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Candidiasis in Infant/Neonate
Other Resources UpToDate PubMed

Candidiasis in Infant/Neonate

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

This summary is an overview of local mucocutaneous candidiasis. Local mucocutaneous candidiasis refers to a variety of infections caused by Candida albicans (in 70%-80% of cases) or any of the 200 other yeasts in this genus involving skin and mucous membranes. 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. See also neonatal and congenital candidiasis.

In neonates, Candida is a common cause of mucous membrane infections including oral candidiasis, or thrush. Cutaneous candidiasis includes generalized cutaneous candidiasis, candidal intertrigo, erosio interdigitalis blastomycetica, and perineal skin infections. Paronychia and onychomycosis, diaper dermatitis, and chronic mucocutaneous candidiasis are also cutaneous syndromes.

Deep visceral involvement occurs with disseminated or systemic candidiasis. Approximately 5% of low-birth-weight infants are affected.

Mucous membrane infection: 
Cutaneous candidiasis:
  • 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.
  • Candidal 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. See male genital candidiasis.
  • 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.

Codes

ICD10CM:
B37.2 – Candidiasis of skin and nail

SNOMEDCT:
78048006 – Candidiasis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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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.

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References

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Last Updated:08/16/2021
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Candidiasis in Infant/Neonate
Candidiasis : Erythema, Macerated skin, Pruritus, Pustules, Skin folds
Clinical image of Candidiasis
Erosio interdigitalis blastomycetica showing a macerated and eroded plaque at the finger web.
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