Yeast Infections (candidiasis)

Candidiasis (moniliasis) is an infection caused by several varieties of candida (‘fungi’), especially candida albicans. Infection of mucous membranes, such as occurs in the mouth or vagina, is common among individuals with a normal immune system. However, these conditions are more frequent or persistent in people with diabetes or AIDS patients and in pregnant women.

They are part of the group of the most frequent diseases that affect man and it can even be said that practically all men throughout their life will ever suffer. There are three types of human mycosis: superficial, intermediate like candidiasis and deep. The usual ones in Spain are superficial ones and candidiasis. In this section we will discuss mucocutaneous candidiases, whose pathogenic agent is Candida albicans.

Candida is commonly found in the mucous membranes of humans. However, these same strains can become pathogenic, increasing their degree of growth and grouping in the form of clusters or colonies. The penetration in the mucosal membrane cause irritation and detachment of the tissues.


The majority of Candida species are saprophytic and can be part of the cutaneous flora with the exception of Candida albicans, which when found on the skin is the etiological agent of a primary candidiasis. There are multiple factors predisposing to candida infection: some depend on the host and others on environmental conditions.

Among the first are the physiological, genetic and acquired. Thus newborns, women in the premenstrual period or pregnant women, patients with Down syndrome, diabetes, lymphoma, leukemia, who take antibiotics or corticosteroids or immunosuppressants or have debilitating diseases, are more likely to suffer from this dermatosis. Among the environmental factors humidity, heat, chronic maceration, for example, of the commissures in the elderly, dental prostheses poorly adjusted, friction between two skin surfaces favor infestation.

Types of Candidiasis

Cutaneous Candidiasis

The initial lesion is characterized by the presence of one or several superficial vesicles, which rupture and expose an eroded red background that does not bleed. When the fold is opened, a more or less extended background is seen bright and moist red; at the bottom there is a crack that may be covered by a whitish magma of macerated skin. Patients may feel a more or less accentuated itching and burning sensation. If the lesion is scraped with a scalpel blade or edge of a slide, wet and pasty chip species are collected.

Candidal Intertrigo.

Candidal Intertrigo.

This infection appears in the folds of the skin, where there is a moist environment, conducive to the development of yeast. Pruritus, hypersensitivity and pain are frequent symptoms. In this type of infection, the erythematous pustules erode and converge. Then, very well defined plaques appear, polycyclic, erythemated and eroded with small pustular lesions in the periphery (satellite pustulosis). This disease is commonly distributed in the inframammary or submammary zones, the armpits and English, the perineal and intergluteal cleft, among others.


Candidal Intertrigo Interdigital

This infection is more frequent in elderly or obese people. Beginning with the formation of a pustule that erodes causing fissure or cracking between the fingers, usually between the third and fourth finger, probing maceration in the interdigital space. This mycosis can reach the nails (paronychia).

Diaper rash.

Diaper rash.

In this variant, as its name implies, it attacks babies. These present Irritability and discomfort with urination, defecation or diaper change. The lesions appear in the genital and perianal areas, or even the inner surface of the thighs and buttocks. they manifest in the form of erythema and edema with papular and pustular lesions. The erosion and flaking of the skin in the form of a collar at the edges of the lesion is also observed.

Treatment (also Balanitis)

Topical  Imidazole or ciclopirox cream  or lotion twice a daily  for 1 – 2 weeks or until resolvedq

Systemic agents for recalcitrant or severe cases r


  • 50 to 100 mg per orally, daily for 14 days
  • 150 mg per orally, weekly for 2- 4 weeks


  • 200 mg po twice daily for 14 days

Oropharyngeal candidiasis


It is the most common of the oral affections. It is common in babies up to 3 months of age (lack of serum candidiasis factor, acidity of the baby’s mucosa, etc.); in the adult it is more rare, its appearance is favored in the elderly by the use of artificial denture and in patients with treatments with antibiotics, chemotherapy, rays, HIV +, etc. The lesion may present with red and shiny mucosa (erythematous form) or lesions may appear as whitish plaques that can converge forming true membranes, very adherent as embedded in the epithelium (acute or chronic pseudomembranous form), other common is Angular cheilitis or nozzles.

