See also treatment of Fungal Infections
Candidiasis:
Candidiasis is a fungal infection caused by yeast from the genus Candida. Candidiasis can be mucocutaneous or invasive; the most common invasive form is Candida bloodstream infection (candidemia), which is among the most frequent health care associated infection in the US. Additional forms of invasive candidiasis can occur after diseemination of Candida from the bloodstream to ther nroamlly sterile boyd sites (e.g., the abdomen, bones, eyes, heart, kidneys or lungs). Candidemia is assocaited with costly hospitalization, high morbidity, and high call cause mortality (about 25%).
Candidiasis is a dimorphic fungus with yeast on mucosal surfaces. It is actually part of one’s normal flora in skin, mouth and intestines and stays as yeast but it forms hyphae when invasive. When the normal balance of microbiota is disrupted, the yeast proflierates and causes inflaamtion. Candida species are responsible for a majority of superficial and disseminated fungal infections in humans.
Candidemia can occur after disruption of the body’s skin and mucosal barriers, includig in the intestines. The infection might develop after translocation of Candida from the gut through disruptions in the intestinal mucosa, making abdominal surgeries a candidemia risk factor. Critical illness might predispose patients to candidemia because of immune dysregulation from physiologic stress and becasue care for critically ill patietns often invovles using indwelling medical devices (e.g., central venous catheters), which can serve as entry points for infection. Additional candidemia risk factors include malignancies, hemodialysis, diabetes, and receipt of immunosuppressive medications (including corticosteroids), total parenteral nutrition and systemic antibacterial medications.
Treatment of Candidiasis:
Treatment includes cessation of antibiotic and can also include itraconzaole. Itraconazole works by inhibiting a fungal enzyme necessary to produce ergosterol, a vital component of the fungal cell membrane. This interference compromises the membrane’s integrity, leading to the fungal cell’s death.
Within the limited antifungal armamentarium, the azole antifungals are the most frequent class used to treat Candida infections. Azole antifungals such as fluconazole are often preferred treatment for many Candida infections as they are inexpensive, exhibit limited toxicity, and are available for oral administration. There is, however, extensive documentation of intrinsic and developed resistance to azole antifungals among several Candida species. See Rogers
There are several classes of compounds that comprise the arsenal used to treat Candida infections. The polyenes, azoles, echinocandins, nucleoside analogs, and allylamines are used with varying efficacy depending on the type and site of infection and the sensitivity of the Candida species.
Treatment of candidiasis, from superficial to invasive infections, relies on a limited drug arsenal, composed of 3 major classes of antifungal drugs: polyenes, azoles and echinocandins. The polyenes were the first class of antifungal drugs introduced into the clinic (in the1950s) and include amphotericin B and nystatin. These amphipathic molecules bind to the ergosterol in fungal cell membranes and form pores, leading to leakage of intracellular constituents and impaired protein traffic through the membrane. Triazoles, including both first generation (fluconazole and itraconazole) and second generation (voriconazole and posaconazole), comprise the most commonly used class of antifungals. The introduction of triazoles in clinics during the 1980s and 1990s revolutionized medical mycology, and until the introduction of the
echinocandins fluconazole was the drug of choice in the treatment of most C. albicans infections. All triazoles are inhibitors of C14a-lanosterol demethylase, a key enzyme involved in the biosynthesis of ergosterol; thus disturbing the integrity of the fungal cell membranes. Echinocandins, including anidulafungin, micafungin and caspo-fungin, inhibit the synthesis of b-1,3 glucan, a major polysaccharide of the fungal cell wall and, therefore, is the only antifungal class to target an exclusive fungal component.
Azole Antifungals: Within the limited antifungal armamentarium, the azole antifungals are the most frequent class used to treat Candida infections. Azole antifungals such as fluconazole are
often preferred treatment for many Candida infections as they are inexpensive, exhibit
limited toxicity, and are available for oral administration. There is, however, extensive
documentation of intrinsic and developed resistance to azole antifungals among several
Candida species. See Rogers
Candida Species:
Candida species are the predominant fungi isolated from infected medical devices and account for ~15% of hospital-acquired cases of sepsis.
