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Candidiasis in Emergency Medicine Follow-up

  • Author: Sukhveer (Sukhi) Bains, MD, MA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
Updated: Mar 13, 2015

Further Outpatient Care

Uncomplicated vaginal and cutaneous candidiasis: When treated in the ED and discharged with medication, patients should be instructed to see their primary physician if symptoms persist or worsen. For recurrent vulvovaginitis, patients should be screened for HIV infection, diabetes mellitus, leukemia, or other immunologic dysfunction.

Severe candidiasis: If an underlying disorder is suspected, patients should be referred for workup in an outpatient setting for possible primary causes leading to the immunocompromised state.


Further Inpatient Care

Patients with invasive candidiasis often have a prolonged inpatient course and may require several weeks of parenteral antifungal therapy.

Removal of invasive catheters with positive fungal culture results is an essential step in management.[30]


Inpatient & Outpatient Medications

Localized mucocutaneous infections are treated with outpatient topical and oral medication. Patients with invasive infections that have stabilized may be discharged with parenteral medications administered at home.



Patients with invasive candidiasis may require transfer to a facility where intensive care and specialty consultations are available.



Multiple studies have been performed evaluating fluconazole prophylaxis in the ICU; however, the studies had either limited numbers or were performed in only one center, thereby limiting the ability to apply the evidence to the general population.[31]

Candida prevention in the neonatal ICU is also controversial. Fluconazole prophylaxis can lead to the emergence of Candida species that are not susceptible to fluconazole. This is a concern, as mortality varies substantially by Candida species. C glabrata is associated with the highest mortality rate in neonates. Studies have demonstrated that less frequent dosing may delay the emergence of antifungal resistance, but more evidence-based data are required.

Screening pregnant women for vaginal infection and subsequently treating the infection, including vaginal candidiasis, reduces preterm delivery rates by 50%.

Oral candidiasis can be prevented in patients who wear dentures (ie, immunocompromised population) by various methods of disinfections, which include microwave irradiation and sodium hypochlorite soaks.[32, 33]



Untreated candidemia can lead to metastatic foci of virtually any organ system and may lead to blindness, organ failure, and death.



The prognosis of candidal infection varies based on location of infection. Local mucocutaneous infections typically respond well to medical therapy. Response to invasive infection is determined by how quickly infection with Candida is recognized and treatment is initiated, as well as underlying host immune response and comorbidities.


Patient Education

Patients should be informed that immunocompromising agents and widespread administration of antibiotics may increase the likelihood of developing candidal infections.

Patients should be educated to follow diets low in refined sugars and to avoid clothing that is tight and/or synthetic. Cotton underclothing may be beneficial.

For patient education resources, see the Yeast and Fungal Infections Center; Children's Health Center; and Skin, Hair, and Nails Center, as well as Candidiasis (Yeast Infection), Understanding Vaginal Yeast Infection Medications, Yeast Infection Diaper Rash, and Yeast Infection Skin Rash.

Contributor Information and Disclosures

Sukhveer (Sukhi) Bains, MD, MA Resident Physician, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital

Disclosure: Nothing to disclose.


Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.


Tarlan Hedayati, MD Assistant Professor of Emergency Medicine, Rush Medical College, John H Stroger Hospital of Cook County

Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Emily Anne Carpenter Rose, MD, Fellow in Pediatric Emergency Medicine, Loma Linda University School of Medicine

Disclosure: Nothing to disclose. Ghazal Shafiei, MD Resident Physician, Department of Emergency Medicine, John H Stroger Jr Hospital

Ghazal Shafiei, MD is a member of the following medical societies: American Medical Association and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

  1. Delaloye J, Calandra T. Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence. 2014 Jan 1. 5(1):161-9. [Medline]. [Full Text].

  2. Mayer FL, Wilson D, Hube B. Candida albicans pathogenicity mechanisms. Virulence. 2013 Feb 15. 4(2):119-28. [Medline]. [Full Text].

