Candida albicans - Fungal skin infections

Fungal skin infections

Candida albicans

Definition

Candida albicans, a commensal yeast of the gastrointestinal tract, may cause opportunistic infections such as mucocutaneous candidiasis.

Aetiology/pathophysiology

Candida is a dimorphic fungus occurring as a yeast on mucosal surfaces. In immunocompetent patients most infections result from disruption of the normal body flora. Patients with cell-mediated immune deficiency tend towards more extensive persistent mucous membrane infections. Neutropenic patients are at risk of widespread disseminated illness. Predisposing factors to opportunistic infection include moist and opposing skin folds, obesity, diabetes mellitus, pregnancy, poor hygiene and the use of broad-spectrum antibiotics.

Clinical features

1.     1 Oral candidiasis is commonly seen in babies and patients treated with antibiotics or chemotherapy. Patients develop white plaques on the oral mucosa, palate and tongue.

2.     Candidal oesophagitis causes painful swallowing most commonly seen in patients with human immunodeficiency virus (HIV) infection. The diagnosis requires direct visualisation on endoscopy.

3.     Vulvovaginal candidiasis is the most common form of mucosal candidiasis associated with increased oestrogens, systemic steroids, antibiotics, diabetes mellitus and HIV infection. Women develop itching and discharge occasionally with dysuria or dyspareunia. There is erythema and a white vaginal discharge.

4.     Candidal balanitis may occur in uncircumcised men. Patients present with an inflamed glans and prepuce.

5.     Systemic infections may occur in the immunosuppressed.

Management

Topical antifungals are used in the form of creams, lozenges or pessaries. Resistant, recurrent or severe infections may require systemic antifungal medication.