Introduction
Infections caused by Candida sp are major causes of morbidity and mortality causing diverse spectrum of clinical diseases that range from superficial and mucosal infections to invasive disease associated with candidemia and metastatic organ involvement. Mucocutaneous candidiasis may appear in otherwise healthy individuals, unlike in invasive candidiasis and candidemia that mostly affects immunocompromised or critically ill individuals. Patients undergoing treatment with new targeted biologics (eg IL-17 inhibitors) are predisposed to Candida infections.
Epidemiology
Candidiasis affects approximately 1,565,000 individuals annually, affecting those at the extremes of age, patients with impaired immunity (eg those with advanced human immunodeficiency virus [HIV] disease or uncontrolled diabetes, as well as people with poor oral hygiene). Candidiasis is also one of the most prevalent opportunistic infections in patients with advanced HIV, affecting up to 20%, often diagnosed together with esophageal candidiasis. While vulvovaginal candidiasis affects as much as 75% of women at least once in a lifetime; 50% with a second episode, and up to 10% with recurrent vulvovaginal candidiasis.
In Asia, vulvovaginal candidiasis remains a public health concern, albeit with limited data on its prevalence. Current studies show a pooled estimated prevalence of vulvovaginal candidiasis of 23%, with Laos having the highest estimated prevalence at 33%. Pregnancy and high sexual activity (ie sex workers) show higher estimated prevalence.
Candidiasis_Disease BackgroundPathophysiology
Candidiasis occurs following the overgrowth of Candida, accompanied by the breakdown of host immune defenses and/or localized disruption of the microbiome. Pathogenicity is promoted through several virulence factors, such as surface adhesion molecules. Tissue invasion occurs with the secretion of enzymes, facilitating tissue damage and enabling deeper penetration, and change in morphology, switching from the commensal yeast form to the invasive hyphal form.
Etiology
Candida albicans is the causative organism of mucocutaneous candidiasis. Non-albicans species such as Candida glabrata, Candida krusei and Candida tropicalis have also been identified. While the most common pathogens of invasive candidiasis are C albicans, C glabrata, C tropicalis, Candida parapsilosis, and C krusei.
Please see Invasive Candidiasis disease management chart for further information