Candidiasis
Definition
Candidiasis is an infection caused by a species of the yeast
Candida, usually
Candida albicans. This is a common cause of vaginal infections in women. Also,
Candida may cause mouth infections in people with reduced immune function, or in patients taking certain
antibiotics.
Candida can be found in virtually all normal people but causes problems in only a fraction. In recent years, however, several serious categories of candidiasis have become more common, due to overuse of antibiotics, the rise of
AIDS, the increase in organ transplantations, and the use of invasive devices (catheters, artificial joints and valves)—all of which increase a patient's susceptibility to infection.
Description
Vaginal candidiasis
Over one million women in the United States develop vaginal yeast infections each year. It is not life-threatening, but it can be uncomfortable and frustrating.
Oral candidiasis
This disorder, also known as thrush, causes white, curd-like patches in the mouth or throat.
Deep organ candidiasis
Also known as invasive candidiasis, deep organ candidiasis is a serious systemic infection that can affect the esophagus, heart, blood, liver, spleen, kidneys, eyes, and skin. Like vaginal and oral candidiasis, it is an opportunistic disease that strikes when a person's resistance is lowered, often due to another illness. There are many diagnostic categories of deep organ candidiasis, depending on the tissues involved.
Causes and symptoms
Vaginal candidiasis
Most women with vaginal candidiasis experience severe vaginal
itching. They also have a discharge that often looks like cottage cheese and has a sweet or bread-like odor. The vulva and vagina can be red, swollen, and painful. Sexual intercourse can also be painful.
Oral candidiasis
Whitish patches can appear on the tongue, inside of the cheeks, or the palate. Oral candidiasis typically occurs in people with abnormal immune systems. These can include people undergoing
chemotherapy for
cancer, people taking immunosuppressive drugs to protect transplanted organs, or people with HIV infection.
Deep organ candidiasis
Anything that weakens the body's natural barrier against colonizing organisms—including stomach surgery,
burns, nasogastric tubes, and catheters—can predispose a person for deep organ candidiasis. Rising numbers of AIDS patients, organ transplant recipients, and other individuals whose immune systems are compromised help account for the dramatic increase in deep organ candidiasis in recent years. Patients with granulocytopenia (deficiency of white blood cells) are particularly at risk for deep organ candidiasis.
Diagnosis
Often clinical appearance gives a strong suggestion about the diagnosis. Generally, a clinician will take a sample of the vaginal discharge or swab an area of oral plaque, and then inspect this material under a microscope. Under the microscope, it is possible to see characteristic forms of yeasts at various stages in the lifecycle.
Fungal blood cultures should be taken for patients suspected of having deep organ candidiasis. Tissue biopsy may be needed for a definitive diagnosis.
Treatment
Vaginal candidiasis
In most cases, vaginal candidiasis can be treated successfully with a variety of over-the-counter antifungal creams or suppositories. These include Monistat, Gyne-Lotrimin, and Mycelex. However, infections often recur. If a women has frequent recurrences, she should consult her doctor about prescription drugs such as Vagistat-1, Diflucan, and others.
Oral candidiasis
This is usually treated with prescription lozenges or mouthwashes. Some of the most-used prescriptions are nystatin mouthwashes (Nilstat or Nitrostat) and clotrimazole lozenges.
Deep organ candidiasis
The recent increase in deep organ candidiasis has led to the creation of treatment guidelines, including, but not limited to, the following: Catheters should be removed from patients in whom these devices are still present. Antifungal chemotherapy should be started to prevent the spread of the disease. Drugs should be prescribed based on a patient's specific history and defense status.
Alternative treatment
Home remedies for vaginal candidiasis include vinegar douches or insertion of a paste made from Lactobacillus acidophilus powder into the vagina. In theory, these remedies will make the vagina more acidic and therefore less hospitable to the growth of Candida. Fresh garlic (Allium sativum) is believed to have antifungal action, so incorporating it into the diet or inserting a gauze-wrapped, peeled garlic clove into the vagina may be helpful. The insert should be changed twice daily. Some women report success with these remedies; they should try a conventional treatment if an alternative remedy isn't effective.