  3. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014. 10:95-105. [Medline]. [Full Text].

  4. Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010 Nov. 14(11):e954-66. [Medline].

  5. Hachem R, Hanna H, Kontoyiannis D, Jiang Y, Raad I. The changing epidemiology of invasive candidiasis: Candida glabrata and Candida krusei as the leading causes of candidemia in hematologic malignancy. Cancer. 2008 Jun. 112(11):2493-9. [Medline].

  6. Trofa D, Gacser A, Nosanchuk JD. Candida parapsilosis, an emerging fungal pathogen. Clin Microbiol Rev. 2008 Oct. 21(4):606-25. [Medline].

  7. Wellinghausen N, Moericke A, Bundschuh S, Friedrich W, Schulz AS, Gatz SA. Multifocal osteomyelitis caused by Candida dubliniensis. J Med Microbiol. 2009 Mar. 58:386-90. [Medline].

  8. van Hal SJ, Stark D, Harkness J, Marriott D. Candida dubliniensis Meningitis as delayed sequela of treated C. dubliniensis Fungemia. CDC. Available at Accessed: January 29, 2008.

  9. Zaoutis T. Candidemia in children. Curr Med Res Opin. 2010 Jul. 26(7):1761-8. [Medline].

  10. Hirshoren N, Eliashar R, Weinberger JM. Candida epiglottitis: a rare emergent condition--appearance, treatment and pitfalls. Eur J Intern Med. 2008 Dec. 19(8):e84-5. [Medline].

  11. Yildirim M, Ozaydin I, Sahin I, Yasar M. Acute calculous cholecystitis caused by Candida lusitaniae: an unusual causative organism in a patient without underlying malignancy. Jpn J Infect Dis. 2008 Mar. 61(2):138-9. [Medline].

  12. Chassot F, Negri MF, Svidzinski AE, Donatti L, Peralta RM, Svidzinski TI, et al. Can intrauterine contraceptive devices be a Candida albicans reservoir?. Contraception. 2008 May. 77(5):355-9. [Medline].

  13. Loulergue P, Mahe V, Bougnoux ME, Poiree S, Hot A, Lortholary O. Fournier's gangrene due to Candida glabrata. Med Mycol. 2008 Mar. 46(2):171-3. [Medline].

  14. Stamatakos M, Kontzoglou K, Sargedi C, Tsaknaki S, Safioleas M. Mammary candidiasis. A breast infection difficult to handle. Chirurgia (Bucur). 2008 Sep-Oct. 103(5):583-6. [Medline].

  15. Welsh O, Vera-Cabrera L, Welsh E. Onychomycosis. Clin Dermatol. March/2010. 28(2):151-159. [Medline].

  16. Agrawal V, Gupta RK, Jain M. Invasive fungal infections in renal allograft recipients. Indian J Pathol Microbiol. 2005 Oct. 48(4):448-52. [Medline].

  17. Mendes V, Castro S, Linhares P, Ribeiro-Silva ML. Tumoriform presentation of cerebral candidiasis in an HIV-infected patient. J Clin Neurosci. 2009 Apr. 16(4):587-8. [Medline].

  18. Baradkar VP, Mathur M, Kulkarni SD, Kumar S. Thoracic empyema due to Candida albicans. Indian J Pathol Microbiol. 2008 Apr-Jun. 51(2):286-8. [Medline].

  19. McGee SM, Thompson CA, Granberg CF, Hutcheson JC, Vandersteen DR, Reinberg Y, et al. Acute renal infarction due to fungal vascular invasion in disseminated candidiasis. Urology. 2009 Mar. 73(3):535-7. [Medline].

  20. Cha JG, Hong HS, Koh YW, Kim HK, Park JM. Candida albicans osteomyelitis of the cervical spine. Skeletal Radiol. 2008 Apr. 37(4):347-50. [Medline].

