleansing after anal sex and using lubricants
containing glycerin remain controversial
 

] Diabetes mellitus and the use of anti-
bacterial antibiotics are also linked to an increased incidence of yeast infections8] Diet has been
found to affect rates of symptomatic Candidiases in some animal infection models,9] and
hormone replacement therapy and infertility treatments may also be predisposing factors10]
Wearing wet swimwear for long periods of time is also believed to be a risk factor11]

A weakened or undeveloped immune system or metabolic illnesses such as diabetes are

significant predisposing factors of candidiasis12] Diseases or conditions linked to candidiasis
include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress, and nutrient deficiency
Almost 15% of people with weakened immune systems develop a systemic illness caused by
c



species
 

] In extreme cases, these superficial infections of the skin or mucous
membranes may enter into the bloodstream and cause systemic c



infections

In penile candidiasis, the causes include sexual intercourse with an infected individual, low
immunity, antibiotics, and diabetes Male genital yeast infection is less common, and incidence
of infection is only a fraction of that in women; however, yeast infection on the penis from direct
contact via sexual intercourse with an infected partner is not uncommon1 ]

Ñ   !


Micrograph of esophageal candidiasis Jiopsy specimen; ëAS stain

Diagnose of a yeast infections is done either via microscopic examination or culturing

For identification by light microscopy, a scraping or swab of the affected area is placed on a
microscope slide A single drop of 10% potassium hydroxide (K‰H) solution is then added to
the specimen The K‰H dissolves the skin cells but leaves the c



cells intact, permitting
visualization of pseudohyphae and budding yeast cells typical of many c



species

For the culturing method, a sterile swab is rubbed on the infected skin surface The swab is then
streaked on a culture medium The culture is incubated at
°C for several days, to allow
development of yeast or bacterial colonies The characteristics (such as morphology and colour)
of the colonies may allow initial diagnosis of the organism that is causing disease symptoms

Ñ  " 


c



species are frequently part of the human body's normal oral and intestinal flora
Treatment with antibiotics can lead to eliminating the yeast's natural competitors for resources,
and increase the severity of the condition

In clinical settings, candidiasis is commonly treated with antimycotics²the antifungal drugs

commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and
topical ketoconazole

For example, a one-time dose of fluconazole (as Diflucan 150-mg tablet taken orally) has been
reported as being 90% effective in treating a vaginal yeast infection14] (Care should be taken by
people who have allergic reactions to azole group of medicines; this medicine has different levels
of contradictory reactions with other medicines as well ) This dose is only effective for vaginal
yeast infections, and other types of yeast infections may require different treatments In severe
infections (generally in hospitalized patients), amphotericin J, caspofungin, or voriconazole may
be used Local treatment may include vaginal suppositories or medicated douches Gentian violet
can be used for breastfeeding thrush, but when used in large quantities it can cause mouth and
throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to
cancer in the digestive tract of other animals15]

c

 can develop resistance to antimycotic drugs,16] such as fluconazole, one of the drugs
that is often used to treat candidiasis Recurring infections may be treatable with other anti-
fungal drugs, but resistance to these alternative agents may also develop

Ñ  
The genus c



and species c

 was described by botanist Christine Marie Jerkhout
in her doctoral thesis at the University of Utrecht in 192  ‰ver the years, the classification of
the genera and species has evolved ‰bsolete names for this genus include  
and
   The species has also been known in the past as  


 and 



 The current classification is   

, which means the name is authorized
for use by the International Jotanical Congress (IJC)1
]

The genus c




includes about 150 different species, however, only a few are known to
cause human infections: c

 is the most significant pathogenic species ‰ther c




species pathogenic in humans include c  
, c 


, c  , c 

 , c

 , and c 



c
 
#$% # ! Assistant ërofessor, Universidad de San Marcos Medical School;
Attending ëhysician, Department of Internal Medicine, Division of Infectious Diseases,
Guillermo Almenara Hospital
c &'$% #( )* )#c×# Consulting Staff, Division of Infectious
Diseases, Henry Ford Hospital; ërofessor, Department of Internal Medicine, Wayne State
University School of Medicine
Contributor Information and Disclosures

Updated: Jan 11, 2010

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Candidiasis is caused by infection with species of the genus c




 predominantly with
c





 c



species are ubiquitous fungi that represent the most common fungal
pathogens that affect humans The growing problem of mucosal and systemic candidiasis reflects
the enormous increase in the number of patients at risk and the increased opportunity that exists
for c



species to invade tissues normally resistant to invasion c



species are true
opportunistic pathogens that exploit recent technological advances to gain access to the
circulation and deep tissues

