Pediatric Candidiasis

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Candidal infections are extremely common (see the images below).

Candida albicans is the most common cause of human candidal infections,^[1]but other pathogenic species include Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida lusitaniae, and Candida stellatoidea.

Infections caused by Candida may affect numerous organ systems, such as the eyes, lungs, kidneys, heart, and CNS.

The most common manifestation of candidal infection is diaper dermatitis in infants. Candida organisms can also cause intertrigo in older individuals. Intertrigo has a predilection for dark moist areas, such as the groin or fat folds. Predisposing conditions include diabetes mellitus, obesity, and hyperhidrosis.

A chronic paronychia may be caused by one of several Candida species. Candida organisms can also cause onychomycosis, including total nail dystrophy due to chronic mucocutaneous candidiasis (CMCC), a rare T-cell disorder.

Thrush, or oral candidiasis, is also common in infants. Oral candidiasis may also be an adverse effect from using inhaled corticosteroids for asthma due to oral deposition. Patients who are immunocompromised may suffer from candidal esophagitis as well as thrush.

Vaginal yeast infections affect nearly 75% of women. Male partners may develop balanitis or balanoposthitis. Individuals with chronic indwelling catheters are also predisposed to recurrent candidal infections.

Candida organisms can cause severe systemic infections in immunocompromised patients, compared with benign cutaneous or localized infections in immunocompetent patients. Reports of systemic candidiasis are common in children with acquired immunodeficiency syndrome (AIDS) and other immune deficiencies, as well as in very low birth weight premature infants. Risk factors for candidemia in critically ill children have been identified.^{[2, 3]}Manifestations include fungemia, endophthalmitis, meningitis, renal or bladder bezoars, and arthritis.

Numerous factors can contribute to the likelihood of candidal infections. An intact skin barrier is protective. Candidal infections are promoted in the face of lymphocyte dysfunction, as is observed in persons with AIDS and those with CMCC. Adherence of Candida organisms to oral and vaginal epithelium is believed to be promoted by biologic factors (eg, fibronectin in thromboses) and by iatrogenic factors (eg, presence of plastic catheters, disruption of normal bacterial flora). In neonates, risk factors include indwelling catheters, prolonged antibiotic use, necrotizing enterocolitis, previous bloodstream infections, total parenteral nutrition, and low birth weight.

CMCC is a heterogeneous group of disorders characterized by chronic candidal infections of the nails, skin, and mucous membranes. Most CMCC disorders are autosomal recessive and related to a mutation in the AIRE gene.^[4]Lymphocyte numbers are normal; however, response to in vitro exposure to candidal antigen is absent.

United States

Thrush occurs in approximately 2-5% of healthy newborns and a slightly higher percentage of infants in the first year of life. Vaginal candidal infections occur in approximately 75% of women, and 40-50% of women experience recurrence. Approximately 2-5% of premature infants weighing less than 1500 g develop disseminated disease.^[5]

Candidal infections rarely cause significant morbidity in the healthy host. However, systemic disease may be found in as many as 15% of patients who are neutropenic. Mortality in low birth weight premature infants with systemic candidiasis may reach 50%. Candida is the second leading cause of sepsis in critical care patients.

No racial predilection is noted.

Vaginal candidosis is a frequent problem among women and adolescent girls. No gender predilection is noted in other forms of candidiasis.

In the healthy host, candidal infections are most common in the first year of life as thrush or diaper dermatitis. Vulvovaginitis is more common in adolescent and adult females.

Crislip MA, Edwards JE Jr. Candidiasis. Infect Dis Clin North Am. 1989 Mar. 3(1):103-33. [Medline].

Zaoutis TE, Prasad PA, Localio AR, Coffin SE, Bell LM, Walsh TJ, et al. Risk Factors and Predictors for Candidemia in Pediatric Intensive Care Unit Patients: Implications for Prevention. Clin Infect Dis. 2010 Jul 16. [Medline].

Lee JH, Hornik CP, Benjamin DK Jr, Herring AH, Clark RH, Cohen-Wolkowiez M, et al. Risk Factors for Invasive Candidiasis in Infants >1500 g Birth Weight. Pediatr Infect Dis J. 2012 Oct 4. [Medline]. [Full Text].

Green L, Dolen WK. Chronic Candidiasis in Children. Curr Allergy Asthma Rep. 2017 May. 17 (5):31. [Medline].

Steinbach WJ, Roilides E, Berman D, Hoffman JA, Groll AH, Bin-Hussain I, et al. Results From a Prospective, International, Epidemiologic Study of Invasive Candidiasis in Children and Neonates. Pediatr Infect Dis J. 2012 Dec. 31(12):1252-1257. [Medline].

Blyth CC, Palasanthiran P, O’Brien TA. Antifungal therapy in children with invasive fungal infections: a systematic review. Pediatrics. 2007 Apr. 119(4):772-84. [Medline].

