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Clinical Features Oropharyngeal (OPC) (i.e., thrush): white mucosal patches. Vulvovaginal (VVC): pruritis, edema, or erythema with or without white discharge. Esophagitis: retrosternal pain and difficulty swallowing. Bloodstream infection and disseminated disease--usually fever and chills unresponsive to antibiotic therapy. Rarely, pneumonia, osteomyelitis, arthritis, hepatosplenic infection, and endophthalmitis.
Etiologic Agent Candida albicans and less commonly, C. tropicalis, C.parapsilosis, C. glabrata, and C. krusei. Rarely, other Candida species.
Incidence Fourth most common cause of nosocomial bloodstream infections. Incidence is 8 cases/100,000 in the general population; higher incidence among neonates and African-Americans. Overall, 75% of adult women have had at least one episode of VVC during their lifetimes. OPC in HIV-positive patients is a common opportunistic infection.
Sequelae None with appropriate antifungal therapy. High case-fatality rate is associated with bloodstream and disseminated infection.
Transmission Infection may be endogenous (colonizing flora), less commonly may be a nosocomial infection transmitted on hands of healthcare personnel, and is particularly associated with intravascular catheters. Sexual transmission of VVC has been reported but is not common.
Risk Groups Invasive disease occurs in critically ill patients in intensive-care units with intravascular lines, persons receiving multiple antibiotic therapy, persons with granulocytopenia, postsurgical patients, and bone marrow and organ transplant recipients. OPC in HIV-infected patients. VVC is associated with birth control pills, diabetes mellitus, antibiotic and corticosteroid therapy.
Surveillance Nosocomial disease surveillance is conducted by NNIS in selected hospitals. Population-based active surveillance for candidemia is being conducted in select U.S. areas.
Trends The incidence of candidiasis has increased recently, reflecting the overall increased number of susceptible severely immunocompromised patients.
Challenges Diagnosis of invasive disease can be difficult, blood cultures can be falsely negative and invasive biopsy may be needed. Advent of effective, less toxic oral antifungal drugs (i.e., fluconazole) has facilitated therapy, but these drugs may also select for infections caused by Candida species innately resistant to azoles (C. krusei, and C. glabrata) or strains with acquired azole resistance.
Opportunities Development of new rapid noninvasive antigenemia and antigenuria tests and molecular probes may facilitate clinical diagnosis. Availability of molecular typing methods (RFLP) may assist in tracing nosocomial transmission in outbreak investigations.

December 1999



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This page last reviewed April 6, 2000

Centers for Disease Control and Prevention
National Center for Infectious Diseases
Division of Bacterial and Mycotic Diseases
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