Mucocutaneous candidiasis

Mucocutaneous candidiasis is generally not life-threatening nor invasive and can be treated with topical azoles (clotrimazole troches), oral azoles (fluconazole, ketoconazole, or itraconazole), or oral polyenes (such as nystatin or oral amphotericin B). Orally administered and absorbed azoles (ketoconazole, fluconazole, or itraconazole solution), amphotericin B suspension, intravenous caspofungin, or intravenous amphotericin B are recommended for refractory or recurrent infections.20... 

Lilic D New perspectives on the immunology of chronic mucocutaneous candidiasis. Curr Opin Infect Dis 2002 15 143-147. 

Lammas DA, Drysdale P. Calvert JE. Cant AJ, Abinun M Deregulated production of protective cytokines in response to Candida albicans infection in patients with chronic mucocutaneous candidiasis. Infect Immun 2003 71 5690-5699. 

Use only to treat severe systemic fungal disease Coccidioidomycosis, candidiasis, cryptococcosis, pseudoallescheriosis (petriellidiosis, allescheriosis), paracoccidioidomycosis, and for the treatment of chronic mucocutaneous candidiasis. 

Systemic fungal infections Candidiasis, chronic mucocutaneous candidiasis, oral... 

Younger than 2 years of age) - Daily dosage has not been established. Minimum treatment is 1 or 2 weeks for candidiasis and 6 months for the other indicated systemic mycoses. Chronic mucocutaneous candidiasis usually requires maintenance therapy. 

Histoplasmosis, blastomycosis, systemic candidiasis, chronic mucocutaneous candidiasis, coccidioidomycosis, paracoccidioidomycosis, chromomycosis, seborrheic dermatitis,... 

It is indicated in dermatophytoses, tinea versicolor, onychomycoses, oropharyngeal candidiasis, cutaneous candidiasis, chronic mucocutaneous candidiasis, oculomycoses systemic mycoses like cryptococcosis, candidiasis and aspergillosis subcutaneous mycoses like sporotrichosis and chromomycosis. 

Patients with chronic mucocutaneous candidiasis respond well to a once-daily dose of 200 mg of ketoconazole, with a median clearing time of 16 weeks. Most patients require long-term maintenance therapy. Variable results have been reported in treatment of chromomycosis. 

Fluconazole is well absorbed following oral administration, with a plasma half-life of 30 hours. In view of this long half-life, daily doses of 100 mg are sufficient to treat mucocutaneous candidiasis alternate-day doses are sufficient for dermatophyte infections. The plasma half-life of itraconazole is similar to that of fluconazole, and detectable therapeutic concentrations remain in the stratum corneum for up to 28 days following termination of therapy. Itraconazole is effective for the treatment of onychomycosis in a dosage of 200 mg daily taken with food to ensure maximum absorption for 3 consecutive months. Recent reports of heart failure in patients receiving itraconazole for onychomycosis have resulted in recommendations that it not be given for treatment of onychomycosis in patients with ventricular dysfunction. 

Indications Treatment of the following systemic fungal infections Candidiasis Chronic mucocutaneous candidiasis Oral thrush Candiduria Blastomycosis Coccidioidomycosis Histoplasmosis Chromomycosis Paracoccidioidomycosis... 

Nystatin Mycostatin Nilstat others Mycostatin Nilstat Nystex Generic Lozenges oral suspension tablets Cream ointment powder Vaginal cream vaginal tablets Oropharyngeal candidiasis Cutaneous and mucocutaneous candidiasis Vulvovaginal candidiasis... 

Caspofungin is currently licensed only for salvage therapy in patients with invasive aspergillosis who have failed to respond to amphotericin B. Clinical studies indicate that caspofungin is active also against Candida species in the setting of mucocutaneous candidiasis and candidal bloodstream infections. 

Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, Lewis CW, Pariser DM, Skouge JW, Webster SB, Whitaker DC, Butler B, Lowery BJ Guidelines of care for superficial mycotic infections of the skin Mucocutaneous candidiasis. J Am Acad Dermatol 1996 34 110-115. 

Kirkpatrick CH Chrorric mucocutaneous candidiasis, J Am Acad Dermatol 1994 31 S14-S17. 

Clotrimazole was the first oral azole. While it was effective in deep mycoses, its limited absorption and induction of liver microsomal enzymes after a few days, leading to accelerated metabolism of the compound, as well as its toxicity, preclude its use for systemic therapy. Clotrimazole is therefore currently only used for topical therapy of mucocutaneous candidiasis. 

Nystatin, the earliest antifungal drug, is used today primarily by the oral route to treat gastrointestinal mycosis and topically for mucocutaneous candidiasis (SED-11, 576). Absorption from the gut is insufficient to produce systemic activity. 

Humans with deficient IFNy response show several immunological defects, such as increased susceptibility to infections with intracellular pathogens. Impaired IFNy production has been demonstrated in human pathological conditions, namely chronic mucocutaneous candidiasis and systemic lupus erythematosus. ... 

Lflic D, Cant AJ, Abinun M, et al. Chronic mucocutaneous candidiasis. I. Altered antigen-stimulated TL-2, IL-4, IL-6 and interferon-gamma (IFN-y) production. Chn Exp Immuno 1996 105 205-12,... 

Autoimmunity (a) isolated autoimmune premature ovarian failure or (b) as a component of an autoimmune polyglandular syndrome in association with Addison s disease, hypothyroidism, hypoparathyroidism, or mucocutaneous candidiasis Iatrogenic (chemotherapy, radiation, extensive ovarian surgery) X-chromosome abnormalities... 

Topical therapy with clotrimazole or nystatin for 7 days is usually adequate for treating mucocutaneous candidiasis in most solid-organ transplant patients. Use of topical therapy will reduce the number of systemic drugs that these patients receive and hence minimize the risk of drug-drug interactions. Failure to respond to topical agents warrants the use of fluconazole. Low-dose amphotericin B 5-10 mg daily for 7 to 10 days is reserved for the unusual cases of treatment failure. 

Polyendocrinopathies, autoimmune. Autoimmune diseases affecting multiple endocrine organs, (i) The autoimmune polyglandular syndrome type 1 is characterized by mucocutaneous candidiasis in association with endocrine manifestation (also called APECED syndrome autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy), while (ii) the autoimmune polyglandular... 

Thymus transplantation has also been employed experimentally in a variety of conditions including chronic mucocutaneous candidiasis, ataxia-telangiectsia, and Wiscott-Aldrich syndrome, but in these cases results have generally been disappointing (reviewed in Pahwa et al., 1979 Skotnicki et al., 1984). Thus, the only immunodeficiency state that has clearly demonstrated a lasting improvement of T cell immunity following thymus transplantation is DiGeorge s syndrome. 

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