Chronic Mucocutaneous Candidiasis

Also called moniliasis, chronic mucocutaneous candidiasis affects males and females alike and usually develops in childhood. This form of candidiasis is characterized by repeated infection with Candida albicans.

In some patients with chronic mucocutaneous candidiasis, an autoimmune response affects the endocrine system, inducing various endocrinopathies.In these patients, the prognosis depends on the severity of the associated endocrinopathy.

Causes

Although no characteristic immune system defects are known to cause this infection, allergy may playa role. Many patients have a diminished response to various antigens or to Candida organisms alone. In some patients, allergy may result from deficient microphage inhibitory factor, a mediator normally produced by lymphocytes. This leads researchers to think that the disease may result from an inherited defect in cell-mediated (T-cell) immunity. (Humoral immunity, mediated by B cells, remains intact and produces a normal antibody response to C. albicans.)

Clinical Features and Symptoms

• persistent candida (yeast) infections of the mucous membranes, scalp, skin and nails
• thrush (a yeast infection in the mouth) and yeast diaper rash as babies. 

Some patients also have problems with:

• additional germs including bacteria and other fungi. 
• increased incidence of autoimmune disorders including endocrine disorders, diabetes, hemolytic anemia, autoimmune hair loss (alopecia) or loss of skin pigment (vitiligo)

Diagnostic tests 

The diagnosis of chronic mucocutaneous candidiasis, is made on clinical grounds. Microscopy and culture of skin swabs and scrapings confirm the presence of organisms.

Treatment

Infection control is the main goal of treatment. Although miconazole and nystatin can produce sustained improvement, these topical antifungal agents ultimately fail to control infection.

Systemic infections warrant vigorous treatment. Oral ketoconazole and injections of thymosin and levamisole can have a positive effect. Acyclovir may be indicated in viral infections. Iron replacement therapy (administered orally or I.M.) may also be necessary.

Prevention

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