Mucocutaneus Candidiasis

Dosen Pembimbing :
Dr.dr.Anni Andriani, Sp.KK

Pembimbing Residen :
dr. Evelyn

Group 5
Nursyahira Izzati binti Mohd Ridzuan C 111 12 823
Ayu Aqilah binti Khazani C 111 12 825
Hamizah binti Hasbullah C 111 12 827
Nurathifah binti Mohd Zaki C 111 12 828
 Definition
Candidiasis refers to a diverse group of acute
and chronic yeast infections, most commonly
caused by Candida albicans.
Candida species are among the most common
fungal pathogens to affect humans.
(Lowell A. Goldsmith, 2012)
 Epidemiology
Oropharyngeal colonization with Candidiasis
observed in up to 50% of healthy individuals
and may also detected in 40%-65% of normal
stool samples.
C. albicans exist as a commensal organism in
the vaginal mucosa of 20%-25% of
asymptomatic, healthy women and up to 30%
of healthy pregnant women.
 Vulvovaginal candidiasis is the second most
common cause of vaginitis in women.
Candida sp. are the most common cause of
fungal infection in immunocompromised
patients.
 More than 90% of persons infected with HIV
not receiving highly active anti retroviral
therapy (HAART) develop oropharyngeal
candidiasis and 10% of these patients develop
esophageal candidiasis.
(Lowell A. Goldsmith, 2012)
 Etiology
C. albicans is an oval yeast 26 39 m in
size, which can produce budding cells,
pseudohyphae and true hyphae.
ability to simultaneously display several
morphological forms is known as
polymorphism
(Tony Burns, 2010)
 Other species of Candida, for example C.
tropicalis, C. dubliniensis, C. parapsilosis, C.
guilliermondii, C. krusei, C. pseudotropicalis,
C. lusitaniae, C. zeylanoidesand C.
glabrata(formerly Torulopsis glabrata), are
occasional causes of human candidosis,
particularly in disseminated infections.
(Tony Burns, 2010)
Pathogenesis
 Pathogenesis
Surface molecules that permit
adherence of the organism to other
structures
Proteinase secretions that facilitate
damage to cell envelopes
Ability to convert to a hyphal form
Clinical appearance and
effloresensi
ORAL CANDIDIASIS
 Acute pseudomembranous candidiasis or
thrush
Discrete white patches that resembles
cottage cheese or milk curds on the buccal
mucosa, tongue, palate, and gingivae
consists of desquamated epithelial cells,
fungal elements, inflammatory cells, fibrin,
and food debris
Scraping the patches exposes a brightly
erythematous surface underneath
 Acute atrophic candidiasis (erythematous
candidiasis) after sloughing of the thrush
pseudomembrane
Common location on the dorsal surface of
the tongue (depapillated atrophic
patches with minimal pseudomembrane
formation)
Asymptomatic and symptomatic (burning
or pain).
 Chronic atrophic candidiasis (denture
stomatitis) is a common form of oral
candidiasis seen in 24%60% of
denture wearers and more
commonly occurs in women
Chronic erythema and edema of the
palatal mucosal surface in contact
with the dentures
 Candidal cheilosis (angular cheilitis
or perlche) is characterized by
erythema, fissuring, maceration, and
soreness at the angles of the mouth.
Habitual lip lickers and in elderly
patients with sagging skin at the oral
commissures
VAGINAL AND VULVOVAGINAL
CANDIDIASIS
 Vaginal discharge - thick curd-like
whitish plaques on the vaginal wall
Vulvar pruritus, burning, and
occasional dysuria or dyspareunia
Erythema and surrounding edema
that may extend to the labia and
perineum
 BALANITIS AND
BALANOPOSTHITIS
 Transient erythema and burning occurring shortly
after intercourse.
Pruritic.
White patches on the glans or prepuce.
Small papules or fragile vesiculopustules on the
glans or along the coronal sulcus
May spread to the scrotum, gluteal folds,
buttocks, and thighs.
In diabetic or immunosuppressed patients, a
severe edematous, ulcerative balanitis may
occur.
 Differential Diagnosis

