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Candidiasis — Clinical Guidelines

Overview

Candidiasis encompasses infections caused by Candida species, commonly affecting mucosal surfaces but potentially leading to invasive disease, particularly in immunocompromised individuals. 1 3 18

Diagnosis

Microscopic examination of clinical specimens (e.g., vaginal smears) for hyphae and blastospores. 12

Culture of Candida species from relevant sites (e.g., blood, urine, tissue). 1 3 18

Urine D-arabinitol/L-arabinitol ratio for diagnosing invasive candidiasis in high-risk patients. 17

Histopathology for invasive forms, especially in atypical presentations like oesophageal or tonsillar candidiasis. 23 21

Fungal antigen detection tests in specific contexts (e.g., candiduria). 13

Management

First-line treatments:

- Topical antifungals: Miconazole for oral thrush in palliative care patients. 6 - Systemic antifungals: Fluconazole for less severe cases; echinocandins (e.g., micafungin) for severe or refractory infections. 9 15

Adjunctive measures:

- Address underlying conditions (e.g., discontinuing immunosuppressive agents). - Proper cleaning and disinfection protocols for medical devices to prevent nosocomial transmission. 4 19

Special Populations

Pediatrics: Micafungin dosing considerations in neonates and young infants for hematogenous candidiasis. 9

Immunocompromised: Increased vigilance for invasive candidiasis, especially in hematological malignancies and HIV patients. 17 23

Elderly: Higher risk of nosocomial acquisition and complications due to prolonged hospital stays and multiple comorbidities. 19

Key Recommendations

Use urine D-arabinitol/L-arabinitol ratio for diagnosing invasive candidiasis in febrile neutropenic patients with hematological malignancies. (Evidence: Moderate) 17

Employ echinocandins like micafungin for severe or refractory candidiasis in critically ill patients, especially neonates. (Evidence: Moderate) 9 15

Implement stringent disinfection protocols for medical devices to prevent nosocomial candidiasis transmission in healthcare settings. (Evidence: Moderate) 4 19

Monitor and manage warfarin levels carefully when prescribing topical antifungals to patients on anticoagulants to avoid interactions. (Evidence: Expert opinion) 24

