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Authors: Riyad N.H. Seervai, MD/PhD student at Baylor College of Medicine, Houston, Texas, USA; Claire Jordan Wiggins, Medical Student at Baylor College of Medicine, Houston, Texas, USA. Reviewed by Dr Jane Morgan, Sexual Health Physician, Hamilton, New Zealand. DermNet NZ Editor-in-Chief: Adjunct A/Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. February 2020.
The incidence of non-albicans candidiasis has been increasing over recent years.
Of the known non-albicans candida species, C. tropicalis, C. parapsilosis, and C. orthopsilosis are considered to be part of normal skin flora [2,3].
The clinical features and complications of non-albicans candidiasis are indistinguishable from candidiasis caused by C. albicans .
Vulvovaginal candidiasis is one of the most frequent infections experienced by adult women [5,6]. It presents with vulval irritation, itching, soreness, discomfort with sexual activity (dyspareunia), and a curdy-white vaginal discharge [5,6]. Many non-albicans species have been identified in vulvovaginal candidiasis, with most cases associated with C. glabrata, C. krusei, C. tropicalis, C. parapsilosis, and C. dubliniensis.
Oral candidiasis is caused by an overgrowth of Candida species in the mouth. The two main forms are white oral candidiasis (pseudomembranous candidiasis, hyperplastic candidiasis) and erythematous oral candidiasis (atrophic candidiasis, median rhomboid glossitis, angular cheilitis, linear gingival erythema). Other forms are chronic mucocutaneous candidiasis, cheilocandidiasis (candida affecting lips), and chronic multifocal candidiasis .
Non-albicans species implicated in oral candidiasis include:
Candida species are a part of the normal oral flora of healthy individuals .
Non-albicans Candida species have been isolated from the oral cavity of patients with oral squamous cell carcinoma. There is no connection between the presence of candida and mortality rate from oral cancer .
Systemic candidiasis refers to invasion and growth of Candida in specific organ systems (also called disseminated candida) or the bloodstream (candidaemia). It is an opportunistic infection.
All candida infections are diagnosed by their typical clinical features and by seeing pseudohyphae and yeast forms on microscopy of swabs and scrapings. See laboratory test for fungal infections.
Non-albicans candida in the laboratory
Candida infections are treated using the three approved classes of antifungals: azoles, echinocandins, and amphotericin B. Resistance to azoles, while rare in C. albicans, is frequent with non-albicans species and may contribute to their increased incidence [1,4].
Boric acid, which prevents the growth of fungi, is used in the form of intravaginal suppositories for vulvovaginal candidiasis caused by C. glabrata .
There are few clinical trials reporting the response of non-albicans species to treatment .
C. auris is a multidrug-resistant pathogen with a growing incidence since its initial isolation and discovery in 2009 [21–23]. It causes systemic candidiasis, wound infection, and otitis, and is considered to be iatrogenic [22,23].
Treatments for C. auris are extremely limited; echinocandins are the most frequently recommended option, though several strains are believed to be resistant to all antifungals. Off-patent or repurposed drugs may be tried in the treatment of C. auris infections, with the anti-inflammatory compound Ebselen showing the most promise [25,26].
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