  21. Ozdemir N, Celik L, Oguzoglu S, Yildirim L, Bezircioglu H. Cervical vertebral osteomyelitis and epidural abscess caused by Candida albicans in a patient with chronic renal failure. Turk Neurosurg. 2008 Apr. 18(2):207-10. [Medline].

  22. Guillen Fiel G, Gonzalez-Granado LI, Mosqueda R, Negreira S, Giangaspro E. [Arthritis caused by Candida in an immunocompetent infant with a history of systemic candidiasis in the neonatal period.]. An Pediatr (Barc). 2009 Apr. 70(4):383-5. [Medline].

  23. Tiraboschi IN, Niveyro C, Mandarano AM, Messer SA, Bogdanowicz E, Kurlat I, et al. Congenital candidiasis: confirmation of mother-neonate transmission using molecular analysis techniques. Med Mycol. 2009 Mar 20. 1-5. [Medline].

  24. US Food and Drug Administration. FDA allows marketing of the first test to identify five yeast pathogens directly from a blood sample. September 22, 2014. Available at Accessed: December 30th, 2014.

  25. Puig-Asensio M, Pemán J, Zaragoza R, Garnacho-Montero J, Martín-Mazuelos E, Cuenca-Estrella M, et al. Impact of therapeutic strategies on the prognosis of candidemia in the ICU. Crit Care Med. 2014 Jun. 42(6):1423-32. [Medline].

  26. Thompson GR 3rd, Wiederhold NP, Vallor AC, Villareal NC, Lewis JS 2nd, Patterson TF. Development of caspofungin resistance following prolonged therapy for invasive candidiasis secondary to Candida glabrata infection. Antimicrob Agents Chemother. 2008 Oct. 52(10):3783-5. [Medline].

  27. De Rosa FG, Garazzino S, Pasero D, Di Perri G, Ranieri VM. Invasive candidiasis and candidemia: new guidelines. Minerva Anestesiol. 2008 Dec 17. [Medline].

  28. Martinez RC, Franceschini SA, Patta MC, Quintana SM, Candido RC, Ferreira JC, et al. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol. 2009 Mar. 48(3):269-74. [Medline].

  29. Hidalgo J. Candidiasis. Medscape. Available at Accessed: December 30th, 2014.

  30. Liu CY, Huang LJ, Wang WS, Chen TL, Yen CC, Yang MH, et al. Candidemia in cancer patients: impact of early removal of non-tunneled central venous catheters on outcome. J Infect. 2009 Feb. 58(2):154-60. [Medline].

  31. Magill SS, Swoboda SM, Shields CE, Colantuoni EA, Fothergill AW, Merz WG, et al. The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial. Ann Surg. 2009 Apr. 249(4):657-65. [Medline].

  32. Buergers R, Rosentritt M, Schneider-Brachert W, Behr M, Handel G, Hahnel S. Efficacy of denture disinfection methods in controlling Candida albicans colonization in vitro. Acta Odontol Scand. 2008 Jun. 66(3):174-80. [Medline].

  33. Sanita PV, Vergani CE, Giampaolo ET, Pavarina AC, Machado AL. Growth of Candida species on complete dentures: effect of microwave disinfection. Mycoses. 2009 Mar. 52(2):154-60. [Medline].

  34. Anttila VJ, Salonen J, Ylipalosaari P, Koivula I, Riikonen P, Nikoskelainen J. A retrospective nationwide case study on the use of a new antifungal agent: patients treated with caspofungin during 2001-2004 in Finland. Clin Microbiol Infect. 2007 Jun. 13(6):606-12. [Medline].

  35. Ardizzoni A, Posteraro B, Baschieri MC, Bugli F, Sáez-Rosòn A, Manca L, et al. An antibody reactivity-based assay for diagnosis of invasive Candidiasis using protein array. Int J Immunopathol Pharmacol. 2014 Jul-Sep. 27(3):403-412. [Medline].

