A 2-month-old infant is being seen for a diaper rash and the pediatrician notes that the tongue and mouth are covered in white (Figure 121-1). A diagnosis of thrush and Candida diaper dermatitis is made. The child is treated with oral nystatin for the mouth and topical clotrimazole for the diaper dermatitis.

Cutaneous and mucosal Candida infections are seen commonly in infants with thrush and diaper rash (Figure 121-2). Also children and teens with obesity, diabetes, and/or immunodeficiency are at higher risk of developing Candida infections.

Thrush.

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  Candida superinfected diaper dermatitis is highly prevalent in healthy infants (Figures 121-2 and 121-3).

  
  
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  Candida thrush is not uncommon in healthy infants (Figure 121-1).

  
  
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  Candidemia is a major source of morbidity and mortality in neonatal intensive care units (NICU).¹ This chapter focuses on cutaneous Candida infections only.

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  Cutaneous infections caused by Candida species are primarily Candida albicans.

  
  
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  C. parapsilosis and C. albicans infections are the most frequent causes of candidemia in the NICU.¹

  
  
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  C. albicans has the ability to exist in both hyphal and yeast forms (termed dimorphism). If pinched cells do not separate, a chain of cells is produced and is termed pseudohyphae.²

Infancy, prematurity, hospitalization, being in the NICU, obesity, diabetes, immunodeficiency, HIV, use of oral antibiotics, and use of inhaled or systemic steroids.