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

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.

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.

— Richard H. Lampert

Dictionary: can·di·di·a·sis  (kăn'dĭ-dī'ə-sĭs)

Infection with a fungus of the genus Candida, especially C. albicans, that usually occurs in the skin and mucous membranes of the mouth, respiratory tract, or vagina but may invade the bloodstream, especially in immunocompromised individuals. Also called candidosis, moniliasis.

An infection by Candida albicans.See also moniliasis; thrush.

Chronic hyperplastic candidiasis. (Ibsen/Phelan, 2000)

Definition

Candidiasis is an infection caused by a species of the yeast Candida, usually the Candida albicans fungus. Candida is found on various parts of the bodies of almost all normal people but causes problems in only a few. Candidiasis can affect the skin, nails, and mucous membranes throughout the body including the mouth (thrush), esophagus, vagina (yeast infection), intestines, and lungs.

Description

Candida may cause yeast mouth infections (also known as thrush) in children with reduced immune function or in children taking certain antibiotics. Antibiotics may upset the balance of microorganisms in the body and allow an overgrowth of Candida. The use of inhaled steroids for the treatment of asthma has also been shown to cause oral candidiasis. Many infants acquire candidiasis from their mothers during the process of birth, when the baby comes in contact with naturally existing Candida found in the mother's vagina. Candidiasis is not considered harmful to infants unless it lasts more than several weeks after birth. These yeast mouth infections cause creamy white, curd-like patches on the tongue, inside of the mouth, and on the back of the throat. Under the whitish material, there are red lesions that may bleed.

Candida also may infect an infant's diaper rash, as it grows rapidly on irritated and moist skin. Children who suck their thumbs or other fingers may also develop candidiasis around their fingernails, causing redness on the nail edges.

Candida is a common cause of vaginal infections in adolescent girls, especially when the normal populations of the bacteria Lactobacilli have been reduced due to antibiotic use, allowing the overgrowth of Candida. A candidiasis infection in the vagina results in itching, burning, soreness, and a thick, white vaginal discharge.

Other risk factors for candidiasis include obesity, heat, and excessive sweating that result in the formation of moist skin areas where the yeast organism can grow.

In the early 2000s, several serious categories of candidiasis have become more common, due to overuse of antibiotics, the rise of AIDS, the increase in incidence of organ transplantations, the use of chemotherapy in cancer treatment, and the implantation of invasive devices (e.g., nasogastric tubes, catheters, and artificial joints and valves) into the body—all of which increase a patient's susceptibility to infection. Diabetics are especially susceptible to candidiasis, as they have high levels of sugar in their blood and urine and a low resistance to infection, both of which are conditions that favor the growth of yeast. 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 child's resistance is lowered, often due to another illness. Children with granulocytopenia (deficiency of white blood cells) are particularly at risk for deep organ candidiasis. There are many diagnostic categories of deep organ candidiasis, depending on the tissues involved.

In the past candidiasis was referred to as moniliasis.

Demographics

Candidiasis is an extremely common infection. Thrush occurs in approximately 2–5 percent of healthy newborns and occurs in a slightly higher percentage of infants during their first year of life.

Over 1 million adult women and adolescent girls in the United States develop vaginal yeast infections each year. It is not life-threatening, but the condition can be uncomfortable and frustrating.

Causes and Symptoms

Candidiasis is caused by a species of the yeast Candida, usually the Candida albicans fungus.

In oral candidiasis, the disease is characterized by whitish patches that appear on the tongue, inside of the cheeks, or on the palate. Pain or difficulty in swallowing may indicate a fungal infection in the throat, which is a potential complication of AIDS. Most adolescent girls with vaginal candidiasis experience severe vaginal itching and 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. The infected skin in diaper rash that includes infection with Candida appears fiery red with areas that may have a raised red border.

Effects of deep organ or systematic candidiasis include meningitis, arthritis, fungemia (fungi in the blood, causing fever and possibly leading to sepsis), endocarditis (heart infection), endophthalmitis (infection and scarring in the eye that can affect vision), and renal or bladder bezoars (colonization and blockage of the urinary tract by Candida, which can cause urinary tract infections and kidney failure.

Diagnosis

Often clinical appearance and visual examination give a strong suggestion about the diagnosis. Generally, a doctor takes a sample of the vaginal discharge or swabs an area of oral or skin lesions, and then inspects this material under a microscope, where it is possible to see characteristic forms of yeasts at various stages in the lifecycle.

