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# Candidiasis: oral, oesophageal and invasive

Candida yeasts normally live on the body; they can cause thrush and painful swallowing, or, in hospital patients, dangerous blood and organ infections.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/)
- [Tongue](https://durgical.com/en/anatomy/tongue/)
- [Right atrium](https://durgical.com/en/anatomy/right-atrium/)
- [Pharynx](https://durgical.com/en/anatomy/pharynx/)
- [Soft palate](https://durgical.com/en/anatomy/soft-palate/)
- [Gums (gingiva)](https://durgical.com/en/anatomy/gums/)
- [Retina](https://durgical.com/en/anatomy/retina/)
- [Superior vena cava](https://durgical.com/en/anatomy/superior-vena-cava/)
- [Tricuspid anterior leaflet](https://durgical.com/en/anatomy/superior-leaflet-of-right-atrioventricular-valve/)
- [Mitral anterior leaflet](https://durgical.com/en/anatomy/anterior-leaflet-of-left-atrioventricular-valve/)

## Microorganisms that cause it

- [Candida albicans](https://durgical.com/en/microbiology/candida-albicans/)

## Why it happens

- [White blood cells: types and functions](https://durgical.com/en/physiology/white-blood-cells-types-and-functions/)
- [Innate and adaptive immunity: overview](https://durgical.com/en/physiology/innate-and-adaptive-immunity-overview/)

## What it is

Infections caused by Candida yeasts when the normal balance with the host is disturbed. Mucosal disease includes oropharyngeal candidiasis (thrush) and oesophageal candidiasis; invasive candidiasis means candidaemia or deep organ infection (eye, heart valves, [liver](https://durgical.com/en/anatomy/liver/), [spleen](https://durgical.com/en/anatomy/spleen/), [kidney](https://durgical.com/en/anatomy/kidney/), bone, [abdomen](https://durgical.com/en/anatomy/region/abdomen/)), mostly acquired in hospital. Vaginal and [skin](https://durgical.com/en/anatomy/skin/) forms have their own pages.

## Who gets it

Candida is one of the leading causes of bloodstream infection in hospitals, especially in intensive care units. Latin American surveillance shows a high share of C. parapsilosis and C. tropicalis, and Colombia has reported outbreaks of multidrug-resistant Candida auris since 2016, which led to national alerts from the INS. Oral and oesophageal candidiasis remain common markers of advanced HIV.

## Causes

- Candida albicans (most frequent)
- Non-albicans species: C. glabrata (Nakaseomyces glabratus), C. parapsilosis, C. tropicalis, C. krusei
- Candida auris: multidrug resistant, spreads in hospitals and persists on surfaces
- Entry from the gut or skin through damaged mucosa or central venous catheters

## Risk factors

- Central venous catheters and total parenteral nutrition
- Broad-spectrum antibiotics and prolonged ICU stay
- Abdominal surgery, especially with anastomotic leak, and acute necrotising pancreatitis
- Neutropenia, haematological cancer, transplantation and corticosteroids
- Very low birth weight preterm infants
- Kidney failure, haemodialysis and injection drug use
- Mucosal disease: HIV with low CD4 counts, inhaled corticosteroids, dentures, diabetes, infancy

## Pathophysiology

Candida colonises the mouth, gut and skin. Antibiotics remove competing bacteria, while barrier damage, catheters and weak cell-mediated or neutrophil immunity let it switch to invasive hyphal forms and form biofilms on devices. From the bloodstream it seeds the eye, heart valves, kidneys, liver and spleen. Cell-mediated immunity defects (HIV) mainly allow mucosal disease, while neutropenia and catheters drive invasive disease.

## Classification

- Oropharyngeal candidiasis (pseudomembranous, erythematous, angular cheilitis)
- Oesophageal candidiasis
- Candidaemia (bloodstream)
- Deep-seated: endophthalmitis, endocarditis, hepatosplenic, intra-abdominal, urinary, bone and joint

## Symptoms and signs

- White plaques on the [tongue](https://durgical.com/en/anatomy/tongue/) and oral mucosa that scrape off, leaving red bleeding mucosa
- Burning mouth, altered taste and cracks at the corners of the mouth
- Painful swallowing and retrosternal pain with food (oesophageal disease)
- Fever that persists despite antibiotics in a hospitalised patient with a catheter
- Blurred vision or floaters (endophthalmitis)
- Abdominal pain and fever after recovery of neutrophils (hepatosplenic form)

## Red flags

- Hypotension and septic shock
- Visual symptoms or new retinal lesions
- New heart murmur or embolic phenomena
- Oesophageal candidiasis in a person not known to have HIV (indicates immunosuppression)

## Diagnosis

**Clinical**
Thrush is a clinical diagnosis. Odynophagia with thrush in a person with HIV is treated as oesophageal candidiasis. Invasive disease is suspected in a high-risk patient with fever despite antibiotics.

**Tests**
Blood cultures are the key test (any Candida in blood is treated, never considered a contaminant), with species identification and susceptibility; beta-D-glucan as an adjunct. Potassium hydroxide preparation or culture of mucosal scrapings. Upper endoscopy with biopsy when oesophageal disease does not respond. Dilated fundus examination in all candidaemia.

