Candidiasis of the Nail Folds and Nails

Candidiasis of the nail folds (paronychia) and the nail plates (onychia) are the most common forms of yeast diseases and prevail among females. They are often accompanied by interdigital erosions. The process begins in the proximal part of the nail fold which becomes hyperemic and swollen, and a small drop of pus may be pressed out from under it; the cuticle (eponychium) disappears. Then the side folds are involved. There is sharp pain in the acute stage of the disease. After the inflammation subsides, the process usually spreads to the nail plate whose sides and the region of the lunula turn brownish-red-grey. The nail becomes thin, crumbles, and is covered across with stripes (a characteristic sign). In some cases it is easily separated. The disease usually occurs only on the fingernails, mostly on the third and fourth fingers.

Diagnosis. Candidiasis is distinguished from onychomycoses of other etiology by the combination of paronychia and onychia and the positive results of laboratory tests.

Chronic Generalized (Granulomatous) Candidiasis of Children

In most cases, the disease developed in early childhood and was first manifested by thrush. Later, with the use of antibiotics (usually their combination) for various infectious diseases or colds generalization of the process was noted. The lesions in the oral cavity occur on the buccal mucosa, on the mucous membrane of the hard and soft palate and the gums. A persistent perleche forms. Macrocheilia develops due to yeast cheilitis. A scrotal (furrowed and corrugated) tongue is found in most cases. The appearance on the skin of the face (usually the nose, cheeks, and middle of the forehead), scalp, trunk, and limbs of hyperemic, infiltrated, and peeling spots, which gradually transform to granulomatous foci with scalloped outlines, is characteristic. Most of the lesions are covered with crusts on removal of which vegetations and hyperkeratosis are revealed. The nail folds of all the children are infiltrated and oedematous, while the nail plates are very thick, distorted, and dirty-grey in colour. The cuticle is preserved (as distinct from yeast paronychia in adults).

After resolution of the lesions, cicatricial atrophy remains on the smooth skin and permanent baldness on the scalp.

Most of these children have recurrent pneumonia, bronchitis, diarrhea; X-ray demonstrates an abnormally pronounced bronchovascular pattern, a denser shadow of the pulmonary tissue in the vicinity of the roots, etc. There are regular bouts of elevation of body temperature (to 38-39 °C) with a rapid fall.

The disease follows a very long course with regular exacerbations, despite the use of modern methods of treatment.

Laboratory Diagnosis of Candidiasis

Microscopy of native preparations is mostly used in the laboratory diagnosis of candidiasis. Serological tests are conducted in addition. Depending on the character and localization of the process, the skin scales, scrapings from the mucous membranes and nails, pus, mucous clots of sputum are examined with the microscope for Candida fungi.

In examination of native preparations, the pathological material is placed on a glass slide and 10 per cent alkali (KOH or NaOH) solution is poured over it, a cover slide is then put on top and the preparation examined with a microscope first at low and then at high magnification. Fine mycelial threads (particularly abundant in thrush) and yeast cells characteristically in the stage of division (budding) are seen. Several smaller daughter cells are found next to the maternal (large) cell. The budding yeast cells in the preparation may form clusters resembling bunches of grapes. It should be borne in mind that when yeast are present as saprophytes, only occasional yeast cells are found in the preparation, and not always, while in candidiasis yeast cells and mycelium are a constant finding.

The preparations are stained when there is doubt concerning the origin of the occasional yeast cells. A small clump of the material to be examined is placed into a drop of tap water on a glass slide, blended with a loop or small spatula, spread in a thin layer on the glass, and fixed over the flame of a burner. The Gram, Ziehl-Neelsen or Romanovsky-Giemsa stain is used.

The agglutination reaction testifies to the presence of candidiasis only if the result is sharply positive in a dilution of 1:160 and higher. A lower titre of the reaction may be produced in individuals who do not have candidiasis but are simply carriers of saprophytic yeast.