Candidiasis is a fungal infection caused by Candida.

bubble_chart Etiology

Candida is widely distributed in nature and is one of the normal flora of the human body. It can be detected in the oropharynx, anus, vagina, midstream urine, and skin of healthy individuals. Candida can cause infections of the skin, mucous membranes, internal organs, bones, and brain through exogenous or endogenous pathways, and may even lead to fungemia or sepsis through hematogenous dissemination. Most cases of candidiasis are caused by Candida albicans. Under normal circumstances, Candida albicans coexists with the human body in a symbiotic state and does not cause disease. However, when this symbiotic balance is disrupted, infections can occur, hence it is also referred to as an opportunistic infection. Therefore, Candida is considered an opportunistic pathogen. Predisposing factors for infection include prolonged use of antibiotics, immunosuppressants, antineoplastic drugs, corticosteroids, surgical trauma, organ transplantation, compromised immune function, certain chronic sexually transmitted diseases, leukemia and malignant tumors, endoscopic procedures, and advanced age. The incidence of this disease has significantly increased in recent years, warranting attention.

bubble_chart Clinical Manifestations

(1) Cutaneous Candidiasis Bingben type is mostly exogenous infection, caused by Candida albicans invading the epidermis and triggering an inflammatory reaction. It is generally not accompanied by mucous membrane or visceral infections.

1. Intertriginous erythema is commonly seen in obese women and individuals with latent diabetes. The lesions frequently occur in the perianal region, gluteal cleft, groin, armpits, neck, and breast folds. Infection often results from warmth, humidity, and skin maceration. The lesions present as erythema with clearly defined borders, often surrounded by satellite-distributed papules and vesicles. The surface of the papules typically exhibits a collarette-like scale.
2. Interdigital intertrigo is common among workers who are constantly exposed to water and housewives, primarily affecting the spaces between the middle and ring fingers. The interdigital epidermis becomes macerated and whitish, and upon removal of the epidermis, an eroded surface is revealed.
3. Candidal paronychia manifests as redness, swelling, and pain around the nail, with a pale white exudate upon pressure. It may lead to secondary suppurative felon. The course is chronic and often complicated by candidal onychomycosis.
4. Candidal diaper rash predominantly affects newborns and can occur as early as one day after birth. The characteristic lesions are bright red patches with well-defined borders on the buttocks and external genitalia, surrounded by satellite-distributed papules and pustules. The papules have a collarette-like scale on their surface. Some patients may also have thrush concurrently.

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1. Oral candidiasis, also known as thrush (thrush), is relatively common and often occurs in malnourished infants. It typically affects the gums, lateral edges of the tongue, and the oral and pharyngeal mucous membranes. The lesions present as grade I erythema covered with white, curd-like pseudomembranes that can be easily wiped away, exposing an eroded surface. If the condition spreads to the esophagus or trachea, it can lead to visceral candidiasis.
2. Candidal vulvovaginitis is often triggered by pregnancy, diabetes, or prolonged antibiotic use. Mixed bacterial infections are also not uncommon. Symptoms include increased leucorrhea, vulvar cutaneous pruritus, and a burning sensation. The leucorrhea appears curd-like, and the vaginal mucous membrane and vulvar skin exhibit erythema with grayish-white, cheese-like pseudomembranes on the surface.
3. Candidal balanitis is more likely to occur in individuals with redundant foreskin. Patients often contract the disease through sexual intercourse with partners who have candidal vaginitis. Symptoms include erythema with superficial erosions, covered by white scales, and may present with satellite-like small papules and pustules. Cutaneous pruritus and a burning sensation are common.

1. Pulmonary candidiasis can result from direct spread of oral or bronchial candidiasis, hematogenous dissemination, or secondary to other pulmonary diseases. Symptoms include low-grade fever, cough, and thick white sputum. Chest X-rays are nonspecific, and diagnosis relies on fungal examination.
2. Gastrointestinal candidiasis clinically presents as esophagitis, angular cheilitis, colitis, or perianal inflammation. Additionally, candidal endocarditis, meningitis, and septicemia may occasionally occur.

bubble_chart Diagnosis

Cutaneous and mucosal candidiasis can be diagnosed based on clinical manifestations and fungal examinations. The clinical presentation of visceral candidiasis is complex and lacks specificity, but most Candida infections occur on the basis of an underlying condition. Therefore, if a patient develops new symptoms and signs that cannot be explained by the primary disease, along with the presence of various predisposing factors and positive fungal test results, candidiasis should be considered.

bubble_chart Treatment Measures

(1) Cutaneous Candidiasis

This condition is relatively easy to treat, primarily with topical antifungal medications. Options include 1-3% clotrimazole cream or 2% miconazole cream (Daktarin).

(2) Mucosal Candidiasis

Oral clotrimazole or ketoconazole is often required. Tioconazole cream (Trosyd) shows rapid efficacy for candidal vaginitis. Alternatively, vaginal irrigation with 2% sodium bicarbonate solution can be used. Traditional Chinese medicines such as Sophora, stemona root, Cnidium Fruit, belvedere fruit, Chinese Gentian, Coptis Rhizome, and Carpesium Fruit can be decocted for external washing or sitz baths.

(3) Visceral Candidiasis

1. Intravenous amphotericin B at 0.1-0.7mg/kg daily. Patients with meningitis require intrathecal administration.
2. 5-fluorocytosine at 8g daily for adults or 150mg/(kg·d) for children.
3. Ketoconazole 0.2g twice daily orally.
4. Polyaldehyde nystatin 50,000 units for aerosol inhalation to treat pneumonia, twice daily.
5. Administer transfer factor injections to enhance immune function.
6. Actively prevent and treat underlying diseases.
7. Use antibiotics and corticosteroids rationally.