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PATIENT STORY

A 42-year-old man (Figure 142-1) was admitted to the hospital for community-acquired pneumonia and type 2 diabetes out of control. On the second day of admission, when he was feeling a bit better, he asked about the itching he was having on his penis. Physical examination revealed an uncircumcised penis with white discharge on the glans and inside the foreskin consistent with Candida balanitis. KOH prep was positive for the pseudohyphae of Candida. The patient was treated with a topical azole and the balanitis resolved.

FIGURE 142-1

Candida balanitis in a man with uncontrolled diabetes. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Cutaneous and mucosal Candida infections are seen commonly in persons with obesity, diabetes, hyperhidrosis, and/or immunodeficiency.

SYNONYMS

Perlèche = angular cheilitis.

EPIDEMIOLOGY

Candida thrush is common in normal infants and in adults may be a sign of immunosuppression (Figure 142-2).

FIGURE 142-2

Thrush in an otherwise healthy infant. (Reproduced with permission from Richard P. Usatine, MD.)

Candida balanitis is more common in uncircumcised men than in those who have been circumcised (Figure 142-1).

ETIOLOGY AND PATHOPHYSIOLOGY

  • Infections caused by Candida species are primarily Candida albicans.1

  • C. albicans has the ability to exist in both hyphal and yeast forms (termed dimorphism). If pinched cells do not separate, a chain of cells is produced and is termed pseudohyphae.1

RISK FACTORS

Obesity, diabetes, hyperhidrosis, immunodeficiency, HIV, heat, use of oral antibiotics, and use of inhaled or systemic steroids.1

DIAGNOSIS

CLINICAL FEATURES

  • Typical distribution—Groin, glans penis, vulva, inframammary, under abdominal pannus, between fingers, in the creases of the neck, corners of mouth, nail folds in chronic paronychia.

  • Morphology—Macules, patches, plaques that are pink to bright red with small peripheral satellite lesions.

  • Candidiasis of the nipple in the nursing mother is associated with infantile thrush (Figures 142-2 and 142-3). Nipple candidiasis is almost always bilateral, with the nipples appearing bright red and inflamed. In this case, the inflammation was made worse by the application of a topical antibiotic that caused a secondary contact dermatitis.

  • Candida infection in the corners of the mouth is called perlèche or angular cheilitis (Figure 142-4). When accompanied by thrush it may be a sign of HIV/AIDS.

  • Thrush can be caused be Candida growing on the upper plate of a denture and the roof of the mouth (Figure 142-5).

  • Ask about recent antibiotic use if there ...

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