Candidiasis
Infections caused by *Candida* species ranging from mucosal disease to candidaemia and deep organ infection. *Candida albicans* remains common, but non-albicans species and azole resistance are increasingly relevant in hospitalised patients.
Key Facts
Key points
- Oropharyngeal: fluconazole 50–100 mg OD 7–14 days**; nystatin topical alternative.
- Vulvovaginal: fluconazole 150 mg** single oral dose; topical azoles.
- Invasive/candidaemia: echinocandin first line (caspofungin 70 mg IV loading then 50 mg OD**).
- Fluconazole step-down (400 mg OD) if susceptible isolate and stable.
- Remove intravenous lines where possible; ophthalmology review for candidaemia (endophthalmitis screen).
- Chronic mucocutaneous candidiasis suggests immune deficiency — investigate.
Overview
Risk factors for invasive disease
Central lines, TPN, broad-spectrum antibiotics, ICU, immunosuppression.
Clinical Presentation
Mucosal
White plaques, sore mouth; vulval itch/discharge.
Invasive
Fever with candidaemia; hepatosplenic lesions in chronic disseminated disease.
Differential Diagnosis
| Condition | Notes |
|---|---|
| HSV oral ulcers | Vesicular, different distribution |
| Bacterial sepsis | Positive blood cultures |
Diagnosis / Investigation
Microbiology
Blood cultures; species ID and susceptibility.
Imaging
Abdominal imaging if deep candidiasis suspected.
Management
Candidaemia
- Anidulafungin/caspofungin/micafungin per BNF dosing.
- Duration often ≥14 days after first negative culture and resolution of signs.
Oesophageal (HIV)
- Fluconazole 200–400 mg OD until symptom resolution — maintain ART.
Prognosis
Mucocutaneous: excellent. Candidaemia: mortality significant; early echinocandin and line removal improve outcomes.
Other Relevant Information
C. auris
Outbreak risk in healthcare settings — infection control alert.