Fungal blood and stool cultures for detection of the Candida organism should be taken for patients suspected of having deep organ candidiasis. Tissue biopsy may be needed for a definitive diagnosis.

When to Call the Doctor

The doctor should be called if a child exhibits any symptoms of the various types of candidiasis.

Treatment

Treatment of candidiasis is primarily accomplished through the use of antifungal drugs. Oral candidiasis is usually treated with prescription lozenges or mouthwashes. Some of the most-used prescriptions are nystatin mouthwashes (Nilstat or Nitrostat) and clotrimazole lozenges. Skin infections can be treated with topical antifungal creams. Highly inflamed skin lesions can also be treated with corticosteroid creams.

For infants with oral candidiasis, pacifiers should be sterilized or discarded. Bottle nipples should be discarded and new ones used as the infant's mouth begins to heal.

The risk of diaper rash complicated with candidiasis can be reduced by preventing irritating dermatitis through the use of absorbent diapers and prevention of excessive exposure to urine or feces through frequent changing of diapers. The use of plastic pants that do not allow air circulation over the diaper area is not recommended. Children may still attend child care; however, childcare providers should follow good hygienic practices, including thorough hand washing and disposal of materials that may contain nasal and oral secretions of infected children, in order to prevent transmitting the infection to other children.

In most cases, vaginal candidiasis can be treated successfully with a variety of over-the-counter antifungal creams or suppositories, including Monistat, Gyne-Lotrimin, and Mycelex. However, infections often recur. If an adolescent girl has frequent recurrences, she should consult her doctor about prescription drugs such as Vagistat-1, Diflucan, and others.

The early 2000s 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 children with candidiasis.
• Antifungal therapy may be used during chemotherapy to prevent candidiasis.
• Drugs should be prescribed based on a child's specific history and immune defense status (this is especially critical for children with AIDS). Stronger antifungal drugs, such as ketoconazole or fluconazole, may be necessary.
• Diabetes mellitus should be controlled with appropriate medication and dietary changes.

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 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; however, they should try a conventional treatment if an alternative remedy is not effective.

Prognosis

Oral and skin candidiasis, though painful, are usually cured with the use of antifungal medications. However, in premature infants, in children with poor or compromised immune systems, or in children with deep organ or systematic infections, eradication of the infections may be more difficult to achieve. Mortality in low birth-weight premature infants with systemic candidiasis may reach 50 percent.

Prevention

Often candidiasis can be prevented through good sanitation procedures, such as keeping the body cool and dry, wearing natural fabric underclothes, changing underclothes frequently, wiping from front to back after bowel movements, and washing hands often. For children who are susceptible to candidiasis because of immune deficiencies, the regular use of antifungal drugs to prevent infections may be required.

Parental Concerns

Parents need to practice good hygienic procedures as they care for their children, in order to prevent the development of candidiasis.

Resources

Books

Martin, Jeanne Marie, and Rona P. Soltan. Complete Candida Yeast Guidebook: Everything You Need to Know about Prevention, Treatment, and Diet. New York: Prima Lifestyles, 2000.

The Official Patient's Sourcebook on Invasive Candidiasis. San Diego, CA: Icon Health Publications, 2002.

Web Sites

Greenberg, Michael E. "Candidiasis." eMedicine, September 1, 2004. Available online at www.emedicine.com/ped/topic312.htm (accessed December 7, 2004).

[Article by: Judith Sims Richard H. Lampert]

Candidiasis (thrush, monilia infection) is caused by a fungus that most commonly infects the mouth (usually of infants or persons with weakened immune systems), or the vagina (yeast infection). Another form of candidiasis causes painful inflammation under the fingernails (paronychia). It also occurs as an opportunistic infection in the late stages of HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), as a nosocomial infection after catheterization; and it can invade the spinal canal and meninges, where it is obviously much more serious.

Candidiasis is transmitted by close contact of an infected with an uninfected mucous membrane. Infants acquire it as they pass through the birth canal. Topical application of antifungal paint or ointment can usually eliminate the infection and thus prevent transmission. Management is more difficult in debilitated and immunocompromised patients, in whom the condition can be very stubborn.

