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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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