Overview Candida spp., although rare Central Nervous System (CNS) pathogens, can infect both the meninges and the parenchymal brain tissue. In practice, the majority of cases of CNS candidiasis are associated with disseminated or invasive candidiasis (IC). On this page we will focus on the discussion of this form of infection and will refer to it as IC-related CNS Candidiasis. Another form of candidal CNS infection is the one occurring as a postoperative complication of neurosurgical procedures, especially ventriculo-peritoneal (VP) shunt placement. Because of the unique characteristics of this patient population, we have a separate discussion neurosurgery-related CNS candidiasis. Epidemiology About […]

Overview Chronic mucocutaneous candidiasis (CMC) is the label given to a group of overlapping syndromes that have in common a clinical pattern of persistent, severe, and diffuse cutaneous candidal infections. These infections affect the skin, nails and mucous membranes. As suggested by Kirkpatrick’s papers on this topic [1196, 1197, 1198], the syndromes of CMC can be grouped as follows: Classification of Chronic Mucocutaneous Candidiasis (CMC) (A):Chronic oral candidiasis Related to denture stomatitis HIV-associated candidiasis Related to inhaled corticosteroid use (A):CMC and polyendocrinopathy Localized CMC Diffuse CMC CMC with thymoma CMC with interstitial keratitis CMC associated with “KID” (keratitis, ichthyosis, deafness) […]

Overview It has been proposed that the asymptomatic colonization with Candida might be associated with a variety of symptoms and cause a “Candida Hypersensitivity Syndrome” [599] This concept was popularized by William Crook, MD in his book The Yeast Connection [491]. Previously, C.O. Truss, a physician from Birmingham, Alabama had proposed the existence of such a malady [2257, 2259]. Other names that have been given to this presumed condition include: Candida-Related Complex Polysystemic Candidiasis Chronic Candidiasis (This term should not be confused with Chronic Mucocutaneous Candidiasis) The syndrome is theoretically due to an overgrowth of Candida albicans in the gastrointestinal […]

Overview Candida spp. are the most frequent fungal agent causing cardiac infection both in adults and children [137, 1981, 2361]. From a histopathologic perspective three types of cardiac candidiasis may occur and are discussed on this page: (A):endocarditis, myocarditis, and pericarditis. Candidal Endocarditis   Overview Candidal endocarditis is a severe condition that has been traditionally associated with an exceptional high mortality and recurrence rates [2040]. Both native and prosthetic valves may be affected [1981]. Combining medical with surgical interventions, the hospital survival rates have been commonly below 50%. The highest long term survival rate is 67% [137, 1135, 1513, 1592, […]

Overview Candidemia is the isolation of Candida from one or more blood specimens. While it is more convincing to have two or more positive cultures, even a single culture should not be ignored. An important debate took place for many years regarding the possibility that candidemia could be an insignificant finding. It is possible for any organism in a blood culture to represent contamination of the specimen during the collection process, and early reports also suggested that candidemia was often a trivial process that could simply be ignored [664]. This idea was gradually reversed by reports showing that candidemia was […]

Overview Unlike oropharyngeal candidiasis, Candida vulvovaginitis is generally not considered an opportunistic infection. The majority of cases of Candida vulvovaginitis occur in perfectly healthy women and respond well to (A):conventional antifungal treatments for Candida vulvovaginitis. Epidemiology Vaginal colonization Candida spp. are part of the lower genital tract flora in 20 to 50% of healthy asymptomatic women [855]. Carriage rates are higher in: Women treated with broad spectrum antibiotics [346, 1693]. Pregnant women [256, 346]. Diabetic women [2300]. Women with the diagnosis of AIDS (CD4+ counts < 200 cells/mL) [629]. Lower CD4+ T-cell counts are associated with higher rates of colonization […]

Overview Most cases of onychomycosis are due to dermatophytes, and we discuss this entity separately under our N/A(L):general discussion of onychomycosis. However, Candida spp. also cause this condition, and there are enough differences to warrant a separate discussion. Onychomycosis due to dermatophytes occurs more frequently in toenails than in fingernails. Conversely, candidal onychomycosis more commonly affects the fingernails. Indeed, about 50% of cases of fingernail-related onychomycosis is caused by Candida spp. In addition, most episodes of Candida onychomycosis begin as paronychial infections (“whitlow”). In other words, infection begins in the structures around the nail rather than in the nail itself. […]

Overview Candida pneumonia is one of the most challenging of all the Candida infections. Rules for a practical and accurate diagnostic approach are elusive. As Candida spp. are frequent asymptomatic colonizers of the upper respiratory tract, especially among hospitalized patients, the predictive value of sputum and even bronchoalveolar cultures for actual candidal lung invasion is very low. In addition, physicians would ideally like to distinguish hematogenous Candida pneumonia related to invasive candidiasis from isolated lung infection. However, in the clinical practice such discrimination is very difficult. Nevertheless, in order to make this discussion meaningful, some standards must be applied. The […]