Candidiasis

Excerpt

Candidiasis serves as the overarching term for a spectrum of fungal infections caused by yeasts of the genus Candida and represents the most common fungal infection worldwide. Candida species function as commensal organisms within the normal mycobiome, a fungal community that inhabits the skin, mucosal surfaces, and gastrointestinal tract. The mycobiome constitutes an essential component of the broader human microbiome. Disruption of microbial balance or impairment of host immune function allows Candida species to proliferate, invade host tissues, and produce clinical disease. The mycobiome plays a critical role in immune system development, metabolic regulation, and maintenance of microbial homeostasis. Alterations within this fungal community, referred to as mycobiome dysbiosis, have demonstrated associations with multiple disease states, including inflammatory bowel disease, liver disease, and certain malignancies.

Most mild Candida infections result from localized overgrowth on mucous membranes secondary to changes in the normal microbiota, leading to conditions, eg, oropharyngeal candidiasis, esophagitis, mastitis, balanitis, and vulvovaginitis. Patients with impaired immune responses, including deficiencies in cell-mediated immunity, eg, acquired immunodeficiency syndrome (AIDS), neutropenia, or critical illness requiring intensive care unit (ICU) admission, may develop extensive mucosal disease, bloodstream infections, or invasive dissemination. Candida species exhibit adhesive properties that facilitate biofilm formation on endothelial surfaces, heart valves, osteoarticular structures, prosthetic devices, intravascular catheters, and central nervous system shunts.

Management strategies for candidiasis vary according to infection type and severity, the identified Candida species, and patient-specific health status and risk factors. This article presents a comprehensive overview of candidiasis, including risk factors, epidemiology, clinical manifestations, physical examination findings, diagnostic approaches, and management principles.