The increased prevalence of local and systemic disease caused by c




species has resulted
in numerous new clinical syndromes, the expression of which depends primarily on the immune
status of the host c



species produce a wide spectrum of diseases, ranging from superficial
mucocutaneous disease to invasive illnesses, such as hepatosplenic candidiasis, c




peritonitis, and systemic candidiasis The management of serious and life-threatening invasive
candidiasis remains severely hampered by delays in diagnosis and the lack of reliable diagnostic
methods that allow detection of both fungemia and tissue invasion by c



species

Advances in medical technology, chemotherapeutics, cancer therapy, and organ transplantation

have greatly reduced the morbidity and mortality of life-threatening disease ëatients who are
critically ill and in medical and surgical ICUs have been the prime targets for opportunistic
nosocomial fungal infections, primarily due to c



species Studies suggest that the problem
is not under control and, in fact, show it is worsening ‰n a daily basis, virtually all physicians
are confronted with a positive c



isolate obtained from one or more various anatomical
sites High-risk areas for c



infection include neonatal, pediatric, and adult ICUs, both
medical and surgical1 c



infections can involve any anatomical structure

 !

c



species are yeastlike fungi that can form true hyphae and pseudohyphae For the most
part, c



species are confined to human and animal reservoirs; however, they are frequently
recovered from the hospital environment, including on foods, countertops, air-conditioning
vents, floors, respirators, and medical personnel They are also normal commensals of diseased
skin and mucosal membranes of the gastrointestinal, genitourinary, and respiratory tracts

c



species also contain their own set of well-recognized but not well-characterized
virulence factors that may contribute to their ability to cause infection2 The main virulence
factors include the following:
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As with most fungal infections, host defects also play a significant role in the development of
candidal infections Host defense mechanisms against c



infection and their associated
defects that allow infection are as follows:

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Risk factors associated with invasive or systemic candidiasis include the following:

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The first step in the development of a candidal infection is colonization of the mucocutaneous
surfaces All of the factors outlined above are associated with increased colonization rates The
routes of candidal invasion include (1) disruption of a colonized surface (skin or mucosa),
allowing the organisms access to the bloodstream, and (2) persorption via the gastrointestinal
wall, which may occur following massive colonization with large numbers of organisms that
pass directly into the bloodstream

 *


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c



species are the most common cause of fungal infection in immunocompromised
persons ‰ropharyngeal colonization is found in 0-55% of healthy young adults, and c




species may be detected in 40-65% of normal fecal florae

Three of every 4 women experience at least one bout of vulvovaginal candidiasis (VVC) during
their lifetime

More than 90% of persons infected with HIV who are not receiving highly active antiretroviral
therapy (HAART) eventually develop oropharyngeal candidiasis (‰ëC), and 10% eventually
develop at least one episode of esophageal candidiasis4

In persons with systemic infections, c




species are now the fourth most commonly isolated
pathogens from blood cultures5

Clinical and autopsy studies have confirmed the marked increase in the incidence of
disseminated candidiasis, reflecting a parallel increase in the frequency of candidemia This
increase is multifactorial in origin and reflects increased recognition of the fungus, a growing
population of patients at risk (eg, patients undergoing complex surgical procedures, patients with
indwelling vascular devices), and the improved survival rates among patients with underlying
neoplasms or collagen-vascular disease and patients who are immunosuppressed

×  



Similar rates of mucocutaneous and systemic candidiasis/candidemia have been observed

worldwide6,
In fact, throughout the world, c



species have replaced c  species
as the most common fungal pathogens affecting immunocompromised hosts

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Neither sex is predisposed to candidal colonization; however, VVC is the second most common
cause of vaginitis in women

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ëersons at the extremes of age (neonates and adults >65 y) are most susceptible to candidal
colonization Mucocutaneous candidiasis is also more prevalent in neonates and older adults
Very-low-birth-weight and extremely-low-birth-weight infants are at high risk for blood culture±
proven late-onset candidiasis (defined as sepsis that develops after age
2 h)8

c
 


Candidiasis can cause a wide spectrum of clinical syndromes, as described below The clinical
presentation can vary depending on the type of infection and the degree of immunosuppression

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Chronic mucocutaneous candidiasis describes a group of c




infections of the skin, hair,
nails, and mucous membranes that tends to have a protracted and persistent course

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The respiratory tract is frequently colonized with c




species, especially in hospitalized
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Hepatosplenic candidiasis is a form of systemic candidiasis in patients with an underlying

hematologic malignancy and neutropenia and develops during the recovery phase of a
neutropenic episode The patient's history includes the following:

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ëhysical examination findings include right upper quadrant tenderness and hepatosplenomegaly
(<40%)

 
 

Systemic can
didiasis can be divided into 2 primary syndromes: candidemia and disseminated candidiasis
(organ infection by c



species) Deep organ infections due to c



species are
generally observed as part of the disseminated candidiasis syndromes and may involve one or
more organs

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See History for physical examination findings paired with clinical syndromes

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‰ver 200 species of c




exist in nature; thus far, only a few species have been associated
with disease in humans

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