  36. Borman AM, Petch R, Linton CJ, Palmer MD, Bridge PD, Johnson EM. Candida nivariensis, an emerging pathogenic fungus with multidrug resistance to antifungal agents. J Clin Microbiol. 2008 Mar. 46(3):933-8. [Medline].

  37. Brion LP, Uko SE, Goldman DL. Risk of resistance associated with fluconazole prophylaxis: systematic review. J Infect. 2007 Jun. 54(6):521-9. [Medline].

  38. Charles PE. Multifocal Candida species colonization as a trigger for early antifungal therapy in critically ill patients: what about other risk factors for fungal infection?. Crit Care Med. 2006 Mar. 34(3):913-4. [Medline].

  39. Cohen and Powderly's: Infectious Diseases. 2nd ed. 2004.

  40. Gafter-Gvili A, Vidal L, Goldberg E, Leibovici L, Paul M. Treatment of invasive candidal infections: systematic review and meta-analysis. Mayo Clin Proc. 2008 Sep. 83(9):1011-21. [Medline].

  41. Healy CM, Baker CJ, Zaccaria E, Campbell JR. Impact of fluconazole prophylaxis on incidence and outcome of invasive candidiasis in a neonatal intensive care unit. J Pediatr. 2005 Aug. 147(2):166-71. [Medline].

  42. Kauffman CA. Candidemia in adults. 2007. [Full Text].

  43. Kauffman CA. Hepatosplenic candidiasis. 2007. [Full Text].

  44. Kauffman CA. Overview of Candida infections. 2007. [Full Text].

  45. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Grossman LB. Twice weekly fluconazole prophylaxis for prevention of invasive Candida infection in high-risk infants of 1111J Pediatr</i>. 2005. 147(2):172-9. [Medline].

  46. Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ. 2004 Aug 14. 329(7462):371. [Medline].

  47. Kuse ER, Chetchotisakd P, da Cunha CA, Ruhnke M, Barrios C, Raghunadharao D, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007 May 5. 369(9572):1519-27. [Medline].

  48. Li L, Redding S, Dongari-Bagtzoglou A. Candida glabrata: an emerging oral opportunistic pathogen. J Dent Res. 2007 Mar. 86(3):204-15. [Medline].

  49. Long SS, Stevenson DK. Reducing Candida infections during neonatal intensive care: management choices, infection control, and fluconazole prophylaxis. J Pediatr. 2005 Aug. 147(2):135-41. [Medline].

  50. Lum LC. Candidal bloodstream infection: will prevention work?. Pediatr Crit Care Med. 2006 Mar. 7(2):184-5. [Medline].

  51. Makhoul IR, Bental Y, Weisbrod M, Sujov P, Lusky A, Reichman B, et al. Candidal versus bacterial late-onset sepsis in very low birthweight infants in Israel: a national survey. J Hosp Infect. 2007 Mar. 65(3):237-43. [Medline].

  52. Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, et al. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007 Jun 14. 356(24):2483-95. [Medline].

  53. Ostrosky-Zeichner L. Prophylaxis for invasive candidiasis in the intensive care unit: is it time?. Crit Care Med. 2005 Sep. 33(9):2121-2. [Medline].

  54. Ostrosky-Zeichner L, Pappas PG. Invasive candidiasis in the intensive care unit. Crit Care Med. 2006 Mar. 34(3):857-63. [Medline].

  55. Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006 Sep. 20(3):485-506. [Medline].

  56. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1. 48(5):503-35. [Medline].

  57. Parker ER, Guitart J. Candidal Intertrigo. 2007. [Full Text].

  58. Patel DA, Gillespie B, Sobel JD, Leaman D, Nyirjesy P, Weitz MV, et al. Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study. Am J Obstet Gynecol. 2004 Mar. 190(3):644-53. [Medline].

  59. Phillips AJ. Treatment of non-albicans Candida vaginitis with amphotericin B vaginal suppositories. Am J Obstet Gynecol. 2005 Jun. 192(6):2009-12; discussion 2012-3. [Medline].

