| Clinical
Features |
Oropharyngeal infection (OPC): white
mucosal patches. Vulvovaginal infection (VVC): pruritus, vulval
erythema, with or without discharge. Systemic infection usually
presents as fever and chills unresponsive to antibacterial
therapy. May manifest as renal or hepatosplenic infection,
meningitis, endophthalmitis, endocarditis, osteomyelitis and/or
arthritis. |
| Etiologic
Agent |
Candida albicans and C.
glabrata. Less commonly, C.tropicalis, C. parapsilosis,
and C. krusei. Rarely, other Candida species.
|
| Reservoir |
Forms part of the normal microbial
flora of the mouth and gastrointestinal tract. |
| Incidence |
Fourth most common cause of nosocomial
bloodstream infections. Incidence is 8 cases per 100,000 in
the general population. Higher incidence among neonates and
African-Americans. OPC used to be a common opportunistic infection
in HIV-infected persons (prior to the introduction of highly
active antiretroviral therapy [HAART]). |
| Sequelae |
None with appropriate antifungal
therapy. Mortality rate is almost 50% with bloodstream and
disseminated infection. |
| Transmission |
Most infections are endogenous in
origin, but organisms can be transmitted on the hands of care
givers. |
| Risk
Groups |
Invasive disease occurs in critically
ill patients in intensive-care units, in persons with severe
granulocytopenia, and in hematopoietic stem cell and organ
transplant recipients. OPC can be associated with HIV infection.
VVC is often associated with pregnancy, diabetes mellitus,
and antibiotic therapy. |
| Surveillance |
Nosocomial disease surveillance
is conducted by NNIS in selected hospitals. Active population-based
surveillance for candidemia is being conducted in selected
U.S. sites. |
| Challenges |
Identifying modifiable risk factors
for disease in immunocompromised and debilitated persons.
Developing sensitive and specific methods for earlier diagnosis. |
| Opportunities |
Development of rapid antigenemia
and antigenuria tests and molecular probes may facilitate
earlier clinical diagnosis. Availability of molecular typing
methods may assist in epidemiologic studies. |
|
December 2003
|
