Symptoms of candidiasis in children

The most common form of candidal infection is thrush. It is most often observed in newborns and young children, especially in weakened or having other diseases, in those treated with antibiotics for a long time. The main symptom of the disease is cheesy white deposits on the mucous membrane of the cheeks, gums, soft and hard palate. At first, the deposits are point-like, then they merge. The deposits are easily removed. In advanced cases, the deposits become dense, acquire a grayish-dirty color, are difficult to remove, after their removal, the mucous membrane may bleed. In children in the first days of life, not burdened by any diseases, the general condition is not noticeably disturbed when thrush occurs. In weakened children, thrush can take a long-term chronic course, with white deposits spreading along the edge of the gums, to the soft and hard palate, mucous membranes of the cheeks and tongue.

When the mucous membrane of the tongue is affected, in addition to fungal deposits, areas devoid of papillae are visible. The tongue is edematous, with focal hyperemia and striation with longitudinal and transverse grooves.

• Candidal tonsillitis as an isolated lesion is rare, it usually occurs against the background of candidiasis of the oral mucosa. In this case, on the surface of the tonsils, sometimes on the arches, loose whitish insular or solid deposits are found, easily removed with a spatula. The tissue of the tonsils is slightly changed. There is no hyperemia of the mucous membranes of the pharynx and no reaction of the regional lymph nodes. The general condition of the children is not significantly impaired. Body temperature remains within normal limits.
• Candidiasis of the angles of the mouth (angular cheilitis): cracks and erosions with perifocal infiltration appear in the corner of the mouth. The lesion is usually bilateral. It should be differentiated from streptococcal angular cheilitis, in which the inflammatory reaction is more pronounced.
• Cheilitis: the red border of the lips is hyperemic, edematous, and striated with radial stripes. Patients complain of burning and dry lips. The course of the disease is long. It should be differentiated from cheilitis of other etiologies.
• Candidal vulvovaginitis is characterized by white discharge. Whitish or gray loose cheesy deposits, less often superficial erosions, are found on the moderately hyperemic mucous membrane of the genitals. Deposits can be on the mucous membrane of the vagina and cervix. Patients complain of severe itching and burning in the area of the external genitals.
• Intertriginous candidiasis in the area of large skin folds is more often observed in infants. Maceration of the stratum corneum can be seen against the background of hyperemic or eroded skin. Folds in the area of the anus, genitals, inguinal-femoral zones, behind the ears, on the neck, face, eyelids, around the mouth are mainly affected.
• Candidal erosions differ from common diaper rashes by their dark red color and varnish shine, moist (but not oozing) surface, distinct, non-blurred borders with scalloped edges, and a narrow peripheral border of a thin white macerated horny layer of the skin. From the folds, the process can spread to smooth skin, and in severe cases to the entire skin. Such forms of fungal lesions should be differentiated from streptococcal or streptostaphylococcal diaper rash, desquamative erythroderma of infants (Leiner's erythroderma) and exfoliative dermatitis of newborns (Ritter's disease).
• Candidiasis of the smooth skin in infants is usually the result of the spread of intertriginous candidiasis from skin folds, as is the case with lesions of the skin of the soles.
• Candidiasis of the scalp, as well as candidiasis of the nail folds and nails, in children can occur in cases of chronic generalized granulomatous candidiasis.
• Chronic generalized granulomatous candidiasis occurs in people with poor nutrition, gastrointestinal disorders or bronchitis. The disease begins in childhood with persistent oral thrush. Later, the process spreads: cheilitis, glossitis, angular cheilitis occur, which are difficult to treat. Many are diagnosed with deep dental caries.

Nails and nail folds are almost always affected. Large subcutaneous nodes may appear, which gradually soften and open up, forming fistulas that do not heal for a long time. The appearance of such nodes and tuberculous rashes in various areas indicates hematogenous spread of the Candida fungus.

• Pulmonary candidiasis is currently one of the most common manifestations of visceral candidiasis, which occurs as a result of long-term irrational antibiotic therapy.

The course may be acute, protracted or chronic, with relapses, exacerbations. Abscessing and cavernous forms of candidal pneumonia, pleurisy, which are difficult to differentiate from tuberculosis clinically and radiologically, have been described. The course of candidal pneumonia and other candidiasis is especially unfavorable in children with allergies. In these cases, pulmonary candidiasis may proceed as bronchial asthma. To establish a diagnosis of candidal pneumonia, it is necessary to take into account the occurrence of pneumonia during antibiotic treatment of any disease, the appearance of thrush, angular cheilitis, intertriginous dermatitis, deterioration of the condition despite antibiotic therapy. Hectic body temperature, lymphopenia, normal or increased number of leukocytes, increased ESR are noted.

Laboratory tests (repeated detection of the fungus in sputum and positive serological reactions) together with the clinical picture provide the basis for diagnosing candidal pneumonia. Improvement in the patient's condition after discontinuation of antibiotic therapy is also important to consider when diagnosing this disease.

• Gastrointestinal candidiasis. Abundant, continuous fungal deposits can cover the entire mucous membrane of the esophagus. Clinically, progressive dysphagia and the inability to swallow food are noted.
• Gastric candidiasis is diagnosed only by histological examination. On the affected part of the stomach, hyperemia of the mucous membrane and small erosions are noted; typical superpositions of thrush are rarely observed.
• Intestinal candidiasis manifests itself with symptoms of enterocolitis or colitis; abdominal distension, intestinal colic, watery stool, sometimes with blood. The course is usually long, recurrent. Morphological examination of those who died from generalized forms of candidiasis reveals multiple ulcers in the intestine, sometimes with perforation and the development of peritonitis.
• Urinary tract lesions - urethritis, cystitis, pyelitis, nephritis - can be the result of an ascending candidal infection or occur hematogenously (with sepsis).
• Generalized candidiasis. Patients may develop candidal endocarditis with damage to the heart valves or candidal meningitis and meningoencephalitis (mainly in young children). Candidal meningitis is accompanied by mild meningeal symptoms, a slight increase in body temperature, and has a sluggish torpid course with very slow sanitation of the cerebrospinal fluid. Relapses are common. Isolation of yeast-like fungi of the genus Candida from the cerebrospinal fluid confirms the diagnosis.
• Candidal sepsis is the most severe manifestation of candidal infection. Candidal sepsis is usually preceded by another severe disease or microbial sepsis, which are complicated by superinfection with Candida fungus.

Candidiasis can spread directly through the oral mucosa to the esophagus, intestines or larynx, bronchi and lungs and end in sepsis. It is also possible for the Candida fungus to spread from the oral mucosa hematogenously. However, in any case, the initial clinical form of candidiasis leading to candidal sepsis in newborns is thrush of the mouth, esophagus or lungs.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]