  60. Piarroux R, Grenouillet F, Balvay P, Tran V, Blasco G, Millon L, et al. Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med. 2004 Dec. 32(12):2443-9. [Medline].

  61. Mandell, Bennet and Dolin. Principles and Practice of Infectious Diseases. 6th ed. 2005.

  62. Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007 Jun 14. 356(24):2472-82. [Medline].

  63. Singhi SC, Reddy TC, Chakrabarti A. Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med. 2004 Jul. 5(4):369-74. [Medline].

  64. Smith PB, Steinbach WJ, Benjamin DK Jr. Neonatal candidiasis. Infect Dis Clin North Am. 2005 Sep. 19(3):603-15. [Medline].

  65. Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004 Aug 26. 351(9):876-83. [Medline].

  66. Spinillo A, Zara F, Gardella B, Preti E, Mainini R, Maserati R. The effect of vaginal candidiasis on the shedding of human immunodeficiency virus in cervicovaginal secretions. Am J Obstet Gynecol. 2005 Mar. 192(3):774-9. [Medline].

  67. Sullivan DJ, Westerneng TJ, Haynes KA, Bennett DE, Coleman DC. Candida dubliniensis sp. nov.: phenotypic and molecular characterization of a novel species associated with oral candidosis in HIV-infected individuals. Microbiology. 1995 Jul. 141 ( Pt 7):1507-21. [Medline].

  68. Sun RL, Jones DB, Wilhelmus KR. Clinical characteristics and outcome of Candida keratitis. Am J Ophthalmol. 2007 Jun. 143(6):1043-1045. [Medline].

  69. Wells CL, Johnson MA, Henry-Stanley MJ, Bendel CM. Candida glabrata colonizes but does not often disseminate from the mouse caecum. J Med Microbiol. 2007 May. 56(Pt 5):688-93. [Medline].

  70. Wertz KK, Pretzlaff RK. Caspofungin in a pediatric patient with persistent candidemia. Pediatr Crit Care Med. 2004 Mar. 5(2):181-3. [Medline].

  71. Zaas AK, Dodds Ashley ES, Alexander BD, Johnson MD, Perfect JR. Caspofungin for invasive candidiasis at a tertiary care medical center. Am J Med. 2006 Nov. 119(11):993.e1-6. [Medline].

  72. Zhang AY, Camp WL, Elewski BE. Advances in topical and systemic antifungals. Dermatol Clin. 2007 Apr. 25(2):165-83, vi. [Medline].

Candidiasis. Image courtesy of Hon Pak, MD.
Candidiasis. A moist, erosive, pruritic patch of the perianal skin and perineum (with satellite pustule formation) is demonstrated in this woman with extensive candidosis. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. Discrete superficial pustules developed within hours of birth on the hand of an otherwise healthy newborn. A potassium hydroxide preparation revealed spores and pseudomycelium, and culture demonstrated the presence of Candida albicans. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. Dry, red, superficially scaly, pruritic macules and patches on the penis represent candidal balanitis. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. White plaques are present on the buccal mucosa and the undersurface of the tongue and represent thrush. When wiped off, the plaques leave red erosive areas. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. Erythema, maceration, and satellite pustules in the axilla, accompanied by soreness and pruritus, result in a form of intertrigo. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. A nailfold with candidal infection becomes erythematous, swollen, and tender with an occasional discharge. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. Soreness and cracks at the lateral angles of the mouth (angular cheilitis) is a frequent expression of candidosis in elderly individuals. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. Fine superficial pustules on an erythematous patchy base are suggestive of candidosis. Image courtesy of Matthew C Lambiase, DO.
Candidiasis. Candida infection should be in the differential diagnosis when one or more nails become discolored, has subungual discoloration, nailplate separation from the nailbed, and lack evidence of a dermatophyte. Image courtesy of Matthew C Lambiase, DO.
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