skin candidiasis
Introduction
Introduction to cutaneous candidiasis Candidiasis is a fungal disease of the skin, mucous membranes or internal organs caused by Candida, mainly Candida albicans. Candida infection can affect all internal organs of the body, of which intestinal candidiasis and pulmonary candidiasis are more common, in addition, can also cause urinary tract inflammation, kidney and nephritis, endocarditis and meningitis, etc., can even cause rosary Bacterial sepsis, all visceral infections are often secondary to a variety of chronic wasting diseases, and long-term application of broad-spectrum antibiotics, corticosteroids and chemotherapy, radiotherapy and other predisposing factors, more symptoms without specificity, should be vigilant. basic knowledge The proportion of illness: 1.5% Susceptible people: no specific population Mode of infection: digestive tract transmission, respiratory tract transmission, sexual transmission Complications: herpes, endocarditis, meningitis
Cause
Causes of cutaneous candidiasis
Environmental factors (45%):
Candida is widely found in the mouth, digestive tract, upper respiratory tract, vagina and skin of nature and normal people. Under normal circumstances, Candida is in a symbiotic state with the human body and does not cause disease. It can cause disease only under certain conditions. It is called a conditional pathogen. Whether a pathogen can invade after the body invades the body depends on the number of pathogenic bacteria, virulence, invasion path and the body's resistance to pathogenic bacteria.
Low resistance (35%):
When patients have diabetes, tumors, chronic wasting diseases, and long-term use of broad-spectrum antibiotics, glucocorticoids and immunosuppressive agents, etc., the body's resistance is reduced, it is easy to cause infection, but also due to long-term placement of catheters, intubation, organ transplantation , radiotherapy, chemotherapy and disease, most of the disease is endogenous infection, a small number of exogenous infections.
About 8 species of Candida species can cause disease in humans, but Canidida albicans is a common pathogen and has the strongest virulence. Other Candida species are less pathogenic and cause less infection. These Candida species can cause disease alone or in combination with Candida albicans only when the body's immunity is particularly low.
Prevention
Skin candidiasis prevention
1. Actively treat primary diseases that are susceptible to the disease, such as diabetes, malignant tumors and other chronic wasting diseases.
2. Reasonable application of antibiotics, corticosteroids and immunosuppressive agents, etc., long-term application should closely observe the signs of various candidiasis, and timely treatment.
3. Skin wrinkles, especially obese and sweaty people should be kept clean and dry; pay attention to the oral and vulva parts clean and hygienic.
Complication
Complications of cutaneous candidiasis Complications herpes endocarditis meningitis
Pre-neck, interphalangeal, axillary, breast, groin, medial, hip, perianal, perineum, external genital and other skin wrinkles with or without flushing, whitish, scaly, erosion, nails without thickening, discoloration, A Whether the skin around the skin is red or swollen, whether there is a small amount of secretions exuding, whether the mouth is smashed, impregnated or chapped; the baby pays attention to the skin, or the red rash or pustule with fine circles and scales, oral cavity There is no milky white film on the mucous membrane, tongue, gums, etc., pay attention to the presence or absence of visceral lesions.
Symptom
Symptoms of cutaneous candidiasis common symptoms candida infection septic scars benign reactive changes immunodeficiency red hail scalp meningitis white viscous jelly
(a) skin candidiasis
1. Erosion between fingers is more common in people who have been engaged in wet work for a long time. The rash is most common between the third and fourth fingers. The skin is impregnated and whitened, and the impregnated epidermis is removed. Face, base flushing, may have a small amount of exudate, consciously itchy or painful.
2. Candida intergranular eczema is more common in children and obesity hyperhidrosis. The rash occurs in the groin, gluteal groove, axilla, and under the breast. The local part has a clear and moist erosion surface, the base is flushed, and the edge is attached to the mouth. Scales, often scattered in the periphery of red pimples, herpes or pustules.
3. Papillary candidiasis is more common in obese children, and can be complicated with red sputum. The rash is a flat dark red papule of mung bean with clear edges and covered with gray-white collar-like scales scattered or densely distributed in the chest, hip or perineum. Accompanied by candidal angular cheilitis, stomatitis.
4. Candida paronychia, nail bed inflammation is more common in nails, redness and swelling of the nail groove, or a small amount of discharge, but no pus, slightly pain and tenderness, chronic disease, turbid deck, white spots, hardening, and lateral sputum And groove pattern, uneven but still shiny, and not broken.
