Diagnostic Considerations

See the list below:

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

Sobel JD. Vulvovaginal candidosis. Lancet. 2007 Jun 9. 369(9577):1961-71. [QxMD MEDLINE Link].
Nurbhai M, Grimshaw J, Watson M, et al. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev. 2007 Oct 17. CD002845. [QxMD MEDLINE Link].
Pappas PG, Rex JH, Lee J, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis. 2003 Sep 1. 37(5):634-43. [QxMD MEDLINE Link].
Yang YL. Virulence factors of Candida species. J Microbiol Immunol Infect. 2003 Dec. 36(4):223-8. [QxMD MEDLINE Link].
Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006 Sep. 20(3):485-506. [QxMD MEDLINE Link].
de Repentigny L, Lewandowski D, Jolicoeur P. Immunopathogenesis of oropharyngeal candidiasis in human immunodeficiency virus infection. Clin Microbiol Rev. 2004 Oct. 17(4):729-59, table of contents. [QxMD MEDLINE Link].
Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007 Jan. 20(1):133-63. [QxMD MEDLINE Link].
Morgan J. Global trends in candidemia: review of reports from 1995-2005. Curr Infect Dis Rep. 2005 Nov. 7(6):429-39. [QxMD MEDLINE Link].
Colombo AL, Nucci M, Park BJ, et al. Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol. 2006 Aug. 44(8):2816-23. [QxMD MEDLINE Link].
Maródi L, Johnston RB Jr. Invasive Candida species disease in infants and children: occurrence, risk factors, management, and innate host defense mechanisms. Curr Opin Pediatr. 2007 Dec. 19(6):693-7. [QxMD MEDLINE Link].
Malani AN, Kauffman CA. Candida urinary tract infections: treatment options. Expert Rev Anti Infect Ther. 2007 Apr. 5(2):277-84. [QxMD MEDLINE Link].
Guery BP, Arendrup MC, Auzinger G, Azoulay E, Borges Sá M, Johnson EM, et al. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis. Intensive Care Med. 2009 Jan. 35(1):55-62. [QxMD MEDLINE Link].
Picazo JJ, González-Romo F, Candel FJ. Candidemia in the critically ill patient. Int J Antimicrob Agents. 2008 Nov. 32 Suppl 2:S83-5. [QxMD MEDLINE Link].
Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore). 2009 May. 88(3):160-8. [QxMD MEDLINE Link].
Shah CP, McKey J, Spirn MJ, et al. Ocular candidiasis: a review. Br J Ophthalmol. 2008 Apr. 92(4):466-8. [QxMD MEDLINE Link].
Blot SI, Vandewoude KH, De Waele JJ. Candida peritonitis. Curr Opin Crit Care. 2007 Apr. 13(2):195-9. [QxMD MEDLINE Link].
Vazquez JA, Sobel JD. Candidiasis. Clinical Mycology, Dismukes WE, Pappas PG, and Sobel JD, eds. Oxford Univers. 2003. 143-87.
Eiland EH, Hassoun A, English T. Points of concern related to the micafungin versus caspofungin trial. Clin Infect Dis. 2008 Feb 15. 46(4):640-1; author reply 641. [QxMD MEDLINE Link].
CDC. Candida auris. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html#world. March 29, 2019; Accessed: April 5, 2019.
Ostrowsky B, Greenko J, Adams E, et al. Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm. January 10, 2020; Accessed: January 17, 2020.
US Food and Drug Administration. FDA allows marketing of the first test to identify five yeast pathogens directly from a blood sample [news release.] September 22, 2014. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm415728.htm. Accessed: September 30, 2014.
Brooks M. FDA clears rapid blood test for sepsis-causing pathogens. Medscape Medical News. September 23, 2014. [Full Text].
Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses. Clin Infect Dis. 2006. 43:S15-S27.
Odabasi Z, Mattiuzzi G, Estey E, et al. Beta-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis. 2004 Jul 15. 39(2):199-205. [QxMD MEDLINE Link].
