chronic mucocutaneous candidiasis, a heterogeneous group of disorders, unified by impaired cell-mediated immunity against Candida species; a rare form of candidiasis characterized by candidal infection lesions of the skin, mucous membranes, GI tract, and respiratory tract. This disease usually occurs during the first year of life or with immune system dysfunction but can develop at any time. It affects both males and females and may be associated with an inherited defect of the cell-mediated immune system that allows autoantibodies to develop against target organs. The humoral immune system functions normally in this disease. The onset of infections associated with the disease may precede endocrinopathy. ▪ OBSERVATIONS: Diagnosis of this disease usually includes laboratory tests, which commonly show a normal T cell count and normal immunological responses to antigens other than Candida albicans. The endocrinopathy associated with this disease may include nonimmunological aberrations, such as hypocalcemia, abnormal hepatic function, hyperglycemia, iron deficiency, and abnormal vitamin B12 absorption. Required after diagnosis of chronic mucocutaneous candidiasis are evaluations of numerous physiological mechanisms, such as adrenal, gonadal, pancreatic, parathyroid, pituitary, and thyroid functions. ▪ INTERVENTIONS: Chronic mucocutaneous candidiasis resists treatment with topical antifungal agents, miconazole, and nystatin. Endocrinopathies associated with the disease must be treated individually by hormone replacement; some success in this regard has been reported with experimental injections of thymosin and levamisole. Most success in treating severe cases has been achieved with transfer factor from a Candida-positive donor, with IV amphotericin B. Some success against systemic infection may also be possible with amphotericin B, but that agent is highly nephrotoxic. Some patients respond fairly well to fetal thymus transplantation. Plastic surgery may aid patients in coping with disfigurements caused by the disease. Treatment may also include oral or intramuscular iron replacement. ▪ PATIENT CARE CONSIDERATIONS: Patients with chronic mucocutaneous candidiasis must be closely monitored for signs of other associated diseases, such as Addison’s disease, diabetes, hepatitis, and pernicious anemia. Patients suffering psychologically from disfigurements associated with the disease often respond positively to encouragement and appropriate referrals for support or counseling. Amphotericin B, a nephrotoxin, is involved in the treatment. Therefore, the patient must be carefully monitored for renal function. Patients benefit from calm explanations of the progressive manifestations of the disease and the importance of regular endocrinological checkups.
