Candida
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Introduction

Candida is the name of a group of yeast (fungal) species, which can cause skin and mucosal surface infections. It is one of three type of yeast that can infect humans:

Candida infection is sometimes called “candidiasis” and it is characterised by its white appearance. The most common species is¬†candidiasis albicans.¬†

  • Candida requires a host to survive
  • It is a normal commensal organism of the digestive tract and is typically acquired soon after birth
  • Candida infection is often associated with immunosuppression

Sites of infection include:

  • Oral (oral thrush)
  • Vaginal
  • Nails
    • “Fungal nail infection”
  • Skin
    • Particularly in skin folds – where it is sometimes called¬†intertrigo
  • Penis (balanitis)
  • Nappy rash
Sites of candida infection
Sites of candida infection. Image from Dermnet. Used in accordance with Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) license

Aetiology

Risk factors include:

  • Extremes of age (babies, elderly)
  • Warm climate
  • Occlusion of skin – e.g. nappy rash
  • Diabetes
  • Iron deficiency
  • Immunosuppresion
    • HIV
    • Chemotherapy
    • Other

Rarely, invasive candidiasis can occur Рthis refers to candidiasis in the bloodstream, leading to organ infection. It is typically associated with severe immunosuppression.

Diagnosis

Often a clinical diagnosis. Swabs can be taken for microscopy and culture, but be aware, that false positives are common – candidiasis often lives harmlessly on the skin. It can also cause secondary infection to an already existing skin condition (e.g. psoriasis or eczema).

Management

Oral candidiasis

  • Often topical
  • e.g. Nystatin liquid drops 100 000 units / ml QID for 7 to 14 days
    • OR miconazole 2% gel – applied orally and then swallowed QID for 7-14 days
    • Nystatin first line in babies, ¬†miconazole in adults

Intertrigo (in skin folds)

  • Miconazole or clotrimazole cream – typically applied BD

References

  • Candida - Dermnet NZ
  • Murtagh‚Äôs General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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