Which patient groups are at highest risk for cutaneous candidiasis?

Updated: Jan 17, 2020
  • Author: Richard Harold "Hal" Flowers, IV, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Neonatal cutaneous and systemic candidiasis have become increasingly prevalent in neonatal intensive care nurseries. Postnatal acquisition has been attributed to increased survival rates of low-birth-weight babies in association with an increased number of invasive procedures and widespread use of broad-spectrum antibiotics. In neonates, parenteral nutrition, time in the intensive care unit, and mechanical ventilation are major risk factors for infection. [26] Neonatal candidiasis presents 3-7 days after birth with oral thrush and diaper dermatitis. This has been attributed to mucosal contact with the organism during labor and delivery. Neonatal candidiasis is distinct from congenital candidiasis, a more common infection, which occurs after birth as opposed to in utero and often preferentially involves the oral area. [27]

The number of candidal infections has risen dramatically in recent years, mirroring the increasing number of patients who are immunocompromised. [28] Increased age appears to be associated with increased morbidity and mortality. [29] Older adults are more likely to be exposed to situations that increase the risk of invasive candidiasis, including treatment with broad-spectrum antibiotics, hyperalimentation, and increased contact with invasive monitoring devices in an intensive care unit. [30]

Candidal infections are exacerbated by certain medications (eg, antibiotics), poor self-care, and decreased salivary flow (oral candidiasis), all of which often are associated with aging. In addition, treatment with cytotoxic agents (eg, methotrexate, cyclophosphamide) for dermatologic and rheumatic conditions or aggressive chemotherapy for malignancy in elderly patients puts them at higher risk.


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