Candida species is the most common oral cavity-colonising fungus, which is a unicellular, dimorphic (blastospore and mycelium) eukaryote cell with sexual and asexual reproduction. It contains a cell wall that is external to the cell membrane. The plasma membrane contains large quantities of ergosterol. Many species of Candida occur in the oral cavity and are identified during a diseased and commensal state. The most common species are Candida albicans, C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, C. guilliermondii and C. dubliniensis. Among these Candida species, C. albicans is the species most frequently isolated from the oral cavity as well as from extraoral sites.
Candida albicans:
C albicans is a dimorphic fungus that is noraml biota in the majority of humans, living in low numbers on many mucosal surfaces such as the mouth, gastrointestinal tract and vagina. In otherwise healthy people, the fugus is not invasisive.
Candida albicans is the most commonly identified Candida species in clinical contexts and is one of the leading causes of hospital-acquired infections. However, in healthy humans, C. albicans is usually a harmless member of the native microbiota and asymptomatically colonizes many niches, including the gastrointestinal tract, reproductive tract, mouth and skin.
C. albicans is a common commensal fungus that colonizes the oropharyngeal cavity,
gastrointestinal and vaginal tract, and healthy individuals’ skin. In 50% of the population, C. albicans is part of the normal flora of the microbiota. The various clinical manifestations of Candida species range from localized, superficial mucocutaneous disorders to invasive diseases that involve multiple organ systems and are life-threatening. C. albican causes oral thrush and vaginal yeast infections, and can also infect the blood, heart and other internal organs. The mortality rate of Candida auris, which often spreads in hospitals, can be as high as 60%, according to the CDC.
Although yeast infection is the most common cause, there are several other etiologies that exist and must be considered by the provider. These include the following infectious and noninfectious etiologies: 1) Candidal species (most commonly associated with diabetes) 2) Group B and group A beta-hemolytic streptococci 3) Neisseria gonorrhea 4) Chlamydia species 5) Anaerobic infection 6) Human papillomavirus 7) Gardnerella vaginalis 8) Treponema pallidum (syphilis) 9) Trichomonas species 10) Borrelia vincentii and Borrelia burgdorferiNoninfectious etiologies.
Candidad albicans is normally present on the skin of the glans and can be a considered normal flora. The yeast can cause infection in certain circumstances, especially when the patient has underlying conditions, poor hygiene, overgrowth, or changes in baseline pH. Oral prostheses, such as removable partial and full dentures and prostheses placed after corrective surgeries, are known to be risk factors for Candida colonisation and hence development of oral infections. In total, 60% to 100% of denture wearers carry Candida in their oral cavity. Dentures decrease the flow of oxygen and saliva to the underlying tissues, creating an acidic, anaerobic environment, which is conducive to Candida growth. In addition, surface characteristics: porosity and hydrophobicity of denture acrylic and the denture lining allow adhesion of Candida.
In addition to forming biofilms on implanted medical devices (for example, catheters, pacemakers, heart valves, joint pros-theses and dentures), C. albicans biofilms also form on host surfaces, including mucosal surfaces, epithelial cell linings and parenchymal organs. Existing antifungal drugs, at concentrations effective against planktonic C. albicans, are largely ineffective against C. albicans cells in biofilms. Although much higher concentrations can be effective against biofilms, these doses often cause serious side effects to the host (that is, kidney or liver damage). Resistance to antifungal drugs associated with C. albicans biofilms and the ability to colonize implanted medical devices have been linked to increased medical costs and negative patient outcomes. See Nobile
The cell wall is made of glucan, chitin, and protein. Its role is to protect the cell
from stressful conditions in the environment, such as osmotic changes, dehydration, and
temperature changes, and protect the cells from the host’s immune defense
Many systemic and topical preparations containing antifungal agents such as fluconazole, amphotericin B, miconazole, nystatin and clotrimazole are available for the treatment of oral candidiasis. Treatment is relatively easy, apart from the side effects, threat of over-use and development of resistance.
–Treatment: There vaccine is available for C. albicans. Topical and oral azole drugs are used to treat vaginal candidiasis and many of them are available over the counter.
