• Candida sp are the most common cause of fungal infections
• It can cause infections that range from benign mucocutaneous illnesses to invasive process that may affect any organ
• Considered as normal flora in the gastrointestinal & genitourinary tracts, but when there is an imbalance in the ecological niche they can invade and cause disease

• Signs and symptoms: Erythematous papules or macules that may be confluent, very pruritic, frequently pustular with distinct border and sometimes accompanied by creamy white exudate or scaling
• Usually occurs in warm moist places (eg inguinal, axillary and intergluteal regions)

• Signs and symptoms of paronychia: Well-localized area of inflammation that becomes warm, glistening, tense and may extend extensively under the nail that usually occurs in persons who frequently immerse hands in the water
• Signs and symptoms of onychomycosis: Thickened, opaque and onycholytic nails

• Signs and symptoms: Creamy white, curd-like patches on the tongue and other oral mucosal surfaces

Esophageal

• Symptoms: Painful swallowing, a feeling of obstruction on swallowing, substernal chest pain, nausea and vomiting

• Occur in patients that have had recent abdominal surgery or intra-abdominal events refers to a heterogenous group of infections that includes peritonitis, abdominal abscess and purulent or necrotic infection at sites of gastrointestinal perforation or anatomic leak
• Symptoms: Abdominal pain (symptoms of gastritis)

• Common in postpubertal females or females in childbearing age
• Symptoms: Vaginal discomfort, vulvar pruritus, curdlike discahrge, erythematous and swollen labia, erythematous with white plaques vaginal walls

• A group of disorders that includes Candida infections of the skin, mucous membranes, hair and nails characterized by a protracted and persistent course despite what is usually adequate therapy
• Signs: Alopecia, esophageal stenosis, disfiguring lesions of the face, scalp, hands

Invasive Candidiasis

Candidemia

• It is the isolation of Candida sp from ≥1 blood culture specimen with hematogenous spread of the yeast to ≥1 organs
• Positive for Candida in a single central-line or peripheral blood culture (BC)
• The following factors predispose to the condition:
  • Abdominal surgery
  • Neutropenia
  • Broad-spectrum antibiotics
  • Indwelling intravenous catheters
  • Peripheral alimentation
  • Cancer chemotherapy
  • Immunosuppressive therapy in transplant patients
  • Colonization with Candida sp
  • Renal failure
• Clinical features include:
  • Fever of unclear etiology
  • Sepsis syndrome
  • Signs of multiple organ involvement including the kidney, brain, myocardium and eye
• Macronodular skin lesions
• Endophthalmitis
• Suppurative manifestations ie micro- and macro-abscesses

• Most infections occur in severely immunocompromised patients and manifest during their recovery from neutropenia
• Signs and symptoms: Persistent fever, abdominal pain, hepatosplenomegaly, increased alkaline phosphatase levels, leukocytosis

• Candidal endocarditis is associated with the following factors:
  • Underlying valvular heart disease
  • Heroin addiction
  • Cancer chemotherapy
  • Implantation of prosthetic valves
  • Prolonged use of intravenous catheters
  • Preexisting bacterial endocarditis

• Signs and symptoms are similar to bacterial endocarditis with the exception of the occurrence of large emboli to major vessels and include the following:
  • Hepatosplenomegaly
  • Hematuria, proteinuria, pyuria
  • Splinter hemorrhages
  • Osler’s nodes
  • Janeway lesions

• Infections within the eye can be:
  • Exogenous affecting the anterior chamber of the eye that occur following trauma or surgical procedure
  • Endogenous is when Candida infection reaches the posterior chamber of he eye via hematogenous spread; it can be manifested as chorioretinitis with or without extension into the vitreous leading to vitritis

• Signs and symptoms: Retina has visible white lesions that may progress to vitritis with high risk of vision loss

• Risk factors:
  • Diabetes
  • History of previous antibiotic use
  • Indwelling urinary catheters
  • Immunosuppressive therapy

• Male patients: Urethral candidiasis usually results from sexual contact with women with Candida vaginitis
• Female patients: Urethral candidiasis infection may be acquired from the extension of Candida vaginitis
• Signs and symptoms: Lower tract infection (cystitis) is usually asymptomatic but may present with dysuria, hematuria, frequency

• Most cases occur in the setting of trauma, neurosurgery, immunosuppression or AIDS
• Signs and symptoms:
  • Meningeal irritation (eg headache, stiff neck, irritability)
  • In the comatose or non-communicative patient, observation of abnormalities is difficult

• Signs and symptoms: Fever and cough

• Often a complication of peritoneal dialysis, gastrointestinal tract surgery and perforation of an abdominal viscus
• Prior antibiotic administration is a predisposing factor

• Signs and symptoms: Arthritis and osteomyelitis (eg similar to disease of bacterial etiology, includes suppurative synovitis)

• Often occur in association with intravenous catheters
• Signs and symptoms:
  • In patients with peripheral septic thrombophlebitis, symptoms may be minimal with the extent of the disease being greater than is apparent on initial clinical assessment
  • Patient may have fever, signs of sepsis and persistent candidemia
  • Suppuration and thrombosis may be present