Fungal infection usually confined to the mucous membranes and external layers of skin. Severe forms are usually associated with immunosuppressive conditions, such as HIV/AIDS, diabetes, pregnancy, cancer, prolonged antibiotic use, and steroids.
Causes
- Candida albicans, transmitted by direct contact
Clinical features
It may present as:
- Oral thrush
- Intertrigo (between skin folds)
- Vulvo vaginitis and abnormal vaginal discharge (vaginal candida is not a sexually transmitted disease)
- Chronic paronychia (inflammation involving the proximal and lateral fingernail folds)
- Gastrointestinal candidiasis may present with pain on swallowing, vomiting, diarrhoea, epigastric and retrosternal pain
Investigations
- Diagnosis is mainly clinical
- Smear examination with potassium hydroxide (KOH)
Management
Oral candidiasis
- Nystatin tablets 500,000-1,000,000 IU every 6 hours for 10 days (chewed then swallowed)
Child < 5 years: Nystatin oral suspension 100,000 IU every 6 hours for 10 days
Child 5-12 years: 200,000 IU per dose every 6
hours for 10 days
Oropharyngeal candidiasis
- Fluconazole loading dose 400 mg, then 150-200 mg daily for 14-21 days
Child: loading dose 6 mg/kg, then 3 mg/kg daily
Vaginal
- Insert clotrimazole pessary 100 mg high into the vagina with an applicator each night for 6 days or twice a day for 3 days
- Or insert one nystatin pessary 100,000 IU each night for 10 days
- For recurrent vaginal candidiasis, give fluconazole 150-200 mg once daily for 5 days
Chronic paronychia
- Keep hand dry and wear gloves for wet work
- Hydrocortisone cream twice dailyIf not responding
- Betametasone cream twice daily
- Fluconazole 150-200 mg once a day for 5-7 days
Intertrigo
- Clotrimazole cream twice a day for 2-4 weeks
- In severe forms use fluconazole 150-200 mg once a day for 14-21 days
Prevention
- Early detection and treatment
- Improve personal hygiene
- Avoid unnecessary antibiotics