Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

270 Candidiasis

Candidiasis.........................................

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Candida are yeast that reproduce by budding, appear as large oval

Gram positive organisms on Gram stain and grow on routine culture

media

■Found in nature and as part of the normal skin, vaginal, and gas-

trointestinal flora of humans

■Diabetes, neutropenia, broad-spectrum antibiotics, HIV, intravas-

cular devices and Foley catheters predispose to infection

■Important human pathogens include C albicans, C tropicalis, C para-

psilosis, C glabrata, C krusei and C lusitaniae

Signs & Symptoms

■Oral mucosa: thrush refers to white, raised patches on the tongue

and mucous membranes; other lesions include plaques, atrophy

of the tongue and angular cheilitis (cracks at the corners of the

mouth)

■Esophageal: presents as dysphagia, nausea or chest pain; can occur

without thrush

■Other gastrointestinal sites of infection: stomach, small and large

bowel (ulcerations or plaques)

■Cutaneous: lesions include balanitis (white patches on the penis usu-

ally resulting from intercourse with partner with candida vaginitis),

paronychia (inflammation around nail bed common in those with

prolonged water exposure), onychomycosis (involvement of nail),

intertriginous (inflammation with erythema, fissures and macera-

tion in warm moist areas of skin opposition, such as groin or under

breasts) and subcutaneous nodules that are firm, sometimes painful

nodules that are multiple and widespread and represent hematoge-

nous dissemination

■Candidemia: usually associated with intravascular device and

presents as acute onset of fever without localizing findings; also seen

in neutropenic patients

■Genitourinary: asymptomatic candiduria most common and seen

in those with long term, indwelling Foley catheters, on broad spec-

trum antibiotics; cystitis and pyelonephritis less common; vaginitis

discussed elsewhere