Chronic mucocutaneous candidiasis

Candidosis, chronic mucocutaneous, CMC.

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

Often starts with children.

• In chronic mucocutaneous candidiasis, various causative factors may be involved.
• In most cases, the infection occurs in disorders of the immune system (thymus aplasia, agammaglobulinemia, malignant lymphomas, Hodgkin's disease, malignant tumours, immunosuppressants, hypoparathyroidism, hypoadrenocorticism and iron deficiency).
• A genetic association can be assumed due to increased familial occurrence

• Simultaneous occurrence of several candidoses (candidosis of the oral mucosa including larynx and oesophagus, perlèche, vulvovaginal candidosis, intertriginous candidosis, paronychia candidamycetica- see respective underlying disease) simultaneously.
• In addition, eye diseases (blepharitis and conjunctivitis), urethritis, hematuria, urethrastricture, cystitis, diarrhea, multiple endocrinological disorders, chronic rhinitis, chronic recurrent pneumonia, pulmonary fibrosis and spontaneous pneumothorax may occur.
• The granulomatous inflammatory reaction is often very pronounced.

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

Chronic recurrent course.

If poor oral hygiene is the cause, this is an important treatment approach.

Treatment of an underlying disease (disinfection of dentures).

Topical Therapy

• Mouth gel containing Miconazole 3-5 times daily after meals (also for infants)
• Amphotericin B lozenges p.o. 4x daily 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 esophagus (Esophageal thrush) 
• Fluconazole p.o. 200 mg 1x daily for at least 10 days
• Therapy control with throat rinsing water
• In case of resistance to therapy:
  • Amphotericin B i.v. 0.3 mg/kg bw/day at least 5 days
• In chronic. recurrence:
  • Fluconazole p.o. 100 mg 3x/week
• Prophylaxis for immunocompromised persons:
  • Fluconazole initial 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.