Pediatric Candidiasis

Updated: Feb 07, 2016
  • Author: Sabah Kalyoussef, DO; Chief Editor: Russell W Steele, MD  more...
  • Print
Overview

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 papules Candidal 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.

Next:

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, 3] 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.

Previous
Next:

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. [4]

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.

Previous