(SEE ALSO: Fungal Infections; Fungicides)

— JOHN M. LAST

Candidiasis
Classification & external resources

Agar plate culture of Candida albicans
ICD-10	B37.
ICD-9	112
DiseasesDB	1929
MedlinePlus	001511
eMedicine	med/264  emerg/76 ped/312 derm/67
MeSH	D002177

Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is the most common.^[1]

Manifestation

In immunocompetent people, candidiasis can usually only be found in exposed and moist parts of the body^[1], such as:

• the oral cavity (oral thrush)
• the vagina and/or vulva (vaginal candidiasis or thrush)
• folds of skin in the diaper area (diaper rash)
• the nipples while breastfeeding
• the penis or foreskin
• the armpit
• the ear
• the skin around the nostrils or in the nostrils

Candidiasis is the second most common cause of vaginal irritation, or vaginitis, and can also occur on the male genitals. In immunocompromised patients, the Candida infection can involve the esophagus and can become systemic, causing a much more serious condition: fungemia.

Children, mostly between the ages of 3 and 9 years, can be affected by chronic mouth yeast infections, normally seen around the mouth as white patches. However, this is not a common condition.

Causes

Oral candidiasis on the tongue and soft palate.

Candida yeasts are usually present in most people, but uncontrolled multiplication resulting in disease symptoms is kept in check by other naturally occurring microorganisms, e.g., bacteria co-existing with the yeasts in the same locations, and by the human immune system.

In a study of 1009 women in New Zealand, Candida albicans was isolated from the vaginas of 19% of apparently healthy women. Carriers experienced few or no symptoms. However, external use of irritants (such as some detergents or douches) or internal disturbances (hormonal or physiological) can perturb the normal flora, constituting lactic acid bacteria, such as lactobacilli, and an overgrowth of yeast can result in noticeable symptoms. ^{[citation needed]} Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex, and using lubricants containing glycerin have been found to be causally related to yeast infections. ^{[citation needed]} Diabetes mellitus and the use of antibiotics are also linked to an increased incidence of yeast infections. ^{[citation needed]} Candidiasis can be sexually transmitted from men to women, but only rarely from a woman to a man. ^{[citation needed]} Diet has been found to be the cause in some animals. Hormone Replacement Therapy and infertility treatments may also be predisposing factors. ^{[citation needed]}

Symptoms

Symptoms include severe itching, burning, and soreness, irritation of the vagina and/or vulva, and a whitish or whitish-gray discharge, often with a curd-like appearance.

Many women mistake the symptoms of the more common bacterial vaginosis for a yeast infection. In a 2002 study published in the Journal of Obstetrics and Gynecology, only 33 percent of women who were self treating for a yeast infection actually had a yeast infection. Instead they had either bacterial vaginosis or a mixed-type infection.

In men, symptoms include red patchy sores near the head of the penis or on the foreskin. The sores may feel irritated and itchy, and sometimes they will burn as well.

Diagnosis

Medical professionals use two primary methods to diagnose yeast infections: microscopic examination, and culturing.

For the microscope method, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% potassium hydroxide (KOH) solution is then also placed on the slide. The KOH dissolves the skin cells but leaves the Candida untouched, so that when the slide is viewed under a microscope, the hyphae and pseudo spores of Candida are visible. Their presence in large numbers strongly suggests a yeast infection.

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then rubbed across a culture medium. The medium is incubated for several days, during which time colonies of yeast and/or bacteria develop. The characteristics of the colonies provide a presumptive diagnosis of the organism causing symptoms.

Treatment

It is important to consider that Candida species are frequently part of the human body's normal oral and intestinal flora. Candidiasis is occasionally misdiagnosed by medical personnel as bacterial in nature, and treated with antibiotics against bacteria.^{[citation needed]} This can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition.

