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
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.
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.
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
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.
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
, 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.
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.
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.
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.
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.
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.
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.
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.
Greenspan, Deborah, and John S. Greenspan. "HIV-Related Oral Disease." The Lancet 348 (September 14, 1996): 729-734.
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
The most prominent symptom of vaginitis due to Candida
infection is severe itching. Sexual transmission is unlikely. Intravaginal cream containing miconazole
, 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
, 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
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.
a type of fungal pneumonia caused by infection with Candida
species, seen especially in immunocompromised
patients or those with malignancies. Called also Candida
) 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
or candidal vulvovaginitis
candidiasis (kan?di-di'a-sis) [ Candida + -iasis]
Fungal infection of the skin or mucous membrane with any species of Candida
, but chiefly Candida albicans
species are part of the body's normal flora. Candida
grows in warm, moist areas, causing superficial infections of the mouth, vagina, nails, and skinfolds in healthy people. In patients with immunodeficiencies, central venous lines, and burns, or those receiving peritoneal dialysis, it can invade the bloodstream, causing disseminated infections. See: illustration
; normal flora
Candida infections are due to a disruption in the composition of normal flora or a change in host defenses. Antibiotic therapy, which destroys the bacteria in normal flora, and inhaled or systemic corticosteroid therapy, which decreases white blood cell activity, are common treatments that may cause candidiasis. Vulvovaginal candidiasis is common during pregnancy, possibly as the result of increased estrogen levels. Infections of the nail beds (paronychia) can occur in those whose hands are frequently in water or who wear occlusive gloves or who are receiving chemotherapy. Elevated glucose levels can be the predisposing factor in patients with diabetes mellitus. Chronic mucocutaneous candidiasis is common in patients with AIDS or other immunosuppressant illnesses. Systemic fungal infections may be present in any organ, including the brain, heart, kidneys, and eyes.
Oral lesions (thrush) are raised, white patches on the mucosa and tongue that can be easily scraped off, revealing an underlying red, irritated surface. Skin lesions are red and macerated, and are usually located in skinfolds of the groin or abdomen and under pendulous breasts. Vaginal infections are characterized by itching and a thick, cheesy discharge. Blurred vision is the first symptom noticed in ocular candidiasis. The symptoms produced in systemic infections depend on the extent of the infection and the organs affected, i.e., whether Candida invades the heart, esophagus, meninges, kidneys, or lungs. Candida septicemia can cause chills, fever, and shock with oliguria leading to renal failure.
Oral candidiasis is treated with a single dose of fluconazole or with clotrimazole lozenges or nystatin oral solution (which must be held in the mouth for several minutes before swallowing) for 14 days. Topical forms of amphotericin B, clotrimazole, econazole, nystatin, or miconazole are effective for skin infections. Fluconazole is used for oral or vaginal infections in patients with AIDS. Amphotericin B, fluconazole, flucytosine, ketaconazole, and newer antifungal agents are used to treat patients with systemic infections. For patients with kidney disease, ketaconazole has the advantage of liver metabolism and fecal excretion. Some strains of C. albicans are resistant to fluconazole. Pregnant women should consult their health care providers before taking or applying these drugs.
Patients with thrush need explanations about the need to swish nystatin solution in their mouths for several minutes before swallowing to obtain maximum benefit. A nonirritating mouthwash and a soft toothbrush are provided to loosen tenacious secretions without causing irritation. A topical anesthetic helps relieve mouth discomfort, and a soft diet may be helpful. The patient's intake is monitored: mouth pain may interfere with nutritional intake, esp. in those recovering from surgery, trauma, or severe infection. The patient is weighed twice a week to assess nutritional status.
Patients who are obese or incontinent of urine are at special risk for Candida infection, esp. if they are receiving antibiotics. Skin folds should be carefully washed and dried, and antifungal cream or powder applied, usually 3 to 4 times a day. When possible, the affected area should be exposed to the air.
Patients with vulvovaginal candidiasis should be reminded not to wear constricting clothing such as panty hose and to wear cotton underwear. If there is pain after intercourse (dyspareunia), the patient is counseled that sexual impairment should resolve as the infection subsides, and to complete the full course of medication as prescribed. Although the sexual partners of infected patients usually will not need treatment, partners of patients with recurrent vaginal infections should be examined and treated if indicated to prevent ongoing reinfections.
Patients with systemic candidiasis require inpatient care for intravenous or intrathecal drug administration, monitoring of laboratory findings, and assessment to identify and manage adverse drug effects and to treat infection extension to other sites and complications. Vital signs are monitored because of the risk of septic shock. Supportive care includes premedication with antipyretics, antihistamines, or corticosteroids to minimize hypersensitivity reactions if the patient is receiving intravenous amphotericin B. Multiple factors affect whether or not immunocompromised patients will develop or die from candidiasis. These include the severity of their underlying illness, nutritional status, history of alcohol abuse, diabetes mellitus, renal or liver failure, illicit drug use, or other comorbid conditions. Immunosuppressed individuals should be encouraged to or reduce risk factors for infection. The patient should be encouraged to eat a nutritious diet, balance activity with rest, reduce stressors, and manage time realistically. All high-risk hospitalized patients, esp. those receiving antibiotic therapies, should be assessed for indications of candidiasis superinfection.
chronic atrophic candidiasisDenture stomatitis.