Kaufman D, Boyle R, Hazen KC. Twice weekly fluconazole prophylaxis for prevention of invasive Candida infection in high-risk infants of J Pediatr</i>. Aug 2005. 147(2):172-9. [Medline].

Healy CM, Baker CJ, Zaccaria E. Impact of fluconazole prophylaxis on incidence and outcome of invasive candidiasis in a neonatal intensive care unit. J Pediatr. Aug 2005. 147(2):166-71. [Medline].

Uko S, Soghier LM, Vega M, Marsh J, Reinersman GT, Herring L, et al. Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants. Pediatrics. 2006 Apr. 117(4):1243-52. [Medline].

Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1. 48(5):503-35. [Medline]. [Full Text].

Manzoni P, Wu C, Tweddle L, Roilides E. Micafungin in premature and non-premature infants: a systematic review of 9 clinical trials. Pediatr Infect Dis J. 2014 Nov. 33 (11):e291-8. [Medline].

Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15. 62 (4):409-17. [Medline].

Swift D. New Guideline Calls for Aggressive Treatment of Candidiasis. Medscape Medical News. Available at http://www.medscape.com/viewarticle/856415. December 23, 2015; Accessed: February 8, 2016.

Ericson JE, Kaufman DA, Kicklighter SD, et al. Fluconazole Prophylaxis for the Prevention of Candidiasis in Premature Infants: A Meta-analysis Using Patient-level Data. Clin Infect Dis. 2016 Sep 1. 63 (5):604-10. [Medline].

Kicklighter SD, Springer SC, Cox T, et al. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics. Feb 2001. 107(2):293-8. [Medline].

Long SS, Stevenson DK. Reducing Candida infections during neonatal intensive care: management choices, infection control, and fluconazole prophylaxis. J Pediatr. Aug 2005. 147(2):135-41. [Medline].

Manzoni P, Arisio R, Mostert M. Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics. Jan 2006. 117(1):e22-32. [Medline].

Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, et al. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007 Jun 14. 356(24):2483-95. [Medline].

Mondal RK, Singhi SC, Chakrabarti A, M J. Randomized comparison between fluconazole and itraconazole for the treatment of candidemia in a pediatric intensive care unit: a preliminary study. Pediatr Crit Care Med. 2004 Nov. 5(6):561-5. [Medline].

Feja KN, Wu F, Roberts K, et al. Risk factors for candidemia in critically ill infants: a matched case-control study. J Pediatr. 2005 Aug. 147(2):156-61. [Medline].

Kaufman DA. Aiming for zero: preventing invasive Candida infections in extremely preterm infants. NeoReviews. July, 2011. 12(7):e381-e392.

Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses. Clin Infect Dis. 2006. 43:S15-27.

Bacheller CD, Bernstein JM. Urinary tract infections. Med Clin North Am. 1997 May. 81(3):719-30. [Medline].

Antifungal agents. Benitz WE, Tatro DS, eds. The Pediatric Drug Handbook. 3rd ed. St. Louis, Mo: Mosby; 1975.

Benjamin DK Jr, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment. Pediatrics. 2010 Sep 27. [Medline].

Boiko S. Making rash decisions in the diaper area. Pediatr Ann. 2000 Jan. 29(1):50-6. [Medline].

Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 3rd ed. Baltimore, Md: Williams & Wilkins; 1990.

Chow BD, Linden JR, Bliss JM. Candida parapsilosis and the neonate: epidemiology, virulence and host defense in a unique patient setting. Expert Rev Anti Infect Ther. 2012 Aug. 10(8):935-46. [Medline]. [Full Text].

Denning DW, Evans EG, Kibbler CC, et al. Fungal nail disease: a guide to good practice (report of a Working Group of the British Society for Medical Mycology). BMJ. 1995 Nov 11. 311(7015):1277-81. [Medline].

Dodds Ashley ES, Lewis R, Lewis JS. Pharmacology of sytemic antifungal agents. Clin Infect Dis. 2006. 43:S28-39.

du Vivier A, McKee PH, eds. Atlas of Clinical Dermatology. Philadelphia, Pa: WB Saunders; 1986.

Elder ME. T-cell immunodeficiencies. Pediatr Clin North Am. 2000 Dec. 47(6):1253-74. [Medline].

Elewski BE. Cutaneous mycoses in children. Br J Dermatol. 1996 Jun. 134 Suppl 46:7-11: discussion 37-8. [Medline].

Fidel PL Jr, Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev. 1999 Jan. 12(1):80-96. [Medline].

Harriet Lane Service, Children’s Medical and Surgical Center, Johns Hopkins Hospital. Formulary. Siberry GK, Iannone R, eds. The Harriet Lane Handbook. 15th ed. St Louis, Mo: Mosby; 2000.