In clinical settings, candidiasis is commonly treated with antimycotics—the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole. In severe infections (generally in hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for breastfeeding thrush, but pediatrician William Sears recommends using it sparingly,^[2] since in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.^[3]

One of the most potent nondrug or natural yeast-fighting substances is caprylic acid, a medium-chain fatty acid derived from coconut oil. Caprylic acid in capsule form is commonly sold as a dietary supplement in health food stores. It is very effective against Candida and other forms of fungi. It is even effective mixed with a little coconut oil or vitamin E oil as a topical application for fungal skin infections. Some cases of fungal infections that have lasted for months clear up in a matter of days using caprylic acid and a little coconut oil. It works just as effectively inside the body, killing fungi without the least bit of harm.^{[citation needed]}

Polynesian women who eat their traditional coconut-based diet rarely, if ever, get yeast infections.^{[citation needed]} Only in more temperate climates where processed vegetable oils are the main source of dietary fat are yeast infections, skin fungus, acne, and other skin infections big problems. Lauric acid, found in coconut oil, kills lipid-coated bacteria but does not appear to harm the friendly intestinal bacteria. Medium-Chain Fatty Acids (MCFA)s also have antifungal properties, so not only will they kill disease-causing bacteria and leave good bacteria alone but also they will kill Candida and other fungi in the intestinal tract, further supporting a healthy intestinal environment. Eating coconut oil on a regular basis, as the Polynesians do, helps to keep Candida and other harmful microorganisms at bay.

Some home remedies for candidiasis include the consumption or direct application of yogurt (which contains lactobacillus), probiotics, acidophilus tablets or salves, Pau d'arco tea, and even lightly crushed cloves of garlic, which yield allicin, an antifungal agent.^{[citation needed]} Boric acid has also been used to treat yeast infections (by inserting gelcaps filled with boric acid powder into the vagina at bedtime for three to four consecutive nights). ^{[citation needed]} Eating a diet consisting primarily of green, fresh, raw vegetables also may give relief.^{[citation needed]} Other alternative treatments consist in consuming a fermented beverage called Kefir.

While home remedies may offer relief in minor cases of infection (although a peer-reviewed study in Australia found yogurt ineffective as treatment for Candida albicans^{[citation needed]}), seeking medical attention may be necessary, especially if the extent of the infection cannot be judged accurately by the patient. For instance, oral thrush is visible only at the upper digestive tract, but it may be that the lower digestive tract is likewise colonized by Candida species.

Treating candidiasis solely with medication may not give desired results, and other underlying causes require consideration. As an example, oral candidiasis is often linked to the use of inhaled corticosteroids in asthma medication.^{[citation needed]} Patients on long-term inhaled corticosteroids should rinse their mouths after each dose of steroids to counteract this effect.^{[citation needed]} Oral candidiasis can also be the sign of a more serious condition, such as HIV infection, or other immunodeficiency diseases. Following the health tips at vulvovaginal health can help prevent vaginal candidiasis.

Babies with diaper rash should have their diaper areas kept clean, dry, and exposed to air as much as possible. Sugars assist the overgrowth of yeast, possibly explaining the increased prevalence of yeast infections in patients with diabetes mellitus, as noted above. As many Candida spp. reside in the digestive tract, dietary changes may be effective for preventing or during a Candida infection. Due to its requirement for readily fermentable carbon sources, such as mono- or dimeric sugars (e.g., sucrose, glucose, lactose) and starch, avoiding foods that contain these nutrients in high abundance may help to prevent excessive Candida growth. Breast milk is a suitable growth substrate for yeasts, and both nursing mother and baby need to be treated (even if both are not symptomatic) to prevent thrush from being passed between mother and child.^{[citation needed]}

History and taxonomic classification

B. Lagenbeck in 1839 in Germany was the first to demonstrate that a yeast-like fungus existed in the human oral infection "thrush." He also found that a fungus was able to cause thrush.^{[citation needed]}

The genera Candida, species albicans was described by botanist Christine Marie Berkhout. She described the fungus in her doctoral thesis, at the University of Utrecht in 1923. Over the years the classification of the genera and species has evolved. Obsolete names for this genus include Mycotorula and Torulopsis. The species has also been known in the past as Monilia albicans and Oidium albicans. The current classification is nomen conservandum, which means the name is authorized for use by the International Botanical Congress (IBC).

The full current taxonomic classification is available at Candida albicans.

The genus Candida includes about 150 different species. However, only a few of those are known to cause human infections. C. albicans is the most significant pathogenic (=disease-causing) species. Other Candida species causing diseases in humans include C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. dubliniensis, and C. lusitaniae.

References

1. ^ ^{a b} Walsh TJ, Dixon DM (1996). Deep Mycoses in: Baron's Medical Microbiology (Baron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1. 
2. ^ www.askdrsears.com
3. ^ extoxnet.orst.edu

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)