Shepard JR, Addison RM, Alexander BD, et al. Multicenter evaluation of the Candida albicans/Candida glabrata peptide nucleic acid fluorescent in situ hybridization method for simultaneous dual-color identification of C. albicans and C. glabrata directly from blood culture bottles. J Clin Microbiol. 2008 Jan. 46(1):50-5. [QxMD MEDLINE Link].
Lewis R. Candida: New Rapid Blood Test Could Cut Mortality. Medscape Medical News. Apr 25 2013. Available at http://www.medscape.com/viewarticle/803135. Accessed: Apr 30 2013.
Neely LA, Audeh M, Phung NA, Min M, Suchocki A, Plourde D, et al. T2 magnetic resonance enables nanoparticle-mediated rapid detection of candidemia in whole blood. Sci Transl Med. 2013 Apr 24. 5(182):182ra54. [QxMD MEDLINE Link].
[Guideline] Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15. 62 (4):e1-50. [QxMD MEDLINE Link]. [Full Text].
[Guideline] 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. [QxMD MEDLINE Link].
[Guideline] Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004 Jan 15. 38(2):161-89. [QxMD MEDLINE Link].
Kett DH, Shorr AF, Reboli AC, et al. Anidulafungin compared with fluconazole in severely ill patients with candidemia and other forms of invasive candidiasis: Support for the 2009 IDSA treatment guidelines for candidiasis. Crit Care. 2011 Oct 25. 15(5):R253. [QxMD MEDLINE Link].
Andes DR, Safdar N, Baddley JW, Playford G, Reboli AC, Rex JH, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012 Apr. 54(8):1110-22. [QxMD MEDLINE Link].
Clancy CJ, Nguyen MH. The end of an era in defining the optimal treatment of invasive candidiasis. Clin Infect Dis. 2012 Apr. 54(8):1123-5. [QxMD MEDLINE Link].
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.
Lowes R. FDA, EMA Come Down Hard on Oral Ketoconazole. Medscape Medical News. Available at http://www.medscape.com/viewarticle/808484. Accessed: August 6, 2013.
Chandrasekar PH, Sobel JD. Micafungin: a new echinocandin. Clin Infect Dis. 2006 Apr 15. 42(8):1171-8. [QxMD MEDLINE Link].
Vazquez JA, Sobel JD. Anidulafungin: a novel echinocandin. Clin Infect Dis. 2006 Jul 15. 43(2):215-22. [QxMD MEDLINE Link].
Pasternak B, Wintzell V, Furu K, Engeland A, Neovius M, Stephansson O. Oral Fluconazole in Pregnancy and Risk of Stillbirth and Neonatal Death. JAMA. 2018 Jun 12. 319 (22):2333-2335. [QxMD MEDLINE Link].
Charlier C, Hart E, Lefort A, et al. Fluconazole for the management of invasive candidiasis: where do we stand after 15 years?. J Antimicrob Chemother. 2006 Mar. 57(3):384-410. [QxMD MEDLINE Link].
Sobel JD, Revankar SG. Echinocandins--first-choice or first-line therapy for invasive candidiasis?. N Engl J Med. 2007 Jun 14. 356(24):2525-6. [QxMD MEDLINE Link].
Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007 Jun 14. 356(24):2472-82. [QxMD MEDLINE Link].
Kuse ER, Chetchotisakd P, da Cunha CA, 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. [QxMD MEDLINE Link].
Kullberg BJ, Sobel JD, Ruhnke M, et al. Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in non-neutropenic patients: a randomised non-inferiority trial. Lancet. 2005 Oct 22-28. 366(9495):1435-42. [QxMD MEDLINE Link].
Schuster MG, Edwards JE Jr, Sobel JD, Darouiche RO, Karchmer AW, Hadley S, et al. Empirical fluconazole versus placebo for intensive care unit patients: a randomized trial. Ann Intern Med. 2008 Jul 15. 149(2):83-90. [QxMD MEDLINE Link].
Cornely OA, Lasso M, Betts R, et al. Caspofungin for the treatment of less common forms of invasive candidiasis. J Antimicrob Chemother. 2007 Aug. 60(2):363-9. [QxMD MEDLINE Link].
