The fungus Candida is normally found on and in the body in small amounts. It is present on the skin and in the mouth, as well as in the intestinal tract and genital area. Most of the time, Candida does not cause any symptoms. When these organisms overgrow, they can cause infections (candidiasis), which sometimes can become chronic. If the fungus enters the bloodstream, the infection can spread to other parts of the body. Bloodstream infections are most common in newborns, children with long-term intravenous catheters, and children with weakened immune systems caused by illnesses or medicines.
Candidiasis can affect the skin, mucous membranes (eg, mouth, throat), fingernails, eyes, and skin folds of the neck and armpits, as well as the diaper region (eg, vagina, folds of the groin). The oral infection, called thrush, frequently occurs in infants and toddlers. If Candida infections become chronic or occur in the mouth of older children, they may be a sign of an immune deficiency, such as human immunodeficiency virus (HIV) infection. Very low birth weight babies are susceptible to candidiasis as well. Newborns can acquire the infection from their mothers, not only while they’re still in the uterus, but also during passage through the vagina during birth. Most of these infections are caused by Candida albicans, a yeast-like fungus, although other species of Candida are sometimes responsible. In some cases, children can develop candidiasis after being treated with antibacterials.
Signs and Symptoms
When an infant develops a Candida infection, symptoms can include painful white or yellow patches on the tongue, lips, gums, palate (roof of mouth), and inner cheeks. It can also spread into the esophagus, causing pain when swallowing. Candidiasis can make a diaper rash worse, producing a reddening and sensitivity of the affected area and a raised red border in some cases. Teenaged girls who develop a yeast infection of the vagina and the surrounding area may have symptoms such as itching; pain and redness; a thick, “cheesy” vaginal discharge; and pain when urinating. Infection of the bloodstream occurs in children who are hospitalized or at home with intravenous catheters. A yeast infection often follows antibiotic therapy. Infections occur in children with cancer who are receiving chemotherapy. In these cases, the fungus in the gut gets into the blood system. Once in the blood, the yeast can travel throughout the body, causing infection of the heart, lungs, liver, kidneys, brain, and skin. The early signs of infection are fever and blockage of the intravenous catheter.
How Is the Diagnosis Made?
Your pediatrician will often make the diagnosis by examining your child and her symptoms. Scrapings of Candida lesions inside the mouth or elsewhere can be examined under the microscope for signs of the infection. An ultrasound or CT scan can detect candidal lesions that have developed in the brain, kidney, liver, or spleen. Cultures of the blood or mouth lesions are taken to grow the fungus in the laboratory and identify the type and sensitivity of the yeast.
Antifungal drugs are used to treat candidiasis. Nystatin is often prescribed for children with superficial infections such as oral thrush or a Candida-related diaper rash. The specific medicines given for candidiasis vary, depending on the part of the body where the infection is concentrated. For example:
Mouth and airway (associated with a weakened immune system): nystatin, clotrimazole, fluconazole, itraconazole
Esophagus: nystatin, fluconazole, itraconazole
Skin: topical medicines such as nystatin, miconazole, clotrimazole, naftifine, and ketoconazole, among others
Vagina: topical clotrimazole, miconazole, butoconazole, terconazole, tioconazole
If candidiasis has spread through the bloodstream to various parts of the body, your pediatrician will usually recommend treatment with an intravenous medicine such as amphotericin B. This medicine causes many side effects, but it is still a reliable medicine for serious, invasive fungal infections.
What Is the Prognosis?
Once treatment starts, most candidiasis infections get better within about 2 weeks. Recurrences are fairly common. Long-lasting thrush is sometimes related to pacifiers. The infection is much more difficult to treat in children with catheters or weakened immune systems. The catheter usually must be removed or replaced and tests are done to determine whether infection has spread to other parts of the body. Antifungal therapy may need to be given for weeks to months.
To reduce the risk of candidiasis in your baby’s diaper area, keep the skin as clean and dry as possible, changing diapers frequently. Fungal infections (thrush or vaginitis) often follow courses of antibacterials. To avoid this, it is important to use antibiotics only when necessary. Oral nystatin and fluconazole are often used to prevent candidiasis in children with weakened immune systems.