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:
- Tinea
- Caused by dermatophyte fungus
- Candida
- Caused by the candida fungus
- Pityriasis veriscolor
- Caused by the malassezia fungus
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
- Vaginal thrush is considered separately
- Nails
- “Fungal nail infection”
- Skin
- Particularly in skin folds – where it is sometimes called intertrigo
- Penis (balanitis)
- Nappy rash
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 – this 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’s 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