The most commonly prescribed antifungal used for most C. albicans infections is fluconazole, a member of the azole class of antifungals. Azoles inhibit 14-α-sterol demethylase, encoded by the ERG11 gene, which is an enzyme involved in the biosynthesis of the fungal-specific membrane sterol ergosterol. As some NAC species exhibit intrinsic resistance to azoles, their use is likely a contributing factor to the more frequent incidence of infections caused by these NAC species. Infections caused by C. albicans are associated with varying levels of fluconazole resistance depending on the type of infection. C. albicans isolates from candidemic patients have the lowest incidence of azole resistance (0–5%). The incidence of fluconazole resistance in C. albicans isolates from oropharyngeal candidiasis (OPC) is higher and depends upon previous fluconazole treatment and prior OPC infections. See Rogers
Candida auris:
Candida auris is listed as one of the four critically important fungal agents in the “Fungal Priority List” document published by the World Health Organization (WHO) in October 2022. Therefore, it was recommended that C. auris be focused on as the main area of research. C. auris can survive on surfaces for extended periods and expresses more adhesion molecules than other Candida species.
C. auris is a frequently multidrug resistant fungal pathogen, poses an urgent public health threat due to its potential to spread within and between health care facilities. Facilities that offer dialysis services might face particular challenges in prebenting and ocntaining C. auris and other multidrug-resistant pathogens, given the frequent use of invasive treatments in an immune compromised patient population. Recommendations include chaning personal protective equipment (PPE) (including town and gloves) between patient encounters, throughly cleaning and disinfecting the dialysis station between patient treatments using disinfectant products, scheduling the patients’ dialysis during the alst shfit of the day, when patient traffic is lower for patients colonized or infected with C. auris. (Godwin, “Candida auris containment responses in health care facilities that provide hemodialysis services -New Jsery, North Carolina, South Caroline, and Tennessee, 2020-2-23” MMWR, 74(25), 2025)
–Control/Disinfection: Chlorhexidine is a biocide often used in products targeted for
skin disinfection and is known to be effective against Candida. To disinfect hands or skin to avoid the spread of C. auris, alcohol-based products are recommended. An antiseptic containing 3% hydrogen peroxide showed to have a poor performance against C. auris as only a 1.4-log reduction was obtained. For hard surface disinfection, the CDC suggests the use
of Environmental Protection Agency (EPA)-registered products approved for healthcare and the ECDC recommends European Standards (EN)-registered products with antifungal claims. The WHO suggests cleaning with soap and water followed by disinfection with 0.1%
bleach (1,000 ppm). See Teska
In one study, 200 ppm chlorine-containing cleaning products produced for toilet cleaning were found to be ineffective against both clade 1 and clade 4 C. auris. Chlorine-based disinfectants are generally ineffective in dirty environments. Hence, cleaning with water and soap is recommended before using chlorine-based disinfectants. A concentration of 70% alcohol had a predominantly fungicidal action on C. auris. This biocide is the most widely used product as a hand sanitizer. It has different forms, with or without chlorhexidine. Chlorhexidine is generally present in hand sanitizer products at a concentration of 2%. However, 2% chlorhexidine was not found to be effective on C. auris. Therefore, it is not recommended for use for skin cleansing. However, 2% chlorhexidine in alcohol was demonstrated to be effective against C. auris. See Kalcanci
species
Candida tropicalis: is the second most virulent Candida species after C. albicans. It is among the 5 most common Candida species found in a healthcare setting. This diploid yeast (yeast is a type of fungus) is prevalent in Latin America and Asia and occasionally reported in Africa and Europe. (“emergence of flucytosin-resistant Candida tropicalis clade, the Netherlands” 31(7) -July 2025).
Some fungal infections can be passed on sexually – these include Thrush, Jock Itch (like athletes foot, but around the genitals) and Balanitis (inflammation of the end of the penis). Infectious etiologies of balanitis include certain fungi like yeast and certain bacteria or viruses (including those that cause STDs such as gonorrhea).
Vulvovaginal candidiasis:
Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing.
Vulvovaginal candidiasis (VVC) affects around three-quarters of all women during their reproductive age, although the exact incidence of VVC is difficult to determine because many patients are self-treated. The infections are divided into complicated and uncomplicated. Uncomplicated VVC is most effectively treated with local azoles. Oral treatment with a single dose of fluconazole is also effective for treating uncomplicated VVC. Treatment of complicated VVC is prolonged and most commonly consists of multiple doses of oral fluconazole or at least 1 week of local azoles.