Fungus

Candidiasis

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Candidiasis, Moniliasis

  • Etiology
  1. Candida albicans
  • Risk Factors
  1. Skin maceration
  2. Immunosuppressed patients
    1. Advanced Human Immunodeficiency Virus (AIDS)
    2. Hematologic Malignancy
    3. Antibiotic use
    4. Corticosteroid use
    5. Pregnancy
    6. Diabetes Mellitus
  • Signs
  • Systemic involvement in immunocompromised patient
  1. Severe muscle tenderness
  • Signs
  • Mucocutaneous Rash
  1. Character
    1. Erythematous Papules
    2. Pruritic, eroded areas
    3. Scaling and crusting of lesions
  2. Normal Distribution (Not Immunocompromised)
    1. Mouth
    2. Vagina
    3. Axillae
    4. Inguinal folds
    5. Interdigital surfaces
  • Signs
  • Specific Lesions
  1. Oral Thrush
    1. White Plaques firmly adhered to Oral Mucosa
  2. Cutaneous Candidiasis
    1. Red, macerated intertriginous areas
  3. Chronic mucocutaneous Candidiasis
    1. Circumscribed hyperkeratotic skin lesions
    2. Dystrophic Nails
    3. Partial Alopecia
    4. Oral and vaginal Thrush
    5. Endocrine organ hypofunction
      1. Hypoparathyroidism
      2. Hypothyroidism
      3. Adrenal Insufficiency
  4. Gastrointestinal
    1. Distal esophagus ulcerations
  5. Hematogenous (Immunosuppressed)
    1. Fever
    2. Malaise
    3. Retinal abscess
    4. Pulmonary nodular infiltrate
    5. Endocarditis
  • Labs
  1. Abscess drainage shows candida mycelia
  2. Candida Serology titers elevated
  3. KOH Preparation
    1. Pseudohyphae
  • Management
  1. Cutaneous
    1. Nystatin
    2. Ciclopirox
    3. Imidazole cream
  2. Oral Thrush
    1. Clotrimazole
      1. One troche dissolve in mouth x5 qd for 7-14 days
    2. Nystatin suspension
      1. Swish and swallow 4-6 times per day for 7-14 days
    3. Fluconazole 100 mg PO qd for 7-14 days
  3. Esophageal
    1. Fluconazole 100-200 mg PO/IV qd for 14-21 days
    2. Amphotericin B 0.3 mg/kg/day for 5-10d
      1. Indicated for severe cases only
    3. Ketoconazole 200-400 mg orally daily for 14-21 days
      1. Indicated only for severe, refractory cases due to Ketoconazole hepatotoxicity
      2. If Ketoconazole is used, requires Liver Function Tests at baseline and again weekly
  4. Bladder
    1. Irrigate with Amphotericin B 50 mg in 1L x5 days
  5. Disseminated
    1. Empiric broad Candidiasis coverage or known resistant Candidiasis (Candida glabrata or Candida krusei)
      1. Caspofungin 70 mg IV load, then 50 mg IV every 24 hours or
      2. Micafungin 100 mg IV every 24 hours or
      3. Anidulafungin 200 mg IV load, then 100 mg IV every 24 hours
    2. Known Candida albicans or Candida parapsilosis or Candida tropicalis
      1. Fluconazole 800 mg (12 mg/kg) load then 400 mg IV or oral daily
    3. Alternative empiric protocols
      1. Amphotericin B 0.7 mg/kg IV daily (or lipid based Amphotericin B 3-5 mg/kg daily) or
      2. Fluconazole 800 mg (or 12 mg/kg) load then 400 mg IV or oral daily or
      3. Voriconazole 400 mg (or 6 mg/kg) IV twice daily for 2 doses, followed by 200 mg every 12 hours
    4. References
      1. Gilbert (2013) Sanford Antibiotic Guide