5. Chronic skin mucosal candidiasis is rare, is a chronic progressive Candida infection, often accompanied by certain immunodeficiency or endocrine disorders, such as parathyroid glands, adrenal insufficiency, etc., especially congenital thymoma, the disease often It is caused by infancy, but it can also occur in the neonatal period. The skin lesions occur in the head and face, the back of the hand and the distal ends of the extremities, occasionally in the trunk, erythema from the beginning, scaly damage of the papules, gradually becoming sick or knotted. Knot-like, covered with tan or dark brown clam-like suede, surrounded by dark red halo, some lesions highly hyperplastic, conical or wedge-shaped, shaped like a leather corner, remove the horny mass, under which is the granuloma tissue, the more After crusting, involving the scalp can cause hair loss.
(two) mucosal candidiasis
1. Thrush is more common in infants and young children. The white mucous membrane with clear boundary appears in the oral mucosa, pharynx, tongue and gums. The peripheral redness is visible. The red membrane is visible after removing the pseudomembrane. If the mouth is involved, there is a smashing of the mouth, cleft palate, etc. sense.
2. Genital candidiasis includes vaginal vagina and glans dermatitis, vaginal secretions thick, yellow or cheese-like patches, grayish-white pseudomembrane patches on the vaginal wall, itching or burning sensation, pseudomembrane and vaginal discharge The smear showed pseudohyphae and clusters of spores. Male patients were less common. Most of them were infected by spouses. The foreskin and glans were flushed, and the skin was dry and smooth. Patches of pseudomembrane were seen on the inside of the foreskin and in the coronal sulcus.
(c) visceral candidiasis
Candida infection can affect all internal organs of the body, of which intestinal candidiasis and pulmonary candidiasis are more common, in addition, can also cause urinary tract inflammation, kidney and nephritis, endocarditis and meningitis, etc., can even cause rosary Bacterial sepsis, all visceral infections are often secondary to a variety of chronic wasting diseases, and long-term application of broad-spectrum antibiotics, corticosteroids and chemotherapy, radiotherapy and other predisposing factors, more symptoms without specificity, should be vigilant.
The diagnosis of skin and mucosal candidiasis depends on a variety of unique clinical manifestations, and combined with fungal examination to make multiple judgments. In addition to the clinical manifestations, visceral candidiasis needs to be repeated multiple times and multi-channel culture for the same strain to confirm the diagnosis. Since Candida is one of the normal flora of the human body, sputum, feces and vaginal secretions are cultured positively only, indicating that there is a Candida, can not be diagnosed as candidiasis, direct microscopic examination should see pseudohyphae and spores, The presence of hyphae indicates that it is in a pathogenic state.
Examine
Examination of cutaneous candidiasis
1, direct microscopic examination
Women use long sterile cotton swabs to take the vaginal, cervical secretions or milky white film on the vaginal wall. Males scrape the surface scales of the glans glans, coronary sulcus or foreskin as the specimen to be examined. The specimen to be inspected is made of 10% potassium hydroxide or physiological saline. The microscopic spores and pseudohyphae can be seen under the microscope. If more pseudohyphae are found, it indicates that Candida is in the pathogenic stage. Diagnostics make more sense.
2, dyeing inspection
Gram staining, Congo red staining or PAS staining can also be used for microscopic examination. The positive rate is higher than that of direct microscopy. Gram staining, spores and pseudohyphae dyed blue: Congo red and PAS staining, spores and pseudohyphae dyed red.
3. Separation and culture
Candida culture can be performed in patients with negative smear tests. The test specimens were inoculated on Sabouraud medium under sterile conditions (used in vitro). At the time of inoculation, the test tube culture medium was cut obliquely, and each tube was inoculated with 2 to 3 spots, and each sample was inoculated with 2 tubes. The medium was incubated in a 37 ° C incubator for 24 to 48 hours, and a large number of milky white colonies were observed. A small number of colony smears were picked with the inoculation needle, and microscopic examination or microscopic examination showed that a large number of buds were observed. Diagnosed as a Candida infection.
Candida albicans antibodies can be detected by immunodiffusion or latex coagulation.
Diagnosis
Diagnosis and identification of cutaneous candidiasis
The diagnosis of skin and mucosal candidiasis depends on a variety of unique clinical manifestations, and combined with fungal examination to make multiple judgments. In addition to the clinical manifestations, visceral candidiasis needs to be repeated multiple times and multi-channel culture for the same strain to confirm the diagnosis. Since Candida is one of the normal flora of the human body, sputum, feces and vaginal secretions are cultured positively only, indicating that there is a Candida, can not be diagnosed as candidiasis, direct microscopic examination should see pseudohyphae and spores, The presence of hyphae indicates that it is in a pathogenic state.