References

1 Yang X, Liu T, Lei J, Cai W, Mai Y, Tang X. Drug-Related Candidiasis Risk Profiling: A Real-World Pharmacovigilance Study Leveraging the FDA Adverse Event Reporting System (FAERS). Mycoses 2025. link 2 Zhou T, Chen C, Chen X, Wang B, Sun F, Li W et al.. Possible adverse events of imidazole antifungal drugs during treatment of vulvovaginal candidiasis: analysis of the FDA Adverse Event Reporting System. Scientific reports 2024. link 3 Barac A, Cevik M, Colovic N, Lekovic D, Stevanovic G, Micic J et al.. Investigation of a healthcare-associated Candida tropicalis candidiasis cluster in a haematology unit and a systematic review of nosocomial outbreaks. Mycoses 2020. link 4 Hassaine-Lahfa I, Boucherit-Otmani Z, Sari-Belkherroubi L, Boucherit K. Retrospective study of Candida sp. contaminations of endoscopes at the University Hospital of Tlemcen (Algeria). Journal de mycologie medicale 2017. link 5 Poulat C, Nivoix Y, Launoy A, Lutun P, Bachellier P, Rohr S et al.. Assessment of high-priced systemic antifungal prescriptions. Medecine et maladies infectieuses 2017. link 6 Lagman R, Davis M, LeGrand S, Walsh D, Parala A, Gamier P et al.. Single-Dose Fluconazole Therapy for Oral Thrush in Hospice and Palliative Medicine Patients. The American journal of hospice & palliative care 2017. link 7 Al-Mubarak L, Krakowski AC. A Q-Tip Tip: Use of a Cotton-Tipped Applicator to Desensitize Children to Intralesional Candida Antigen. Pediatric dermatology 2016. link 8 Hassan TI, Mahony M. Oesophageal candidiasis in an immunocompetent child. Irish medical journal 2014. link 9 Hope WW, Smith PB, Arrieta A, Buell DN, Roy M, Kaibara A et al.. Population pharmacokinetics of micafungin in neonates and young infants. Antimicrobial agents and chemotherapy 2010. link 10 van de Veerdonk FL, Kullberg BJ, Verschueren IC, Hendriks T, van der Meer JW, Joosten LA et al.. Differential effects of IL-17 pathway in disseminated candidiasis and zymosan-induced multiple organ failure. Shock (Augusta, Ga.) 2010. link 11 Moriarty AT, Darragh TM, Fatheree LA, Souers R, Wilbur DC. Performance of Candida--fungal-induced atypia and proficiency testing: observations from the College of American Pathologists proficiency testing program. Archives of pathology & laboratory medicine 2009. link 12 Engberts MK, Goedbloed AF, van Haaften M, Boon ME, Heintz PM. Microscopic diagnosis of vulvovaginal candidiasis in stained vaginal smears by Dutch general practitioners. Acta cytologica 2007. link 13 Branda JA, Kratz A. Effects of yeast on automated cell counting. American journal of clinical pathology 2006. link 14 Tada R, Nagi-Miura N, Adachi Y, Ohno N. Candida albicans derived fungal PAMPS, CAWS, water soluble mannoprotein-beta-glucan complex shows similar immunotoxicological activity with bacterial endotoxin from Escherichia coli O9. Biological & pharmaceutical bulletin 2006. link 15 Canivet JL. Clinical impact of the fungicidal activity of caspofungin administered alone or in combination in critically ill patients with severe abdominal candidiasis refractory to conventional antifungal drugs: case studies and critical review of the problem. Acta clinica Belgica 2004. link 16 Alasio TM, Lento PA, Bottone EJ. Giant blastoconidia of Candida albicans. A case report and review of the literature. Archives of pathology & laboratory medicine 2003. link 17 Eisen DP, Bartley PB, Hope W, Sigmundsdottir G, Pehrson C, Larsson L et al.. Urine D-arabinitol/L-arabinitol ratio in diagnosing Candida infection in patients with haematological malignancy and HIV infection. Diagnostic microbiology and infectious disease 2002. link00310-8) 18 Jautová J, Virágová S, Ondrasovic M, Holoda E. Incidence of Candida species isolated from human skin and nails: a survey. Folia microbiologica 2001. link 19 Fanello S, Bouchara JP, Jousset N, Delbos V, LeFlohic AM. Nosocomial Candida albicans acquisition in a geriatric unit: epidemiology and evidence for person-to-person transmission. The Journal of hospital infection 2001. link 20 Nakamura K, Niimi M, Niimi K, Holmes AR, Yates JE, Decottignies A et al.. Functional expression of Candida albicans drug efflux pump Cdr1p in a Saccharomyces cerevisiae strain deficient in membrane transporters. Antimicrobial agents and chemotherapy 2001. link 21 Shah GK, Vander J, Eagle RC. Intralenticular Candida species abscess in a premature infant. American journal of ophthalmology 2000. link00404-3) 22 Sutcliffe R, Hughes SF, Winslet MC. Fungal ball of the oesophagus. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 1999. link 23 Kuo MJ, Warfield AT, Nye KJ, Crocker J. Invasive candidiasis of the tonsil. The Journal of laryngology and otology 1997. link 24 Ezsiás A, Wojnarowska F, Juniper R. Topical use of miconazole antifungal oral gel on warfarinized patients: a word of caution. Dental update 1997. link 25 Gomez MJ, Torosantucci A, Arancia S, Maras B, Parisi L, Cassone A. Purification and biochemical characterization of a 65-kilodalton mannoprotein (MP65), a main target of anti-Candida cell-mediated immune responses in humans. Infection and immunity 1996. link 26 Bailie GR, Romeo B. New York State primary care physicians' attitudes to community pharmacists' clinical services. Archives of internal medicine 1996. link 27 Marcilla A, Mormeneo S, Elorza MV, Manclus JJ, Sentandreu R. Wall formation by Candida albicans yeast cells: synthesis, secretion and incorporation of two types of mannoproteins. Journal of general microbiology 1993. link 28 Peison B, Benisch B. Phagocytosis of Candida parapsilosis by polymorphonuclear leukocytes. New Jersey medicine : the journal of the Medical Society of New Jersey 1992. link 29 Gil ML, Casanova M, Martínez JP, Sentandreu R. Antigenic cell wall mannoproteins in Candida albicans isolates and in other Candida species. Journal of general microbiology 1991. link 30 Shibata N, Fukasawa S, Kobayashi H, Tojo M, Yonezu T, Ambo A et al.. Structural analysis of phospho-D-mannan-protein complexes isolated from yeast and mold form cells of Candida albicans NIH A-207 serotype A strain. Carbohydrate research 1989. link80006-0) 31 Tronchin G, Robert R, Bouali A, Senet JM. Immunocytochemical localization of in vitro binding of human fibrinogen to Candida albicans germ tube and mycelium. Annales de l'Institut Pasteur. Microbiology 1987. link90194-3) 32 Darcis JM, Etienne M, Demonty J, Christophe J, Pierard GE. Candida albicans septicemia with folliculitis in heroin addicts. The American Journal of dermatopathology 1986. link 33 Pugh TF, Fitch SJ. Invasive gastric candidiasis. Pediatric radiology 1986. link 34 Gerster JC, Glauser MP, Delacretaz F, Nguyen T. Erosive candida arthritis in a patient with disseminated candidiasis. The Journal of rheumatology 1980. link 35 Heckmatt JZ, Meadow SR, Anderson CK. Acute anuric renal failure in an infant with systemic candidiasis. Archives of disease in childhood 1979. link 36 Kelvin FM, Clark WM, Thompson WM, Hauch T. Chronic oesophageal stricture due to moniliasis. The British journal of radiology 1978. link 37 Kernbaum S. Effects of hyperosmolality on candidacidal activity of human neutrophil polymorphonuclear leukocytes and on clumping of Candida albicans by human serum. Biomedicine / [publiee pour l'A.A.I.C.I.G.] 1976. link 38 Axelsen NH. Quantitative immunoelectrophoretic methods as tools for a polyvalent approach to standardization in the immunochemistry of Candida albicans. Infection and immunity 1973. link 39 Garcia Mendoza C, Garcia Lopez MD, Uruburu F, Villanueva JR. Structural and immunological studies on the protoplast membrane of the yeast Candida utilis. Journal of bacteriology 1968. link

Candidiasis