Candidiasis in Child
The clinical presentations of candidal infection can be separated into those affecting the mucous membranes, cutaneous syndromes, and invasive candidiasis.
- Mucous membrane infections include thrush, or oral candidiasis; candidiasis of the epiglottitis and esophagitis; and vaginal and vulvovaginal candidiasis.
- Cutaneous candidiasis includes generalized cutaneous candidiasis, candidal intertrigo, erosio interdigitalis blastomycetica, candidal miliaria, and candidiasis of the male genitals (candidal balanitis) and perianal skin.
- Invasive or systemic candidiasis can lead to disseminated disease and deep visceral involvement.
Thrush, or oral candidiasis, is normally seen in infants younger than 1 year or older than 12 years but can be seen in children on medications such as antibiotics or chemotherapy, in immunodeficient children, or in asthmatic patients who take inhaled steroids. The infection manifests as white plaques on the lips, tongue, and palate that bleed on superficial scraping.
Vulvovaginitis occurs commonly in pubertal and postpubertal girls and can arise due to antibiotic or corticosteroid therapy or in adolescent girls who are taking oral contraceptives. Patients complain of pruritus and discharge along with dysuria and dyspareunia in sexually active girls.
Generalized cutaneous candidiasis appears as deep red skin that is edematous and oozing fluid. Crusting and pustular lesions are present as "satellite" lesions. The presence of plaque formation may cause this condition to resemble psoriasis. Infected skin may be localized or widespread, and sometimes the scalp may be affected with resultant hair loss.
Candidal diaper dermatitis develops when sufficient moisture in the diaper area allows C. albicans to proliferate and invade the stratum corneum. Children may experience burning on micturition.
This form of candidiasis is more prevalent in obese or diabetic children. Intertrigo commonly occurs in the axillary region, intergluteal cleft, inguinal folds, and other body folds. Patients frequently feel itchy in these areas. Predisposing factors include moisture, heat and maceration, obesity, and tightly fitting clothing. The skin presents with red erythematous macules with surrounding satellite lesions.
Erosio Interdigitalis Blastomycetica
In erosio interdigitalis blastomycetica, children may develop candidal infection of the web spaces of their fingers or toes if they are constantly moist or remain immersed in water for a long period of time.
Folliculitis is infection of the hair follicles. Although usually localized, it may become widespread and must be differentiated from folliculitis caused by dermatophytes and tinea versicolor.
Male Genital Candidal Infection
Genital candidal infection in boys can manifest as either balanitis or as erythema of the scrotal area or penile shaft.
Mucocutaneous candidiasis is a genetic syndrome linked to defective cell-mediated immunity to Candida antigens in which children experience recurring candidal infections. Chronic skin lesions appear as hyperkeratotic crusted lesions and nail dystrophy. The affected nails are thickened, brittle, and yellow-brown in color and have associated paronychia. Most cases develop in childhood and adolescence.
Systemic or Invasive Candidiasis
See Candida sepsis.
For nail involvement, see paronychia and onychomycosis.
B37.2 – Candidiasis of skin and nail
78048006 – Candidiasis