Prognosis
Vaginal candidiasis
Although most cases of vaginal candidiasis are cured reliably, these infections can recur. To limit recurrences, women may need to take a prescription anti-fungal drug such as terconazole (sold as Terazol) or take other anti-fungal drugs on a preventive basis.
Oral candidiasis
These infections can also recur, sometimes because the infecting Candida develops resistance to one drug. Therefore, a physician may need to prescribe a different drug.
Deep organ candidiasis
The prognosis depends on the category of disease as well as on the condition of the patient when the infection strikes. Patients who are already suffering from a serious underlying disease are more susceptible to deep organ candidiasis that speads throughout the body.
Prevention
Because
Candida is part of the normal group of microorganisms that co-exist with all people, it is impossible to avoid contact with it. Good vaginal hygiene and good
oral hygiene might reduce problems, but they are not guarantees against candidiasis.
Because hospital-acquired (nosocomial) deep organ candidiasis is on the rise, people need to be made aware of it. Patients should be sure that catheters are properly maintained and used for the shortest possible time length. The frequency, length, and scope of courses of antibiotic treatment should also be cut back.
Resources
Periodicals
Greenspan, Deborah, and John S. Greenspan. "HIV-Related Oral Disease." The Lancet 348 (September 14, 1996): 729-734.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
candidiasis
[kan″dĭ-di´ah-sis] infection by fungi of the genus
Candida, generally
C. albicans, most commonly involving the skin, oral mucosa (
thrush), respiratory tract, or vagina; occasionally there is a systemic infection or endocarditis. It is most often associated with pregnancy, glycosuria, diabetes mellitus, or use of antibiotics. The Centers for Disease Control and Prevention has found that in the United States this condition is the fourth most common cause of nosocomial infections of the blood stream. Called also
candidosis and
moniliasis.
The most prominent symptom of vaginitis due to
Candida infection is severe itching. Sexual transmission is unlikely. Intravaginal cream containing
miconazole or
clotrimazole, applied each night for one week, usually clears up the infection. Difficulty or pain with swallowing, or retrosternal pain, may indicate candidiasis of the esophagus. Systemic antifungal therapy is indicated for esophagitis and other more severe forms of the disease. Therapeutic options include
ketoconazole,
fluconazole, and
amphotericin b. Chronic suppressive therapy is sometimes required for severely
immunocompromised patients. The Infectious Disease Society of America has published “Practice Guidelines for the Treatment of Candidiasis” on their web site, http://www.idsociety.org.
atrophic candidiasis oral candidiasis marked by erythematous, pebbled patches on the hard or soft palate, buccal mucosa, and dorsal surface of the tongue, a complication of numerous different conditions such as vitamin deficiency, diabetes mellitus, or poorly fitting dentures. There are acute forms and a chronic form called
denture stomatitis.
bronchopulmonary candidiasis candidiasis of the respiratory tree, occurring in a mild afebrile form manifested as chronic bronchitis, and in a usually fatal form resembling tuberculosis. Called also
bronchocandidiasis.
chronic mucocutaneous candidiasis a group comprising a number of varying forms of Candida infection, marked by chronic candidiasis of the skin and nails and the mucous membranes of the mouth and vagina that is resistant to treatment; it may be localized or diffuse, is sometimes familial, and may be associated with disorders of the immune and endocrine systems.
endocardial candidiasis Candida endocarditis.
pulmonary candidiasis a type of fungal pneumonia caused by infection with
Candida species, seen especially in
immunocompromised patients or those with malignancies. Called also
Candida pneumonia.
vaginal candidiasis (
vulvovaginal candidiasis) candidal infection of the vagina, and usually also the vulva, commonly characterized by itching, creamy white discharge, vulvar redness and swelling, and dyspareunia. Called also
Candida or
candidal vaginitis and
Candida or
candidal vulvovaginitis.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.