| 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
|