**Imaging**
Echocardiography when endocarditis is suspected or cultures stay positive; abdominal ultrasound, CT or MRI for hepatosplenic or intra-abdominal disease.

## Differential diagnosis

- Oral leukoplakia, oral hairy leukoplakia and lichen planus
- Herpes simplex or cytomegalovirus oesophagitis
- Eosinophilic or reflux oesophagitis
- Bacterial sepsis and catheter infection
- Other fungal infections in neutropenia (aspergillosis)

## Goal of treatment

Treat mucosal disease and its cause; in candidaemia, start early effective antifungals, remove the source, look for and treat deep foci, and stop spread of resistant species in the hospital.

## Treatment

**Medical**
Oropharyngeal disease: topical antifungals (nystatin, clotrimazole) for mild cases or oral fluconazole; oesophageal disease needs systemic fluconazole, with other azoles or echinocandins if refractory.

**Acute**
Candidaemia and invasive disease: an echinocandin as initial therapy for most adults, stepping down to fluconazole when the patient is stable, cultures clear and the isolate is susceptible; amphotericin B for some sites, neonates and resistant species.

**Procedure**
Early removal of central venous catheters and drainage of infected collections (source control).

**Follow-up**
Repeat blood cultures until negative, eye examination, treatment continued for a set period after the first negative culture, contact precautions and environmental cleaning for C. auris, and catheter-care bundles.

**Surgical**
Valve replacement for Candida endocarditis and surgery for some intra-abdominal or bone infections.

## Drugs for this condition

- [Amphotericin B](https://durgical.com/en/pharmacology/amphotericin-b/)
- [Fluconazole](https://durgical.com/en/pharmacology/fluconazole/)
- [Nystatin](https://durgical.com/en/pharmacology/nystatin/)
- [Voriconazole](https://durgical.com/en/pharmacology/voriconazole/)
- [Caspofungin](https://durgical.com/en/pharmacology/caspofungin/)
- [Flucytosine](https://durgical.com/en/pharmacology/flucytosine/)
- [Posaconazole](https://durgical.com/en/pharmacology/posaconazole/)
- [Micafungin](https://durgical.com/en/pharmacology/micafungin/)
- [Clotrimazole](https://durgical.com/en/pharmacology/clotrimazole/)
- [Miconazole](https://durgical.com/en/pharmacology/miconazole/)

## Complications

- Septic shock and multiorgan failure
- Endophthalmitis with loss of vision
- Endocarditis with emboli
- Hepatosplenic abscesses, osteomyelitis and kidney infection
- Oesophageal stricture (rare)

## Prognosis

Mucosal disease responds well but recurs if immunosuppression persists. Candidaemia has a crude mortality of about 30–40%; early antifungals and catheter removal improve survival, while C. auris and C. glabrata resistance make treatment harder.

## Prevention

- Careful insertion and care of central lines and early removal when not needed
- Antibiotic stewardship
- Antifungal prophylaxis in selected high-risk groups (some transplant, ICU and very preterm patients)
- Antiretroviral therapy in HIV, rinsing the mouth after inhaled corticosteroids, denture hygiene

## Test yourself

Think of the answer, then tap the question to see it.

## How is oral thrush told apart from leukoplakia on examination?

Thrush plaques scrape off and leave red, sometimes bleeding mucosa; leukoplakia does not scrape off.

## Can Candida in a blood culture be dismissed as a contaminant?

No, Candida in blood is always treated as a true infection.

## What is the recommended initial antifungal class for candidaemia in most adults?

An echinocandin.

## Which examination is done in every patient with candidaemia?

A dilated fundus examination to look for endophthalmitis.

## Which Candida species caused hospital outbreaks in Colombia and is multidrug resistant?

Candida auris.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/candidiasis-oral-oesophageal-and-invasive/)

## Related conditions

- [Infectious and pill-induced oesophagitis (Candida, HSV, CMV)](https://durgical.com/en/conditions/infectious-and-pill-induced-oesophagitis/)
- [Vulvovaginal candidiasis](https://durgical.com/en/conditions/vulvovaginal-candidiasis/)
- [Cutaneous and mucocutaneous candidiasis](https://durgical.com/en/conditions/cutaneous-and-mucocutaneous-candidiasis/)
- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)
- [Febrile neutropenia](https://durgical.com/en/conditions/febrile-neutropenia/)
- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Infective endocarditis](https://durgical.com/en/conditions/infective-endocarditis/)
- [Endophthalmitis](https://durgical.com/en/conditions/endophthalmitis/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Aspergillosis](https://durgical.com/en/conditions/aspergillosis/)
- [Pyogenic liver abscess](https://durgical.com/en/conditions/pyogenic-liver-abscess/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Candidiasis Basics | Candidiasis | CDC](https://www.cdc.gov/candidiasis/about/index.html) (Centers for Disease Control and Prevention, 2024); [Clinical Overview of Invasive Candidiasis](https://www.cdc.gov/candidiasis/hcp/clinical-overview/index.html) (Centers for Disease Control and Prevention, 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/