Pachl J, Svoboda P, Jacobs F, et al. A randomized, blinded, multicenter trial of lipid-associated amphotericin B alone versus in combination with an antibody-based inhibitor of heat shock protein 90 in patients with invasive candidiasis. Clin Infect Dis. 2006 May 15. 42(10):1404-13. [QxMD MEDLINE Link].
Khan FA, Slain D, Khakoo RA. Candida endophthalmitis: focus on current and future antifungal treatment options. Pharmacotherapy. 2007 Dec. 27(12):1711-21. [QxMD MEDLINE Link].
Kauffman CA. Clinical efficacy of new antifungal agents. Curr Opin Microbiol. 2006 Oct. 9(5):483-8. [QxMD MEDLINE Link].
Sable CA, Strohmaier KM, Chodakewitz JA. Advances in antifungal therapy. Annu Rev Med. 2008. 59:361-79. [QxMD MEDLINE Link].
Ostrosky-Zeichner L, Oude Lashof AM, Kullberg BJ, et al. Voriconazole salvage treatment of invasive candidiasis. Eur J Clin Microbiol Infect Dis. 2003 Nov. 22(11):651-5. [QxMD MEDLINE Link].
Skiest DJ, Vazquez JA, Anstead GM, et al. Posaconazole for the treatment of azole-refractory oropharyngeal and esophageal candidiasis in subjects with HIV infection. Clin Infect Dis. 2007 Feb 15. 44(4):607-14. [QxMD MEDLINE Link].
Jaijakul S, Vazquez JA, Swanson RN, Ostrosky-Zeichner L. (1,3)-ß-D-Glucan (BG) as a Prognostic Marker of Treatment Response in Invasive Candidiasis. Clin Infect Dis. 2012 May 9. [QxMD MEDLINE Link].
Ullmann AJ, Cornely OA. Antifungal prophylaxis for invasive mycoses in high risk patients. Curr Opin Infect Dis. 2006 Dec. 19(6):571-6. [QxMD MEDLINE Link].
van Burik JA, Ratanatharathorn V, Stepan DE, et al. Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation. Clin Infect Dis. 2004 Nov 15. 39(10):1407-16. [QxMD MEDLINE Link].
Husain S, Paterson DL, Studer S, et al. Voriconazole prophylaxis in lung transplant recipients. Am J Transplant. 2006 Dec. 6(12):3008-16. [QxMD MEDLINE Link].
Giglio M, Caggiano G, Dalfino L, Brienza N, Alicino I, Sgobio A, et al. Oral nystatin prophylaxis in surgical/trauma ICU patients: a randomised clinical trial. Crit Care. 2012 Apr 10. 16(2):R57. [QxMD MEDLINE Link].
Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clin Infect Dis. Aug 1 2006. 43 (Suppl 1):S3-S14. [Full Text].
Leleu G, Aegerter P, Guidet B. Systemic candidiasis in intensive care units: a multicenter, matched-cohort study. J Crit Care. 2002 Sep. 17(3):168-75. [QxMD MEDLINE Link].
Zaoutis TE, Heydon K, Localio R, et al. Outcomes attributable to neonatal candidiasis. Clin Infect Dis. 2007 May 1. 44(9):1187-93. [QxMD MEDLINE Link].
Vallabhaneni S, Kallen A, Tsay S, et al. Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus — United States, May 2013–August 2016. MMWR. November 2016. 65:[Full Text].
Cunha BA. Antibiotic Essentials. 9th ed. Sudbury, MA: Jones & Bartlett; 2010.
Brooks M. Micafungin Sodium (Mycamine) Gets Pediatric Indication. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/807188. Accessed: July 2, 2013.
Brexafemme (ibrexafungerp) [package insert]. Jersey City, NJ: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214900s000lbl.pdf. June 2021. Available at [Full Text].

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.

of 10

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, Division of Infectious Diseases, Professor, Department of Medicine, Medical College of Georgia at Augusta University

Jose A Vazquez, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, 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, Michigan Infectious Disease Society, 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.