Candidiasis

1. Identification—A mycosis usually confined to the superficial layers
of skin or mucous membranes, presenting clinically as oral thrush,intertrigo, vulvovaginitis, paronychia or onychomycosis. Ulcers orpseudomembranes may form in the oesophagus, stomach or intestine.
Candidemia commonly arises from intravascular catheters and may pro-duce lesions in many organs: oesophagus, CNS, kidneys, vagina, spleen,endocardium, liver, eyes, meninges, respiratory and urinary tracts andnative cardiac valves (or around prosthetic cardiac valves).
Diagnosis requires both laboratory and clinical evidence of candidiasis.
The single most valuable laboratory test is microscopic demonstration ofpseudohyphae and/or yeast cells in infected tissue or body fluids. Cultureconfirmation is important, but isolation from sputum, bronchial washings,stool, urine, mucosal surfaces, skin or wounds is not proof of a causalrelationship to the disease. Severe or recurrent oropharyngeal infection inan adult with no obvious underlying cause should suggest the possibilityof HIV infection.
2. Infectious agents—Candida albicans, C. tropicalis, C. dubliniensis
and occasionally other species of Candida. Candida (Torulopsis) glabrata isdistinguished from other causes of candidiasis by lack of pseudohyphaeformation in tissue.
3. Occurrence—Worldwide. C. albicans is often part of the normal
4. Reservoir—Humans.
5. Mode of transmission—Contact with secretions or excretions of
mouth, skin, vagina and feces, from patients or carriers; by passage frommother to neonate during childbirth; and by endogenous spread.
6. Incubation period—Variable, 2–5 days for thrush in infants.
7. Period of communicability—Presumably while lesions are
8. Susceptibility—The frequent isolation of Candida species from
sputum, throat, feces and urine in the absence of clinical evidence ofinfection suggests a low level of pathogenicity or widespread immu-nity. Oral thrush is a common, usually benign condition during the firstfew weeks of life. Clinical disease occurs when host defences are low.
Local factors contributing to superficial candidiasis include interdigitalintertrigo and paronychia on hands with excessive water exposure(e.g. cannery and laundry workers) and intertrigo in moist skinfolds ofobese individuals. Repeated clinical skin or mucosal eruptions arecommon.
Prominent among systemic factors predisposing to superficial candidi- asis are diabetes mellitus, HIV infection and treatment with broad-spectrum antibiotics or supraphysiological doses of adrenal corticoste-roids. Women in the third trimester of pregnancy are prone tovulvovaginal candidiasis. Factors predisposing to deep candidiasis includeimmunosuppression (including that due to HIV infection), indwellingintravenous catheters, neutropenia, hematological malignancies, burns,postoperative complications and very low birthweight in neonates. Uri-nary tract candidiasis usually arises as a complication of prolongedcatheterization of the bladder or renal pelvis. Most adults and olderchildren have a delayed dermal hypersensitivity to the fungus and possesshumoral antibodies.
9. Methods of control—
A. Preventive measures: Early detection and local treatment of
any infection in the mouth, oesophagus or urinary bladder ofthose with predisposing systemic factors (see Susceptibility) toprevent systemic spread. Fluconazole chemoprophylaxis de-creases the incidence of deep candidiasis during the first 2months following allogenic bone marrow transplantation. Anti-fungal agents that are absorbed fully (fluconazole, ketocon-azole, itraconazole) or partially (miconazole, clotrimazole)from the gastrointestinal tract have been found to be effectivein preventing oral candidiasis in cancer patients receivingchemotherapy.
B. Control of patient, contacts and the immediate environment:
1) Report to local health authority: Official report not ordinarily justifiable, Class 5 (see Reporting).
2) Isolation: Not applicable.
3) Concurrent disinfection: Of secretions and contaminated 4) Quarantine: Not applicable.
5) Immmunization of contacts: Not applicable.
6) Investigation of contacts and source of infection: Not bene- 7) Specific treatment: Ameliorating the underlying causes of candidiasis, e.g. removal of indwelling central venouscatheters, often facilitates cure. Topical nystatin or anazole (miconazole, clotrimazole, ketoconazole, flucon-azole) is useful in many forms of superficial candidiasis.
Oral clotrimazole troches or nystatin suspension are effec-tive for treatment of oral thrush. Itraconazole suspensionor fluconazole is effective in oral and oesophageal candi-diasis. Vaginal infection may be treated with oral flucon-azole or topical clotrimazole, miconazole, butoconazole, terconazole, tioconazole or nystatin. Amphotericin B IV,with or without 5-fluorocytosine, is the drug of choice forvisceral or invasive candidiasis. Lipid formulations of am-photericin B are probably also effective. Fluconazole is aneffective alternative to amphotericin B.
C. Epidemic measures: Outbreaks are most frequently due to
contaminated intravenous solutions and thrush in nurseries fornewborns. Concurrent disinfection and terminal cleaning com-parable to that used for epidemic diarrhea in hospital nurseries(see Diarrhea, section IV, 9A).
D. Disaster implications: None.
E. International measures: None.

Source: http://portaldev.rti.org/10_Midas_Docs/diseaseManual/PDF_FILES/CCD00104000091.PDF