Oral candidiasis Aphthous stomatitis, ulcerative gingivitis

Angular stomatitis Herpes labialis

Vulvovaginal Candidiasis Trikomoniasis, bacterial vaginosis

Balanitis dan Balanoposthitis Herpes genitalis

 INVESTIGATIONS
1. Skin scrapings or mucocutaneous swabs
examined with:
10% KOH solution or gram staining :
VISIBLE of :
1. yeast cells
2. pseudo hyphae
3. blastofore
(Adhi Djuanda, 2011)
 Culture Examination
The sample obtained will be cultured for further
examination in :
1. Agar dextrose glucose Sabouraud
2.Add ons antibiotics to prevent bacterial growth
3.The seeding process will be stored at room or cabinet
temperature of 37 degrees celsius.
4. The colony will grow after 24-48 hours yeast like
colony.
Corn meal agar identify Candida albicans

(Adhi Djuanda, 2011)

 Figure 1 Figure 2

Fig 1.
Candida appearance on gram staining
Fig.2
Microscopic appearance of candida albicans on KOH 10%

David E., 2016. Candidiasis. Mycology Online. School of Molecular and Biomedical
Science. University of Adelaide. Australia.
 Figure 3 Figure 4

Fig .3
KOH 10% show the appearance of budding yeast cells and psudohyphae on skin scrappings sample
Fig .4
PAS stained smear show the appearance of budding yeast cells and pseudohyphae of urin speciment
TREATMENT DAN MANAGEMENT

1. Avoid and eliminate predisposition factors.

2. Topical :
- -1% gentian violet solution for the mucus
membranes, 1-2% for the skin, use 2 times per
day (duration untill 3 days).
- Nistatin : cream, ointment, emulsion.
- Amphotericin B.
(Adhi Djuanda, 2011)
 Azol group :
-Mikonazol 2% : cream or talc, Klotrimazol
1% talc, solution dan cream, Tiokonazol,
butanazol, isokonazol.
Siklopiroksolamin 1% soultion, cream.
Wide spectrum Antimicotik .

(Adhi Djuanda, 2011)

 3. Systemic
-Nistatin tablet :
-used to reduce or relief the focal infection in gastrointestinal
tract
-cannot be absorbed by intestine.

Amfotericin B :
-Given via intravenous in systemic candidiosis.
(Adhi Djuanda, 2011)
For candidosis vaginalis :
-500mg per vaginam single dose
-Ketokonazol 2x200mg for 5 days (systemic)
-itrakonazol 2x200mg single dose
-Flukonazol 150mg single dose
*Itrakonazol : Only use for adult ; 2x100mg per days
for 3 days.

(Adhi Djuanda, 2011)

 Complication
1. Recurrence or repetitive infections
of candida on the skin.
2. Infections on the nails and may
affect areas around the nails.
3. Disseminated candidiasis that would
occur in immunocompromised
patients.
PROGNOSIS
Generally good, depends on the severity of
predisposition factors.

Kuswadji, 2011, Kandidosis. Ilmu Penyakit Kulit dan Kelamin. FKUI. Pg 106
 Bibliography

1. Adhi Djuanda, M. H. (2011). Ilmu Penyakit Kulit dan Kelamin (6th ed.). Jakarta, Indonesia:
Fakultas Kedokteran Universitas Indonesia.
2.John Hunter, J. S. (2011). Clinical Dermatology. Australia: Blackwell Science.
3.Lowell A. Goldsmith, S. I. (2012). Fitzpatrick's Dermatology in General Medicine (8th ed.). New
York: Mc Grawhill.
4.Tony Burns, S. B. (2010). Rook's Textbook of Dermatology (8th ed.). West Sussex: Wiley-Blackwell.
5.Kuswadji, 2011, Kandidosis. Ilmu Penyakit Kulit dan Kelamin. FKUI. Pg 106
6.James, W.D., dkk. 2011, Andrews Disease of the Skin Clinical Dermatoogy. Eleventh Edition.
Saunders Elsevier. United Kingdom. [Page 297-301]
7.Hidalgo J.A., 2015. Candidiasis: Pathophysiology. Medscape. Available at
http://emedicine.medscape.com/article/213853-overview#a6
8. Habif T.P., 2016. Clinical Dermatology. A Color Guide to Diagnosis and Therapy. (Sixth Edition).
China. Elsevier
9. Blander J.M. & Slander L.E,. 2012. Beyond pattern recognition: five immune checkpoints for
scaling the microbial threat: Figure 3: Detecting features of invasiveness, Nature Reviews
Immnunology. Available at http://www.nature.com/nri/journal/v12/n3/fig_tab/nri3167_F3.html
10.David E., 2016. Candidiasis. Mycology Online. School of Molecular and Biomedical Science.
University of Adelaide. Australia.