Oral candidiasis is the most observed fungal infection in HIV patients
(+). The disease occurs in 50% of HIV patients (+) and in 90% of patients with AIDS. Candida albicans is the most frequently isolated species; the species of
Candida no C.albicans are found in patients with AIDS and CD4 counts
very low (less than 100 CD4 / mm3).
In these patients, more than one Candida species can appear and as a result of fluconazole treatments, recurrences are due to Candida species with decreased sensitivity or insensitive to this antifungal (C. glabrata, C. krusei).

Pseudomembranous candidiasis

Pseudomembranous candidosis

Oral Thrush: Candida colonizes the back of the tongue, buccal mucosa, soft palate and pharynx. It can even extend to the esophagus and the tracheobronchial tree. The infection is identified by the appearance of white particles similar to cottage cheese (colonies of Candida) on any surface of the mucosa; these have a variable size of 1 to 2 mm. Extraction with a dry gauze dressing leaves an erythematous mucosal surface.

Angular cheilitis.

Angular cheilitis.

Intertrigo at the corners of the lips. Erythema; slight erosion. White colonies of Candida in some cases. It is usually accompanied by oropharyngeal colonization by Candida.


Nystatin* 100 000 units/ml suspension:

  • Children and adult 4-6 ml swish and swallow qid
  • Infant 2 ml (1 ml inside each cheek) qid

Clotrimazole* 10 mg troche five times daily

Fluconazole° 200 mg po on day 1, then 100 – 200 mg po daily.

Continue treatment for 7 to 14 days after clinical resolution

Genital candidiasis

The most common symptoms are itching, burning when urinating or having sex. Other characteristic symptoms are the reddening of the mucous membranes and the secretion of a white and odorless substance, something dense, lumpy, similar to cut milk. Gray-white pseudomembranous plaques can be found in the vaginal mucosa. The entire genital area is very inflamed and, in general, the itching is very intense. They can occur as an isolated episode or as recurrent episodes.



Erosions, edema, erythema, swelling, cottage cheese-like material that can be removed. Pustule on the lateral portion of the vulva and on the adjacent skin.



The most common symptoms are itching, burning when urinating or having sex. Other characteristic symptoms are the reddening of the mucous membranes and the secretion of a white and odorless substance, something dense, lumpy, similar to cut milk. Gray-white pseudomembranous plaques can be found in the vaginal mucosa. The entire genital area is very inflamed and, in general, the itching is very intense. They can occur as an isolated episode or as recurrent episodes.


Balanitis of the glans and preputial sack


Balanitis (or balanoposthitis) by Candida: it is a superficial erosion, with erythematous or pseudomembranous zones in the area of ​​the glans or in the balanopreputial sulcus. Also maculopapular lesions with diffuse erythema. Edema, ulcerations and fissures in the foreskin, usually in diabetic men; white plates under the foreskin.

Treatment (except balanitis)

Fluconazole * 150 mg po single dose or (for severe disease or immunosuppressed patient) three doses at 3 day intervals.

Butoconazole 2 % vaginal cream, 5 g daily for 1-3 days.

Clotrimazole*  f

  • 1 % vaginal cream (or other topical formulation), 5 g daily for 7 – 14 days.
  • Vaginal suppositories: 100 mg daily for 7 days or 200 mg daily for 3 days

Miconazole*  f 200 mg po daily

  • 2 % vaginal cream 5 g daily for 7 days.
  • Vaginal suppositories: 100 mg daily for 7 days or 200 mg daily for 3 days or 1200 mg single dose

Tioconazole* 6.5 % cream, 5 g single dose


  • 0.4 % or 0.8 % cream 5 g daily for 7 days or 3 days respectively.
  • 80 mg vaginal suppositories  daily for 3 days

Nystatin * 100 000 units vaginal suppositories daily for 14 days

For suppression patient with recurrent infection:

Fluconazole 150 mg weekly for 6 months.

