What is candida?
Candida is the name for a group of yeasts (a type of fungus) that commonly infect the skin. The name ‘candida’ refers to the white colour of the organisms in culture. Candidal infection is known as ‘candidiasis’, ‘candidosis’ or ‘moniliasis’ (monilia is also a genus of ascomycete fungi).
Who gets candida?
Candida depends on a living host for survival. It is a normal inhabitant of the human digestive tract from early infancy, where it lives without causing any disease most of the time. However, if the host's defences are lowered, the organism can cause infection of the mucosa (the lining of the mouth, anus and genitals), the skin, and rarely, deep-seated infection.
How is candida classified?
The most common Candida (C) species to result in candidiasis is C. albicans. Other species are:
- C. tropicalis
- C. parapsilosis
- C. glabrata
- C. guilliermondii
Candidal skin infections include
- Oral candidiasis (oral thrush)
- Angular cheilitis
- Vulvovaginal candidiasis (genital infection in women) including cyclic vulvovaginitis
- Balanitis (penile infection)
- Intertrigo (skin fold infections)
- Napkin dermatitis (nappy or diaper rash)
- Chronic paronychia (nail fold infection)
- Onychomycosis (nail plate infection)
- Chronic mucocutaneous candidiasis
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Predisposing factors for candida infection
- Infancy or old age
- Warm climate
- Occlusion e.g. plastic pants (babies), nylon pantyhose (women), dental plates
- Broad spectrum antibiotic treatment
- High-oestrogen contraceptive pill or pregnancy
- Diabetes mellitus, Cushing's syndrome and other endocrine conditions
- Iron deficiency
- General debility e.g. from cancer or malnutrition
- Underlying skin disease e.g. psoriasis, lichen planus
- Immunodeficiency e.g. low levels of immunoglobulins, infection with human immunodeficiency virus (HIV)
- Chemotherapy or immunosuppressive medications such as systemic steroids
invasive candidiasis refers to spread of candida through the bloodstream (candidaemia) and infection of heart, brain, eyes, bones, and other tissues. This occurs in patients that are very unwell or that are immune suppressed. The common species of candida are usually found on culture, but sometimes one of about 15 other species are detected, such as:
- C auris
- C haemulonii
How is candida diagnosed?
Microscopy and culture of skin swabs and scrapings aid in the diagnosis of candidal infections. However, candida can live on a mucosal surface quite harmlessly. It may also secondarily infect an underlying skin disorder such as psoriasis. The results of laboratory tests must be correlated with the clinical presentation.