ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesInformation for PatientsView all Images (20)
Candidiasis in Infant/Neonate
Print Captions OFF
Other Resources UpToDate PubMed

Candidiasis in Infant/Neonate

Print Patient Handout Images (20)
Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH, Nancy Esterly MD
Other Resources UpToDate PubMed

Synopsis

Candidiasis refers to a variety of infections caused by Candida albicans (in 70%-80% of cases) or any of the 200 other yeast species in this genus.

Candida albicans is also a normal commensal and colonizes the oropharynx of up to 50% of asymptomatic people; 10% of neonates acquire gastrointestinal and respiratory colonization immediately after birth, with skin colonization occurring after 2 weeks. Factors predisposing to colonization in newborns include premature birth, abdominal surgery, receiving ventilatory support, being catheterized, and being on broad-spectrum antibiotics.

The clinical presentations of candidal infection can be separated into those affecting the mucous membranes, the cutaneous syndromes, and deep visceral involvement.
Mucous Membrane Infections
Thrush, or oral candidiasis, is normally seen in infants younger than 1 year.

Cutaneous Candidiasis
Cutaneous candidiasis includes the following:
  • Generalized cutaneous candidiasis is an eruption of lesions covering the trunk, thorax, and extremities; lesions are accentuated in the genitocrural folds and around the anus as well as the axillae, hands, and feet. The skin is erythematous, and lesions are initially discrete and then coalesce into larger plaques. Fissuring of the skin may be present.
  • Intertrigo occurs where skin surfaces are closely apposed to each other. The most common sites are the axillary, inframammary, gluteal, and genitocrural regions. Intertrigo results from widespread colonization, especially of macerated folds of moist skin. This usually presents as inflammation of the skin folds and starts as vesicles and pustules. The skin appears erythematous with surrounding vesicles and pustules.
  • Erosio interdigitalis blastomycetica is candidal infection of the web spaces of the fingers and the toes. The skin lesions appear red and macerated and may extend onto the digits. Pustules may also be present. The toxic dermatitis initiated by Candida species is usually followed by infection with gram-negative rods, exacerbating the chronicity of the lesion.
  • Candidal folliculitis is infection of the hair follicles. Although usually localized, it can become widespread and must be differentiated from folliculitis caused by dermatophytes and tinea versicolor.
  • Candidal balanitis presents as vesicles on the penis that cause intense itching and burning. The lesions may also spread to the scrotum, thighs, and gluteal folds.
  • Angular cheilitis can be caused by candidal infection of the angles of the mouth and results in macerated skin with deep creases and crust formation.
Systemic Candidiasis
Systemic candidiasis ranges in severity from a mild infection to sepsis and shock. Systems commonly affected include the kidneys, with resultant hypertension or renal failure or the development of fungal balls leading to obstruction and hydronephrosis. Central nervous system (CNS) involvement is also frequent, occurring in one-third of cases, and endophthalmitis is seen in almost one-half of cases.

Cutaneous lesions of systemic candidiasis are of 3 characteristic varieties. They may be macronodular lesions or lesions that resemble ecthyma gangrenosum or purpura fulminans. The typical cutaneous manifestations of disseminated candidiasis are usually situated on the trunk and extremities and include erythematous papules with a pustular or hemorrhagic center.

Codes

ICD10CM:
B37.2 – Candidiasis of skin and nail

SNOMEDCT:
78048006 – Candidiasis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required

References

Subscription Required

Last Updated: 09/15/2017
Copyright © 2019 VisualDx®. All rights reserved.
Candidiasis in Infant/Neonate
Captions OFF Print 20 Images Filter Images
View all Images (20)
(with subscription)
 Reset
Candidiasis : Burning skin sensation, Erythema, Inframammary fold of chest, Macerated skin, Inguinal region, Pustules
Clinical image of Candidiasis
Erosio interdigitalis blastomycetica showing a macerated and eroded plaque at the finger web.
Copyright © 2019 VisualDx®. All rights reserved.