Hay RJ. The management of superficial candidiasis. J Am Acad Dermatol. Jun 1999. 40(6 Pt 2):S35-42. [Medline].

Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J. Sep 1997. 16(9):885-94. [Medline].

Hsieh E, Smith PB, Jacqz-Aigrain E, Kaguelidou F, Cohen-Wolkowiez M, Manzoni P, et al. Neonatal fungal infections: when to treat?. Early Hum Dev. 2012 May. 88 Suppl 2:S6-S10. [Medline]. [Full Text].

Kauffman CA. The changing landscape of invasive fungal infections: epidemiology, diagnosis, and pharmacologic options. Clin Infect Dis. 2006. 43:S1-2.

Kaufman DA. “Getting to Zero”: preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants. Early Hum Dev. 2012 May. 88 Suppl 2:S45-9. [Medline].

Kaufman DA. Challenging issues in neonatal candidiasis. Curr Med Res Opin. 2010 Jul. 26(7):1769-78. [Medline].

Kaufman DA. Epidemiology and prevention of neonatal candidiasis: fluconazole for all neonates?. Adv Exp Med Biol. 2010. 659:99-119. [Medline].

Kaufman DA. Neonatal candidiasis: clinical manifestations, management, and prevention strategies. J Pediatr. Apr 2010. 156 (Suppl 2):S53-S67.

Legrand F, Lecuit M, Dupont B, Bellaton E, Huerre M, Rohrlich PS. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. 2008 Mar 1. 46(5):696-702. [Medline].

Leibovitz E. Strategies for the prevention of neonatal candidiasis. Pediatr Neonatol. 2012 Apr. 53(2):83-9. [Medline].

McClelland RS, Richardson BA, Hassan WM, Graham SM, Kiarie J, Baeten JM, et al. Prospective Study of Vaginal Bacterial Flora and Other Risk Factors for Vulvovaginal Candidiasis. J Infect Dis. 2009 Jun 15. 199(12):1883-1890. [Medline].

Odio CM, Araya R, Pinto LE. Caspofungin therapy of neonates with invasive candidiasis. Pediatr Infect Dis J. Dec 2004. 23(12):1093-7. [Medline].

Odom RB. Common superficial fungal infections in immunosuppressed patients. J Am Acad Dermatol. 1994 Sep. 31(3 Pt 2):S56-9. [Medline].

Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clin Infect Dis. 2006. 43:S3-14.

Schwarze R, Penk A, Pittrow L. Administration of fluconazole in children below 1 year of age. Mycoses. Apr 1999. 42(1-2):3-16. [Medline].

Singhi SC, Reddy TC, Chakrabarti A. Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med. Jul 2004. 5(4):369-74. [Medline].

Smith PB, Morgan J, Benjamin JD, et al. Excess costs of hospital care associated with neonatal candidemia. Pediatr Infect Dis J. 2007 Mar. 26(3):197-200. [Medline].

Smith PB, Steinbach WJ, Benjamin DK. Neonatal candidiasis. Infect Dis Clin North Am. Sep 2005. 19(3):603-15. [Medline].

Steinbach WJ. Antifungal agents in children. Pediatr Clin North Am. Jun 2005. 52(3):895-915, viii. [Medline].

Winston DJ, Pakrasi A, Busuttil RW. Prophylactic fluconazole in liver transplant recipients. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. Nov 16 1999. 131(10):729-37. [Medline].

Working Group of the British Society for Medical Mycology. Management of genital candidiasis. BMJ. 1995 May 13. 310(6989):1241-4. [Medline].

Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006. 55(RR-11):1-94. [Medline].

Zaoutis TE. Pediatric fungal infections: a conundrum in children. J Pediatr. 2010/04. 156 (Suppl 2):S47-S52.

Zaoutis TE, Heydon K, Localio R, Walsh TJ, Feudtner C. Outcomes attributable to neonatal candidiasis. Clin Infect Dis. 2007 May 1. 44(9):1187-93. [Medline].

Zaoutis TE, Jafri HS, Huang LM, Locatelli F, Barzilai A, Ebell W. A prospective, multicenter study of caspofungin for the treatment of documented Candida or Aspergillus infections in pediatric patients. Pediatrics. 2009 Mar. 123(3):877-84. [Medline].

Tsekoura M, Ioannidou M, Pana ZD, Haidich AB, Antachopoulos C, Iosifidis E, et al. Efficacy and Safety of Echinocandins for the Treatment of Invasive Candidiasis in Children: A Meta-analysis. Pediatr Infect Dis J. 2019 Jan. 38 (1):42-49. [Medline].

Sabah Kalyoussef, DO Attending Physician, Pediatric Infectious Diseases and Hospital Medicine, The Children’s Hospital at St Peter’s University Hospital

Sabah Kalyoussef, DO is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society