chronic mucocutaneous candidiasis

candidiasis /can·di·di·a·sis/ (kan″dĭ-di´ah-sis) infection by fungi of the genus Candida, generally C. albicans, most commonly involving the skin, oral mucosa (thrush), respiratory tract, or vagina; rarely there is a systemic infection or endocarditis.

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acute pseudomembranous candidiasis  thrush.

atrophic candidiasis  a type of oral candidiasis marked by erythematous pebbled patches on the hard or soft palate, buccal mucosa, and dorsal surface of the tongue.

bronchopulmonary candidiasis  bronchocandidiasis; that found in the respiratory tract.

chronic mucocutaneous candidiasis  any of various forms characterized by chronic candidiasis of oral and vaginal mucosa, skin, and nails, resistant to treatment, and sometimes familial.

oral candidiasis  thrush.

vaginal candidiasis , vulvovaginal candidiasis candidal infection of the vagina, and usually also the vulva, commonly characterized by pruritus, creamy white discharge, vulvar erythema and swelling, and dyspareunia.

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chronic mucocutaneous candidiasis,

a heterogeneous group of disorders, unified by impaired cell-mediated immunity against Candida species; a rare form of candidiasis characterized by candidal infection lesions of the skin, mucous membranes, GI tract, and respiratory tract. This disease usually occurs during the first year of life or with immune system dysfunction but can develop at any time. It affects both males and females and may be associated with an inherited defect of the cell-mediated immune system that allows autoantibodies to develop against target organs. The humoral immune system functions normally in this disease. The onset of infections associated with the disease may precede endocrinopathy.

observations Chronic mucocutaneous candidiasis may affect the skin, the mucous membranes, the nails, and the vagina, usually causing large, circular lesions. Associated viral infections may lead to endocrinopathy and hepatitis. Infections of the mouth, nose, and palate may cause problems with speech and eating. Tetany and hypocalcemia are the most common symptoms associated with the endocrinopathy and are usually confined to the organ involved. Other complications associated with chronic mucocutaneous candidiasis may include diabetes, Addison's disease, hypothyroidism, and pernicious anemia. In some patients psychiatric problems develop as a result of disfigurements and extensive endocrinal disorders. Diagnosis of this disease usually includes laboratory tests, which commonly show a normal T-cell count and normal immunologic responses to antigens other than Candida albicans. The endocrinopathy associated with this disease may include nonimmunologic aberrations, such as hypocalcemia, abnormal hepatic function, hyperglycemia, iron deficiency, and abnormal vitamin B₁₂ absorption. Other immunodeficiency diseases associated with chronic Candida infection must be excluded by diagnosis. Such immunodeficiency diseases as DiGeorge's syndrome, ataxia-telangiectasia, and severe combined immunodeficiency disease all cause serious immunologic defects. Required after diagnosis of chronic mucocutaneous candidiasis are evaluations of numerous physiologic mechanisms, such as adrenal, gonadal, pancreatic, parathyroid, pituitary, and thyroid functions. Chronic mucocutaneous candidiasis is progressive and usually leads to endocrinopathy.

interventions Chronic mucocutaneous candidiasis resists treatment with topical antifungal agents, miconazole, and nystatin. Endocrinopathies associated with the disease must be treated individually by hormone replacement; some success in this regard has been reported with experimental injections of thymosin and levamisole. Most success in treating severe cases has been achieved with transfer factor from a Candida-positive donor, with IV amphotericin B. Some success against systemic infection may also be possible with amphotericin B, but that agent is highly nephrotoxic. Some patients respond fairly well to fetal thymus transplantation. Plastic surgery may aid patients in coping with disfigurements caused by the disease. Treatment may also include oral or intramuscular iron replacement.

nursing considerations Patients with chronic mucocutaneous candidiasis must be closely monitored for signs of other associated diseases, such as Addison's disease, diabetes, hepatitis, and pernicious anemia. Patients suffering psychologically from disfigurements associated with the disease often respond positively to the counsel, encouragement, and kindness of the nursing staff. Amphotericin B, a nephrotoxin, is involved in the treatment. Therefore the patient must be carefully monitored for renal function. Patients benefit from calm explanations of the progressive manifestations of the disease and the importance of regular endocrinologic checkups.