Clotrimazole Vaginal suppositories: 200 mg twice weekly or 500 mg weekly for 6 month.

Esophageal candidiasis

Oropharyngeal candidiasis.

Involves esophagus, stomach and intestine.

The esophageal condition can be part of the canker sore that starts in the mouth. It can appear in patients treated with ATB, corticosteroids, radiation, with diabetes, HIV (+). The most frequent clinical symptoms are odynophagia, dysphagia, retrosternal pain, hemorrhage, nausea, vomiting, although the picture may be asymptomatic.
By endoscopy, lesions similar to canker sores are observed and classified as
different degrees:
I: only a few 1 mm plates
II: larger white or erythematous plaques
III: nodular and elevated plaques, frank ulceration
IV: Same as type III + lumen narrowing
The stomach is the second most frequently attacked site.
Patients with cancer or prolonged treatments with pH depressants are predisposed.
Gastric infection may manifest as an aphthae, but ulcer is more common in the mucosa. The majority of these cases are diagnosed by autopsy.
Candida enteritis is a rare condition. It is more frequent in patients with advanced malignancies, AIDS patients or with severe immunosuppression.
The diagnosis is very difficult to establish since it requires the demonstration of invasion of the intestinal mucosa by Candida or the repeated isolation of the microorganism from ulcerative lesions.

Resistant to the usual treatment. Recurrence after satisfactory treatment.
Chronic infection produces hypertrophic candidosis (leukoplakia).
Cutaneous candidosis manifests as: intertrigo.
Disseminated infection of face, trunk or limbs. The lesions become hypertrophic in chronic cases that are not treated.
The infection of the nail apparatus is invariable: chronic paronychia; infection and dystrophy of the nail plate; Sooner or later total nail dystrophy occurs. Many patients also have dermatophytosis and skin warts.


Fluconazole* 200 – 400 mg po on day 1, then 100 – 400 mg daily.

Intraconazole 200 mg po daily
Voriconazole 200 mg po or iv bid
Ponaconazole 400 mg po bid
Caspofungin 50 mg po iv daily

Continue treatment for 7 to 14 days following resolution of symptoms, for a minimum of 21 days total.

Disseminated candidiasis

Candidemia: it consists of the finding of the fungus in blood culture samples, without immunological changes in the host and in the absence of demonstrable visceral involvement, except for the cutaneous – mucosal location. It may be transient (isolated positive blood culture) or persistent (repeated positive blood cultures).
In most cases the disappearance of funguemia is obtained by removing the catheter and if the patient does not have associated immunosuppression factors, it is not necessary to indicate systemic antifungals.
Candidemia in immunosuppressed, particularly neutropenic, always it must be considered as a systemic infection, potentially serious, the risk of death is high and the laboratory procedures for diagnosis are slow, and specific treatment must be indicated in all cases.
It is more frequent in patients with malignant hematological diseases and in pathologies or surgeries involving the TGI.This variant of candidiasis is rare, it is seen mainly in immunosuppressed patients, usually with defects in the amount of neutrophils (neutropenia).

Treatment complementary notes

* Recommended as first line of treatment for immunocompetent individuals.

° Recommended as first line of treatment for HIV-infected patients (or immunosuppressed individuals) with moderate or severe disease, recurrent infection or a CD4 count of < 200 ml cell/ mcl.

f Preferred treatment (with 7 day regiments) for pregnant patients.

r Outside the settings of chronic mucocutaneus candidiasis, chronic systemic suppressive therapy in immunosuppressed individuals is discouraged due to the risk of colonization with resistant organisms.

Ä  In cases of recurrent vulvovaginitis, treatments of patient’s sexual partner is controversial; in contrast for recurrent Balanitis, eradication of Candida from sexual partner’s   genital tract is generally recommended.

q After clinical resolution, topical treatments may be continued twice weekly to prevent recurrence.

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3 comments on “Yeast Infections (candidiasis)

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