Yeast infections. Oral, mucocutaneous and intertriginous candidiasis. pathogenesis,
epidemiology, clinical features and treatment.
Yeast infections of mucosae membranes and genital region - definition, clinical features,
diagnosis, differential diagnosis, treatment.
- Overview:
▪ Pathogenesis: almost all pathogenic human yeasts are from Candida genus. Major
species is Candida albicans types 1 & 2 (formerly known as Candida stellatoidea).
Candida albicans is normally found in mouth, GI tract & vagina.
▪ Skin & mucosal infections are caused by Candidal mycelia (network of hyphae).
Systemic candidiasis is caused by blastospores produced by budding of yeasts.
▪ Mucocutaneous candidiasis – persistent infections in pts with immune defects.
▪ Etiology:
▪ Candida albicans causes disease in young adults, old or immunosuppressed (except
vulvovaginitis & balanitis which affect all). OBS candida infections are often sign of
immunosuppression (DM, HIV, long-term antibiotic treatment, hematologic
malignancy)
▪ Clinical manifestations:
▪ Candidiasis – infection by Candida albicans. Usually involves skin or mucous
membranes (but can be systemic in immunosuppressed). Rich clinical spectrum:
◦ Intertriginous & anogenital candidiasis
◦ Onychomycosis
◦ Paronychia
◦ Oral candidiasis
◦ Intestinal candidiasis
◦ Systemic candidiasis
◦ Mucocutanous candidiasis
▪ Therapy:
▪ Polyene antifungal agents like nystatin, amphotericin B & natamycin
◦ Nystatin is not absorbed so usually is used to treat oral & intestinal infections.
▪ Imidazoles (topical & systemic) – for oral, GI & vaginal use (Clotrimazole*,
tioconazole)
, - Oral Candidiasis
▪ Clinical manifestations:
▪ Acute pseudomembranous candidiasis “thrush” – classic* form. Thick, cottage-
cheese-like plaques that can be easily scraped off, revealing erythematous base.
Most common in infants. In buccal mucosa, tongue, palate
▪ Acute atrophic candidiasis – often painful, flat erythematous areas. In tongue
▪ Chronic hyperplastic candidiasis – thick persistent white plaques, in men. Not easily
removed. Differential diagnosis: leukoplakia
▪ Chronic atrophic candidiasis – most often in denture wearers (old pts). Atrophic
dusky (dark) erythematous area confined to area under denture. Differential diagnosis:
allergic or irritant reaction.
▪ Angular cheilitis “perlèche” – painful rhagades at corner of mouth. Predisposing
factors: drooling, eating disorders, poorly fitting dentures. Often with Candida
albicans & bacteria.
▪ Median rhomboid glossitis – erythematous rhomboid patch without papillae on
midline of dorsal surface of tongue (at transition from middle to posterior portion).
▪ Differential diagnosis: oral hairy leucoplakia, angioedema, aphthous stomatitis, herpes
gingivomastitis, herpes labialis
▪ Therapy:
▪ Nystatin or imidazole (Clotrimazole) lozenges (“pastille” that slowly dissolves in
mouth)
▪ Protective imidazole pastes (in case of angular stomatitis)
▪ Oral nystatin (in resistant cases)
- Intertriginous Candidal Infections
▪ Clinical manifestations:
▪ In any moist intertriginous area: submammary, inguinal, perianal, axillary. Typically
macerated with fissures & satellite lesions (often pustules)
▪ Commonly with candidal vulvovaginitis & balanitis
▪ Granuloma Gluteale infantum – reactive red-brown inflammatory
nodules that develop in Diaper dermatitis when there is presence of
satellite lesions (Candida albicans colonization)
▪ Differential diagnosis: ACD, ICD, Seborrheic dermatitis
▪ Therapy: minimize moisture & friction with absorptive powders. Clotrimazole
epidemiology, clinical features and treatment.
Yeast infections of mucosae membranes and genital region - definition, clinical features,
diagnosis, differential diagnosis, treatment.
- Overview:
▪ Pathogenesis: almost all pathogenic human yeasts are from Candida genus. Major
species is Candida albicans types 1 & 2 (formerly known as Candida stellatoidea).
Candida albicans is normally found in mouth, GI tract & vagina.
▪ Skin & mucosal infections are caused by Candidal mycelia (network of hyphae).
Systemic candidiasis is caused by blastospores produced by budding of yeasts.
▪ Mucocutaneous candidiasis – persistent infections in pts with immune defects.
▪ Etiology:
▪ Candida albicans causes disease in young adults, old or immunosuppressed (except
vulvovaginitis & balanitis which affect all). OBS candida infections are often sign of
immunosuppression (DM, HIV, long-term antibiotic treatment, hematologic
malignancy)
▪ Clinical manifestations:
▪ Candidiasis – infection by Candida albicans. Usually involves skin or mucous
membranes (but can be systemic in immunosuppressed). Rich clinical spectrum:
◦ Intertriginous & anogenital candidiasis
◦ Onychomycosis
◦ Paronychia
◦ Oral candidiasis
◦ Intestinal candidiasis
◦ Systemic candidiasis
◦ Mucocutanous candidiasis
▪ Therapy:
▪ Polyene antifungal agents like nystatin, amphotericin B & natamycin
◦ Nystatin is not absorbed so usually is used to treat oral & intestinal infections.
▪ Imidazoles (topical & systemic) – for oral, GI & vaginal use (Clotrimazole*,
tioconazole)
, - Oral Candidiasis
▪ Clinical manifestations:
▪ Acute pseudomembranous candidiasis “thrush” – classic* form. Thick, cottage-
cheese-like plaques that can be easily scraped off, revealing erythematous base.
Most common in infants. In buccal mucosa, tongue, palate
▪ Acute atrophic candidiasis – often painful, flat erythematous areas. In tongue
▪ Chronic hyperplastic candidiasis – thick persistent white plaques, in men. Not easily
removed. Differential diagnosis: leukoplakia
▪ Chronic atrophic candidiasis – most often in denture wearers (old pts). Atrophic
dusky (dark) erythematous area confined to area under denture. Differential diagnosis:
allergic or irritant reaction.
▪ Angular cheilitis “perlèche” – painful rhagades at corner of mouth. Predisposing
factors: drooling, eating disorders, poorly fitting dentures. Often with Candida
albicans & bacteria.
▪ Median rhomboid glossitis – erythematous rhomboid patch without papillae on
midline of dorsal surface of tongue (at transition from middle to posterior portion).
▪ Differential diagnosis: oral hairy leucoplakia, angioedema, aphthous stomatitis, herpes
gingivomastitis, herpes labialis
▪ Therapy:
▪ Nystatin or imidazole (Clotrimazole) lozenges (“pastille” that slowly dissolves in
mouth)
▪ Protective imidazole pastes (in case of angular stomatitis)
▪ Oral nystatin (in resistant cases)
- Intertriginous Candidal Infections
▪ Clinical manifestations:
▪ In any moist intertriginous area: submammary, inguinal, perianal, axillary. Typically
macerated with fissures & satellite lesions (often pustules)
▪ Commonly with candidal vulvovaginitis & balanitis
▪ Granuloma Gluteale infantum – reactive red-brown inflammatory
nodules that develop in Diaper dermatitis when there is presence of
satellite lesions (Candida albicans colonization)
▪ Differential diagnosis: ACD, ICD, Seborrheic dermatitis
▪ Therapy: minimize moisture & friction with absorptive powders. Clotrimazole
