Chronic mucocutaneous candidiasis

Candidiasis, chronic mucocutaneous, CMC.

Group of persistent diseases characterised by Candida infection of the skin and mucous membrane.

Often starts with children.

• Different causative factors may be involved in chronic mucocutaneous candidiasis
• The infection usually occurs in the presence of immune disorders (thymic aplasia, agammaglobulinemia, malignant lymphoma, Hodgkin's disease, malignant tumours, immunosuppressants, hypoparathyroidism, hypoadrenocorticism and iron deficiency)
• Because of increased familial occurrence, a genetic association can be assumed

• Simultaneous occurrence of several candidoses (candidiasis of the oral mucosa incl. larynx and oesophagus, perlèche, vulvovaginal candidiasis, intertriginous candidiasis, paronychia candidamycetica - see respective underlying disease)
• Furthermore, eye diseases (blepharitis and conjunctivitis), urethritis, haematuria, urethral strictures, cystitis, diarrhoea, multiple endocrinological disorders, chronic rhinitis, chronic recurrent pneumonia, pulmonary fibrosis and spontaneous pneumothorax can occur.
• The granulomatous inflammatory reaction is often very pronounced.

• Family history
• Clinical
• Myco. smears (native and culture)
• Biopsy if necessary

Chron. rec. Course.

• If poor oral hygiene is causative, this is an important treatment approach
• Treatment of an underlying disease (disinfection of dentures)

Topical therapy

• Miconazole-containing mouth gel 3-5 times a day after eating (also for infants)
• Amphotericin B lozenges p.o. 4x tgl. after meals and before bedtime
• Nystatin suspension p.o. 1ml 4x daily for at least 14 days

Systemic therapy

• In severe cases and infestation or involvement of the oesophagus (thrush oesophagitis)
• Fluconazole p.o. 200 mg 1x daily for at least 10 days
• Therapy control with pharyngeal lavage
• In case of resistance to therapy:
  • Amphotericin B i.v. 0.3 mg/kg bw/day for at least 5 days
• In chron. Recurrences:
  • Fluconazole p.o. 100 mg 3x/week
• Prophylaxis in immunocompromised patients:
  • Fluconazole initially 200 mg p.o., then 100 mg/day for 5-10 days. In case of non-response, double the dose

1. Kirkpatrick CH. Chronic mucocutaneous candidiasis. The Pediatric Infectious Disease Journal 2001;20:197-206.
2. Puel A, Döffinger R, Natividad A, et al. Autoantibodies against IL-17A, IL-17F, and IL-22 in patients with chronic mucocutaneous candidiasis and autoimmune polyendocrine syndrome type I. The Journal of Experimental Medicine 2010;207:291-7.