Candida: Clinical Manifestations

A. Mucocutaneous candidiasis

• Most common organism causing fungal infection of oral cavity
• Oral thrush/Pseudomembranous candidiasis.
• Acute and chronic form. 
• Patch of creamy white pseudomembrane on the buccal epithelium, gums or the palate.
•  Extension to tongue, palate and esophagus can occur. 
• Erosion and ulceration are complications.
•  Seen more often in infants (esp. bottle fed) and immunosuppressed patients (AIDS).

Erythematous candidiasis: 

• The tongue and palate is affected and the mucosa appear red and glazed.
• Stomatitis

Hyperplastic oral candidiasis: 

• White plaques in mouth especially on cheeks and tongue. 
• Cannot be easily removed. 
• The mucosa appear atrophic and there is loss if papillae on tongue.
• Median rhomboid glossitis
• Cheilitis

Oesophagitis: 

• Extension of oral candidiasis (thrush) into the oesophagus.
• Associated with diabetes, AIDS, corticosteroid therapy, neoplasms.
• Characterized by retrosternal pain, dysphagia, GI bleeding and nausea.
• Lesion are in distal 3rd of esophagus. Diagnosed by biopsy
• Pruritis ani, occur as result from long-term antibiotic therapy or extension of intestinal candidiasis.

Vaginitis

Balanitis:

• Symptoms and signs vary from tiny papules and pustules on glans penis to persistant ulceration. 
• Superficial red erosions are frequent.

B. Cutaneous candidiasis

Candida paronychia: 

• Common in patients whose hands are frequently immersed in water.
• The nail fold becomes red and swollen and there is loss of cuticle with detachment of nail fold from nail plate. 
• Tenderness and nail dystrophy can occur.

Candida onychomycosis:

•  Chronic paronychia leads to onychomycosis. 
• The commonest type of candida onychomycosis is distal and lateral subungual onychomycosis (DLSO). 
• After the nail is invaded the nail plate becomes hardened, thickened, brownish coloured which is striated or grooved.

Intertriginous candidiasis:

• Occurs
•  in skin folds such as in axilla, groin, inframammary fold, intergluteal fold, interdigital space etc. 
• Diabetes, obesity, chronic alcoholism, moisture, chronic water contact, tight fitting clothes, shoes etc are predisposing factors.

Chronic mucocuatenous candidiasis:

• Persistent candidial infection of mouth, skin and nail that is refractory conventional topical therapy. 
• Diaper rash.
• The commonest fungal lesion of the eyelid 

Candidial granuloma: 

• Seen in certain genetically predisposed individuals. 
• Characterized by vascular papules that are covered with yellow crusts. 
• These develop into protrusions ~2 cms in length. 
• Lesions are composed of granulomatous tissue with giant cells and chronic inflammatory reaction. 

C. Systemic candidiasis 

Bronchial and pulmonary candidiasis:

• Chronic bronchitis with cough and expectoration.
•  On bronchoscopy small white curd like patched may be seen. 
• Predisposing conditions include leukemia, lymphoma, prolonged antibiotic or steroid therapy. 
• Consolidation of lobe and lobar pneumonia may occur.

Meningitis: 

• Most patients have underlying conditions such as IV catheter, antibiotic or cytotoxic therapy.
•  It occurs a result of dissemination from some other foci. 

Endocarditis: 

• Previously damaged or prosthetic valve

Urinary tract infections:

• This can occur in disseminated candidiasis, diabetes, pregnancy or catheterization. 
• It is more common in females. 
• Pyelonephritis can occur as a result of ascending infection or hematogenous spread from other foci. 

Hepatosplenic candidiasis/Chronic disseminated candidiasis 

• Usually, occur in patient with acute leukemia
• Originates from the intestinal seeding of a portal and venous circulation. 
• Mostly occur in the neutropenic patient.
• Septicemia