Diagnostic Considerations

Diagnostic considerations include the following:

Cutaneous candidiasis - Dermatitis (contact, allergic), folliculitis
Gastrointestinal tract candidiasis - Esophagitis due to herpes simplex virus, herpes zoster, induced by radiation, gastroesophageal reflux disease
Respiratory candidiasis - Bacterial pneumonia, viral pneumonia, tracheitis, Aspergillus pneumonia
Genitourinary tract candidiasis - Bacterial cystitis or pyelonephritis
Candidemia - Bacterial sepsis, bacterial endocarditis
Disseminated candidiasis - Bacterial meningitis, bacterial sepsis, bacterial endocarditis, tuberculosis
Chronic mucocutaneous candidiasis - HIV-seropositive state, chronic granulomatous disease
Hepatosplenic candidiasis - Hepatic abscess, cholelithiasis, cholecystitis, acalculous cholecystitis, ascending cholangitis, graft versus host disease, granulomatous hepatitis, relapsed malignancy

Differential Diagnoses

Workup

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FDA. FDA limits usage of Nizoral (ketoconazole) oral tablets due to potentially fatal liver injury and risk of drug interactions and adrenal gland problems. Available at http://www.fda.gov/Drugs/DrugSafety/ucm362415.htm. Accessed: August 6, 2013.
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Media Gallery

A moist, erosive, pruritic patch of perianal skin and perineum (with satellite pustule formation) is demonstrated in this woman with extensive candidiasis. Courtesy of Matthew C. Lambiase, DO.
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. Courtesy of Matthew C. Lambiase, DO.
Dry, red, superficially scaly, pruritic macules and patches on the penis represent candidal balanitis. Courtesy of Matthew C. Lambiase, DO.
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. Courtesy of Matthew C. Lambiase, DO.
Erythema, maceration, and satellite pustules in the axilla, accompanied by soreness and pruritus, result in a form of intertrigo. Courtesy of Matthew C. Lambiase, DO.
A nailfold with candidal infection becomes erythematous, swollen, and tender with occasional discharge. Courtesy of Matthew C. Lambiase, DO.
Soreness and cracks at the lateral angles of the mouth (angular cheilitis) are a frequent expression of candidiasis in elderly individuals. Courtesy of Matthew C. Lambiase, DO.
Fine, superficial pustules on an erythematous patchy base are suggestive of candidiasis. Courtesy of Matthew C. Lambiase, DO.
Candidal infection should be in the differential diagnosis when one or more nails become discolored, have subungual discoloration, have nailplate separation from the nailbed, and lack evidence of a dermatophyte. Courtesy of Matthew C. Lambiase, DO.
Candida dermatitis in the diaper area. Courtesy of Hon Pak, MD.

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Author

Jose A Hidalgo, MD Assistant Professor, Universidad Nacional Mayor de San Marcos; Attending Physician, Department of Internal Medicine, Division of Infectious Diseases, Guillermo Almenara Hospital, Peru

Jose A Hidalgo, MD is a member of the following medical societies: HIV Medicine Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Jose A Vazquez, MD, FACP, FIDSA Chief, Professor, Department of Medicine, Division of Infectious Diseases, Medical College of Georgia at Augusta University

Jose A Vazquez, MD, FACP, FIDSA is a member of the following medical societies: American Society for Microbiology, HIV Medicine Association, Immunocompromised Host Society, Infectious Diseases Society of America, International AIDS Society, International Immunocompromised Host Society, International Society for Human and Animal Mycology, International Society for Infectious Diseases, Medical Mycological Society of the Americas, Mycological Society of America, National Foundation for Infectious Diseases

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cidara; Amplyx; F2G, Scynexis<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan; Astellas.

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.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

David Hall Shepp, MD Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received salary from Gilead Sciences for management position.