eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Candidiasis: Follow-up

Author: Sabah Kalyoussef, DO, Fellow in Pediatric Infectious Diseases, Children's Hospital at Montefiore
Coauthor(s): Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine; Michael E Greenberg, MD, MPH, Clinical Instructor, Department of Pediatrics, University of California at San Francisco
Contributor Information and Disclosures

Updated: Nov 20, 2008

Follow-up

Transfer

  • Transfer of patients with candidiasis is appropriate if the required level of care is not locally available.

Deterrence/Prevention

  • The risk of candidal diaper rash may be reduced by preventing irritant diaper dermatitis by using absorbent diapers and preventing excessive exposure to urine or feces.
  • Encourage parents to appropriately clean their infant's bottles while they are treated for thrush.
  • Encourage asthma patients to rinse their mouth after using their corticosteroid inhaler.
  • Keep hands dry; when wet work is unavoidable, use rubber gloves with cotton liners. Response is generally quite good to topical azoles.
  • Cutaneous candidiasis may be prevented by keeping areas cool and dry and by using breathable fabrics (eg, cotton).
  • Fluconazole is used extensively in patients with neutropenia, persons undergoing organ transplantation, and in extremely low birth weight infants.3,4,5,6,7,8 Although found to be generally safe in these populations and able to reduce candidal colonization, effect on survival has been minimal. New studies show prophylactic doses of fluconazole given in the newborn intensive care setting may prevent candidemia and colonization in high-risk patients.

Prognosis

  • Prognosis for oral or cutaneous candidiasis is excellent with appropriate medical treatment.
  • Systemic candidiasis, especially in low birth weight premature infants, carries a high rate of morbidity and mortality. Even with appropriate treatment, mortality may reach 50% in this population.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Candidiasis in an individual without known risk factors (eg, infant, immunocompromised state, diabetes, obesity) should prompt a search for such factors, especially immunodeficiency and HIV infection.
 


More on Candidiasis

Overview: Candidiasis
Differential Diagnoses & Workup: Candidiasis
Treatment & Medication: Candidiasis
Follow-up: Candidiasis
Multimedia: Candidiasis
References
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References

  1. Crislip MA, Edwards JE Jr. Candidiasis. Infect Dis Clin North Am. Mar 1989;3(1):103-33. [Medline].

  2. Blyth CC, Palasanthiran P, O'Brien TA. Antifungal therapy in children with invasive fungal infections: a systematic review. Pediatrics. Apr 2007;119(4):772-84. [Medline].

  3. Kaufman D, Boyle R, Hazen KC. Twice weekly fluconazole prophylaxis for prevention of invasive Candida infection in high-risk infants of <1000 grams birth weight. J Pediatr. Aug 2005;147(2):172-9. [Medline].

  4. Kicklighter SD, Springer SC, Cox T, et al. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics. Feb 2001;107(2):293-8. [Medline].

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

  6. Manzoni P, Arisio R, Mostert M. Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics. Jan 2006;117(1):e22-32. [Medline].

  7. [Best Evidence] 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. Jun 14 2007;356(24):2483-95. [Medline].

  8. Mondal RK, Singhi SC, Chakrabarti A, M J. Randomized comparison between fluconazole and itraconazole for the treatment of candidemia in a pediatric intensive care unit: a preliminary study. Pediatr Crit Care Med. Nov 2004;5(6):561-5. [Medline].

  9. Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses. Clin Infect Dis. 2006;43:S15-27.

  10. Bacheller CD, Bernstein JM. Urinary tract infections. Med Clin North Am. May 1997;81(3):719-30. [Medline].

  11. Antifungal agents. In: Benitz WE, Tatro DS, eds. The Pediatric Drug Handbook. 3rd ed. St. Louis, Mo: Mosby; 1975.

  12. Boiko S. Making rash decisions in the diaper area. Pediatr Ann. Jan 2000;29(1):50-6. [Medline].

  13. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 3rd ed. Baltimore, Md: Williams & Wilkins; 1990.

  14. Denning DW, Evans EG, Kibbler CC, et al. Fungal nail disease: a guide to good practice (report of a Working Group of the British Society for Medical Mycology). BMJ. Nov 11 1995;311(7015):1277-81. [Medline].

