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Candidiasis

Background knowledge 🧠

Definition

  • Candidiasis is a fungalΒ infection caused by Candida species,Β most commonly Candida albicans.
  • Can affect various body sites, including oral cavity, genital area, skin, and systemic.

Epidemiology

  • Common in immunocompromised individuals (HIV, chemotherapy, diabetes).
  • High prevalence in hospital settingsΒ due to invasive procedures.
  • Oral candidiasis is frequent in infants and elderly.

Aetiology and Pathophysiology

  • Disruption of normal flora balance allows overgrowth of Candida.
  • Use of broad-spectrum antibioticsΒ is a common predisposing factor.
  • Immunosuppression (HIV, steroids) increases risk.
  • Hyperglycaemia promotes Candida growth.

Types

  • Oral Candidiasis (Thrush).
  • Vulvovaginal Candidiasis.
  • Cutaneous Candidiasis.
  • Invasive Candidiasis.
  • Chronic Mucocutaneous .

Clinical Features 🌑️

Symptoms

  • White patches in mouth (oral).
  • Itching and discharge (vaginal).
  • Red, itchy skin (cutaneous).
  • Fever and chills (invasive).

Signs

  • Erythematous base under white patches (oral).
  • Erythema and oedema of vaginal mucosa.
  • Satellite lesions on skin (cutaneous).
  • Signs of sepsis (invasive).

Investigations πŸ§ͺ

Tests

  • Microscopy and culture of samples (oral, vaginal, cutaneous).
  • Blood cultures (invasive).
  • Serological tests for specific antigens (invasive).
  • PCR assays for Candida DNA (invasive).

Management πŸ₯Ό

Management

  • Topical antifungals for oral/vaginal/cutaneous (e.g. nystatin, clotrimazole).
  • Oral antifungals for extensive or refractory cases.
  • Intravenous antifungals for invasive infections (e.g., fluconazole, echinocandins).
  • Identify and manage underlying conditions (e.g., diabetes, immunosuppression).

Complications

  • Esophagitis (oral).
  • Recurrent infections.
  • Systemic spread (invasive).
  • Organ dysfunction (invasive).
  • Resistance to antifungal treatment.

Prognosis

  • Good prognosis for localised infections with appropriate treatment.
  • Poor prognosis for invasive infections, especially in immunocompromised patients.
  • Importance of early diagnosis and treatment.

Key points

  • Candidiasis is common in immunocompromised individuals.
  • Early recognition and appropriate treatment are crucial.
  • Preventive measures include maintaining good hygiene and managing underlying conditions.

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