Candidiasis Flashcards
What is the aetiology of candidiasis
Most common: Candida albicans (Both yeast and hyphal forms can be seen, hyphal transformation indicates pathogenicity)
Other: C. glabrata | C. tropicalis | C. parapsilosis et.c
In patients with recurrent infection, strain replacement with a new genotype of C albicans or species replacement with a non-albicans species of Candida may occur → refractory infection → azole resistance
What are the types of candidal infection in children
Intertrigo (skin fold): groin, under breasts, axillae
Oral (mucosa)
Genital: vulvovaginal, balanitis
Nappy/diaper rash
Parnoychia/onychomycosis
What causes nappy rash
Skin barrier is compromised by skin maceration (excessive hydration), friction between the skin and nappy, prolonged skin contact with urine and faeces → ↑skin pH → increases permeability + activation of faecal enzymes that irritate the skin. There may be secondary bacterial infection with S. aureus or streptotocci
What are the risk factors of nappy rash
Skin care practices - prolonged contact with urine/faeces
Disposable nappies or reusable cotton nappies
Exposure to chemical irritants e.g. soaps, detergents, alcohol-based baby wipes
Skin trauma e.g. mechanical friction from skin contact with nappies or over-vigorous cleaning
Medication: broad-spectrum Abx
Pre-term infants
Diarrhoea e.g. gastroenteritis, malabsorption, hepatitis
What are the risk factors for skin fold and oral candidiasis
Immunocompromise e.g. chemo, radio, HIV, immunosuppressants
Abx use
Malabsorption and malnutrition e.g. IDA (lack of transferrin (anti-fungal)
Advance malignancy
Endocrine disturbance e.g. DM, hypoparathyroidism, pregnancy, hypoadrenalism
Age >60 | female | inhaled corticosteroids
Skin fold: Diseases where the barrier function of skin is compromised e.g. psoriasis, eczema
Oral: Dental prostheses. Poor oral hygiene, especially among denture wearers, use of steroid inhalers (Asthma)
What are the symptoms and signs of skin fold candidal infections
Infection is more likely where skin rubs on skin e.g. skin folds and where heat and moisture lead to maceration
Soreness and itching
Thin-walled pustules with a red base
Scales may accumulate - produces a white-yellow, curd-like substance
Flexural areas (intertrigo): red and moist → fringed irregular edge and pustular or papular satellite lesion
What are the signs and symptoms of nappy rash
Distress, agitation
Itchy and painful rash
Well-define areas of confluent erythema and scattered papules over convex surfaces in contact with the nappy (buttocks, genitalia, suprapubic area, upper thighs)
- Sparing of the inguinal skin creases and gluteal cleft
- Acute: glazed
- Longstanding: fine scaling
May show skin erosions, oedema, ulceration
What are the symptoms and signs of oral candidiasis
Cream white or yellowish plaques that are fairly adherent to oral mucosa
Removal of the plaque by scraping may reveal an erythematous base or a bleeding surface
May be found on any part of the oral mucosa, and is most common on the palate, buccal, and labial mucosa, and on the lateral borders and dorsum of the tongue.
Minimal symptoms: burning, itching sensation
Chronic: oesophageal mucosa → dysphagia and chest pain
What investigations should be done for candidal infection
Clinical diagnosis
Check the mouth for co-existing oral candidiasis
Bedside: smear of lesion: +ve for candida hyphae (not always helpful as candida is commensal), mouth rinse for culture (>400CFU/mL), sialometry
Bloods: random//fasting glucose, HIV serology, U&Es
Other: upper GI endoscopy ± biopsy: for those with oesophageal candidiasis
What is the management for skin fold candidiasis
Assess need for admission (peritonitis, meningitis, pneumonia, endocarditis)
First line: topical clotrimazole (antifungal), 2-3x a day for at least 2 weeks
+ mildly potent corticosteroid cream e.g. hydrocortisone
+ advice: avoid skin occlusion (loose clothing, breathable fabric), change dressing, incontinence pads, nappies, wash with soap substitute
Widespread or immunocompromised → Oral fluconazole 50mg a day for 2 weeks (>16yo)
What is the management for nappy rash
Advice:
- ensure nappy fits properly
- Leave nappy off for as long as possible to help with drying
- Clean skin and change nappy every 3-4 hours or ASAP after wetting/soiling. Fragrance-free. alcohol-free baby wipes, avoid vigorous rubbing
Mild erythema + asymptomatic → barrier preparations to protect the skin (over the counter) e.g. Zinc, Castor oil ointment, white soft paraffin BP ointment
Inflamed + discomfort → Topical hydrocortisone 1% once a day until symptoms settle (max 7 days) - Should be applied before the barrier preparation
Rash persists → topical imidazole cream
Bacterial infection suspected/confirmed → oral flucloxacillin for 7 days (clarithromycin if allergic)
+ follow up
What is the management for oral candidiasis
Assess need for admission (oesophageal candidiasis, peritonitis, meningitis, endocarditis)
First line: topical miconazole oral gel for 14 days QDS
+ advice: good dental hygiene, review inhaler technique, consider spacer for asthma
What are the complications of candidal infections
Soreness and itching of skin
Systemic/invasive candidiasis
Secondary bacterial infection e.g, impetigo, boils
Jacquet’s erosive diaper dermatitis: Punched out ulcers or erosions with elevated borders
Granuloma gluteale infantum
Oesophageal candidiasis: impaired chewing/oral intake
What is the prognosis for candidal infection in children
Skin fold/oral: For most, untreated candidiasis will persist for months or years unless associated factors are reduced/eliminated
Nappy rash: Uncomplicated nappy rash should settle with appropriate management in primary care. Typically lasts about three days
Oral: In neonates, spontaneous cure of oropharyngeal candidiasis usually occurs after 3–8 weeks