  15. Dodds Ashley ES, Lewis R, Lewis JS. Pharmacology of sytemic antifungal agents. Clin Infect Dis. 2006;43:S28-39.

  16. du Vivier A, McKee PH, eds. Atlas of Clinical Dermatology. Philadelphia, Pa: WB Saunders; 1986.

  17. Elder ME. T-cell immunodeficiencies. Pediatr Clin North Am. Dec 2000;47(6):1253-74. [Medline].

  18. Elewski BE. Cutaneous mycoses in children. Br J Dermatol. Jun 1996;134 Suppl 46:7-11: discussion 37-8. [Medline].

  19. Feja KN, Wu F, Roberts K, et al. Risk factors for candidemia in critically ill infants: a matched case-control study. J Pediatr. Aug 2005;147(2):156-61. [Medline].

  20. Fidel PL Jr, Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev. Jan 1999;12(1):80-96. [Medline].

  21. Harriet Lane Service, Children's Medical and Surgical Center, Johns Hopkins Hospital. Formulary. In: Siberry GK, Iannone R, eds. The Harriet Lane Handbook. 15th ed. St Louis, Mo: Mosby; 2000.

  22. Hay RJ. The management of superficial candidiasis. J Am Acad Dermatol. Jun 1999;40(6 Pt 2):S35-42. [Medline].

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

  24. Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J. Sep 1997;16(9):885-94. [Medline].

  25. Kauffman CA. The changing landscape of invasive fungal infections: epidemiology, diagnosis, and pharmacologic options. Clin Infect Dis. 2006;43:S1-2.

  26. Legrand F, Lecuit M, Dupont B, Bellaton E, Huerre M, Rohrlich PS. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. Mar 1 2008;46(5):696-702. [Medline].

  27. Odio CM, Araya R, Pinto LE. Caspofungin therapy of neonates with invasive candidiasis. Pediatr Infect Dis J. Dec 2004;23(12):1093-7. [Medline].

  28. Odom RB. Common superficial fungal infections in immunosuppressed patients. J Am Acad Dermatol. Sep 1994;31(3 Pt 2):S56-9. [Medline].

  29. Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clin Infect Dis. 2006;43:S3-14.

  30. Schwarze R, Penk A, Pittrow L. Administration of fluconazole in children below 1 year of age. Mycoses. Apr 1999;42(1-2):3-16. [Medline].

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

  32. Smith PB, Morgan J, Benjamin JD, et al. Excess costs of hospital care associated with neonatal candidemia. Pediatr Infect Dis J. Mar 2007;26(3):197-200. [Medline].

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

  34. Steinbach WJ. Antifungal agents in children. Pediatr Clin North Am. Jun 2005;52(3):895-915, viii. [Medline].

  35. Winston DJ, Pakrasi A, Busuttil RW. Prophylactic fluconazole in liver transplant recipients. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. Nov 16 1999;131(10):729-37. [Medline].

  36. Working Group of the British Society for Medical Mycology. Management of genital candidiasis. BMJ. May 13 1995;310(6989):1241-4. [Medline].

  37. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline].

  38. Zaoutis TE, Heydon K, Localio R, Walsh TJ, Feudtner C. Outcomes attributable to neonatal candidiasis. Clin Infect Dis. May 1 2007;44(9):1187-93. [Medline].

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Further Reading

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Keywords

candidiasis, candidosis, monilia, thrush, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida lusitaniae, Candida stellatoidea, candidal infections, diaper dermatitis, intertrigo, diabetes mellitus, obesity, hyperhidrosis, total nail dystrophy, esophagitis, vaginal yeast infection, balanitis, balanoposthitis, acquired immunodeficiency syndrome, AIDS, very low birth weight premature infants, fungemia, endophthalmitis, meningitis, renal bezoars, arthritis, chronic mucocutaneous candidiasis, CMCC, necrotizing enterocolitis, vaginal candidosis, vulvovaginitis, cutaneous candidiasis, paronychia, onychomycosis, otitis externa, glossitis, hepatic candidiasis, liver abscesses, endocarditis

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Contributor Information and Disclosures

Author

Sabah Kalyoussef, DO, Fellow in Pediatric Infectious Diseases, Children's Hospital at Montefiore
Sabah Kalyoussef, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Coauthor(s)

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Michael E Greenberg, MD, MPH, Clinical Instructor, Department of Pediatrics, University of California at San Francisco
Michael E Greenberg, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, and American Public Health Association
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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