Pediatric Candidiasis 

  • Author: Sabah Kalyoussef, DO; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 22, 2011
 

Background

Candidal infections are extremely common (see the images below).

Typical appearance of thrush. Note multiple white Typical appearance of thrush. Note multiple white plaques on lips, gingivae, tongue, and palate. Candidal diaper dermatitis. Note satellite papulesCandidal diaper dermatitis. Note satellite papules and involvement of intertriginous folds.

Candida albicans is the most common cause of human candidal infections,[1] but other pathogenic species include Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida lusitaniae, and Candida stellatoidea.

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Pathophysiology

Infections caused by Candida may affect numerous organ systems, such as the eyes, lungs, kidneys, heart, and CNS.

Skin

The most common manifestation of candidal infection is diaper dermatitis in infants. Candida organisms can also cause intertrigo in older individuals. Intertrigo has a predilection for dark moist areas, such as the groin or fat folds. Predisposing conditions include diabetes mellitus, obesity, and hyperhidrosis.

Nails

A chronic paronychia may be caused by one of several Candida species. Candida organisms can also cause onychomycosis, including total nail dystrophy due to chronic mucocutaneous candidiasis (CMCC), a rare T-cell disorder.

Mucous membranes

Thrush, or oral candidiasis, is also common in infants. Oral candidiasis may also be an adverse effect from using inhaled corticosteroids for asthma due to oral deposition. Patients who are immunocompromised may suffer from candidal esophagitis as well as thrush.

Genitals

Vaginal yeast infections affect nearly 75% of women. Male partners may develop balanitis or balanoposthitis. Individuals with chronic indwelling catheters are also predisposed to recurrent candidal infections.

Systemic

Candida organisms can cause severe systemic infections in immunocompromised patients, compared with benign cutaneous or localized infections in immunocompetent patients. Reports of systemic candidiasis are common in children with acquired immunodeficiency syndrome (AIDS) and other immune deficiencies, as well as in very low birth weight premature infants. Risk factors for candidemia in critically ill children have been identified.[2] Manifestations include fungemia, endophthalmitis, meningitis, renal or bladder bezoars, and arthritis.

Virulence factors

Numerous factors can contribute to the likelihood of candidal infections. An intact skin barrier is protective. Candidal infections are promoted in the face of lymphocyte dysfunction, as is observed in persons with AIDS and those with CMCC. Adherence of Candida organisms to oral and vaginal epithelium is believed to be promoted by biologic factors (eg, fibronectin in thromboses) and by iatrogenic factors (eg, presence of plastic catheters, disruption of normal bacterial flora). In neonates, risk factors include indwelling catheters, prolonged antibiotic use, necrotizing enterocolitis, previous bloodstream infections, total parenteral nutrition, and low birth weight.

Chronic mucocutaneous candidiasis

CMCC is a heterogeneous group of disorders characterized by chronic candidal infections of the nails, skin, and mucous membranes. Most CMCC disorders are autosomal recessive and related to a mutation in the AIRE gene. Lymphocyte numbers are normal; however, response to in vitro exposure to candidal antigen is absent.

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Epidemiology

Frequency

United States

Thrush occurs in approximately 2-5% of healthy newborns and a slightly higher percentage of infants in the first year of life. Vaginal candidal infections occur in approximately 75% of women, and 40-50% of women experience recurrence. Approximately 2-5% of premature infants weighing less than 1500 g develop disseminated disease.

Mortality/Morbidity

Candidal infections rarely cause significant morbidity in the healthy host. However, systemic disease may be found in as many as 15% of patients who are neutropenic. Mortality in low birth weight premature infants with systemic candidiasis may reach 50%. Candida is the second leading cause of sepsis in critical care patients.

Race

No racial predilection is noted.

Sex

Vaginal candidosis is a frequent problem among women and adolescent girls. No gender predilection is noted in other forms of candidiasis.

Age

In the healthy host, candidal infections are most common in the first year of life as thrush or diaper dermatitis. Vulvovaginitis is more common in adolescent and adult females.

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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, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

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 Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis 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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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 Medical School

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.

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

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: Nothing to disclose.

References

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

  2. Zaoutis TE, Prasad PA, Localio AR, Coffin SE, Bell LM, Walsh TJ, et al. Risk Factors and Predictors for Candidemia in Pediatric Intensive Care Unit Patients: Implications for Prevention. Clin Infect Dis. Jul 16 2010;[Medline].

  3. 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].

  4. 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].

  5. 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].

  6. Uko S, Soghier LM, Vega M, Marsh J, Reinersman GT, Herring L, et al. Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants. Pediatrics. Apr 2006;117(4):1243-52. [Medline].

  7. 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. Mar 1 2009;48(5):503-35. [Medline]. [Full Text].

  8. 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].

  9. 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].

  10. 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].

  11. [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].

  12. 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].

  13. 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].

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

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

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

  17. Benjamin DK Jr, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment. Pediatrics. Sep 27 2010;[Medline].

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

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

  20. 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].

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

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

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

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

  25. 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].

  26. 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.

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

  28. 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].

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

  30. Kaufman DA. Aiming for zero: preventing invasive Candida infections in extremely preterm infants. NeoReviews. July, 2011;12(7):e381-e392.

  31. Kaufman DA. Challenging issues in neonatal candidiasis. Curr Med Res Opin. Jul 2010;26(7):1769-78. [Medline].

  32. Kaufman DA. Epidemiology and prevention of neonatal candidiasis: fluconazole for all neonates?. Adv Exp Med Biol. 2010;659:99-119. [Medline].

  33. Kaufman DA. Neonatal candidiasis: clinical manifestations, management, and prevention strategies. J Pediatr. Apr 2010;156 (Suppl 2):S53-S67.

  34. 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].

  35. McClelland RS, Richardson BA, Hassan WM, Graham SM, Kiarie J, Baeten JM, et al. Prospective Study of Vaginal Bacterial Flora and Other Risk Factors for Vulvovaginal Candidiasis. J Infect Dis. Jun 15 2009;199(12):1883-1890. [Medline].

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

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

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

  39. 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].

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

  41. 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].

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

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

  44. 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].

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

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

  47. Zaoutis TE. Pediatric fungal infections: a conundrum in children. J Pediatr. 2010/04;156 (Suppl 2):S47-S52.

  48. 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].

  49. Zaoutis TE, Jafri HS, Huang LM, Locatelli F, Barzilai A, Ebell W. A prospective, multicenter study of caspofungin for the treatment of documented Candida or Aspergillus infections in pediatric patients. Pediatrics. Mar 2009;123(3):877-84. [Medline].

 
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Typical appearance of thrush. Note multiple white plaques on lips, gingivae, tongue, and palate.
Candidal diaper dermatitis. Note satellite papules and involvement of intertriginous folds.
 
 
 
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