CANDIASIS

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