Candidiasis
Candidiasis is a common infection
caused by Candida fungi, especially Candida albicans.
Candida species are ubiquitous fungi found throughout the world as
normal body flora, but they are kept under control by the immune
system. When the immune system is weakened for various reasons
(AIDS, diabetes, malnutrition, certain medications like
corticosteroids or anticancer drugs), it begins to multiply leading
to a variety of diseases. Candidiasis affects many organ systems. In
immunocompetent persons, any warm, moist part of the body exposed to
the environment is susceptible to infection.
Common examples of this are
vaginitis; vulvar rash; oral thrush; conjunctivitis; endophthalmitis
(inflammation of the interior of the eye);
diaper rash; and infections of the nail, rectum, and other skin
folds. In immunocompromised patients, systemic illnesses such as
myocarditis (inflammation of heart muscle),
hepatosplenic abscess, pulmonary infection, CNS (Central Nervous
System) infection, and chronic disease may occur. Candidiasis is not
strictly a sexually transmitted disease but it can be transmitted
through sexual contact.
In the United States, candidiasis colonizes
over 50% of the healthy individuals. The immunocompromised persons are the most
exposed to infection with Candida albicans because their immune system is no
longer capable to fight the fungi.
Depending on the organ system it affects there
are several types of candidiasis:
Thrush:
when it infects the mouth. It
affects moist surfaces around the lips, inside the cheeks, and on the tongue and
palate.
Esophagitis:
when he infection spreads from the mouth to the esophagus.
Cutaneous
(skin) candidiasis: when it
affects the skin, for example diaper rash,
in areas of skin that receive little ventilation and are
unusually moist. Some common sites include the diaper area, the hands of people
who routinely wear rubber gloves, the rim of skin at the base of the fingernail
(especially for hands that are exposed to moisture), areas around the groin and
in the crease of the buttocks, and the skin folds under large breasts.
Vaginal
yeast infections: when it
affects the vagina. Vaginal yeast infections are not necessarily sexually
transmitted. During a lifetime,
75% of all women are likely to have at least one vaginal Candida
infection, and up to 45% have 2 or more.
Deep
candidiasis (for example
candida sepsis): when it contaminates the blood stream and spreads throughout
the body. This is especially
common in newborns with very low birth weights and in people with severely
weakened immune systems or severe medical problems. Deep candidiasis also can
occur in healthy people if Candida fungi enter the blood through
intravenous drug abuse, severe burns or wounds caused by trauma.
SIGNS AND SYMPTOMS
Depending on the area of infection,
canididiasis causes different symptoms.
Oral thrush symptoms include: sore and painful
mouth, burning mouth or tongue, dysphagia (difficulty
in swallowing), whitish, thick patches on the oral mucosa.
Esophagitis symptoms include: dysphagia, pain when
swallowing, chest pain behind the breastbone (sternum), abdominal pain, nausea
and vomiting, almost always oral candidiasis.
Cutaneous candidiasis causes
patches of red, moist, weepy skin,
sometimes with small pustules nearby.
Vaginal yeast infection symptoms include itching or soreness in the vaginal
area, a thick vaginal discharge with a texture like soft or cottage cheese, a
burning discomfort around the vaginal opening, especially if urine touches the
area, and pain or discomfort during sexual intercourse.
Deep
candidiasis causes a wide variety of symptoms, from unexplained fever to shock
and multiple organ failure.
TREATMENT
Certain forms of candidiasis can be easily treated with antifungal agents.
Oral thrush treatment
includes nystatin (Mycostatin
and others) and clotrimazole.
Esophagitis is treated with ketoconazole, itraconazole (Sporanox) or
fluconazole. (Fluconazole is the most effective medication for
people with HIV/AIDS).
Cutaneous candidiasis can be treated with a variety of antifungal
powders and creams. The affected area must be kept clean and dry and
protected from chafing.
Vaginal yeast infections can be treated with different antifungal
medications that are applied directly into the vagina as tablets,
creams, ointments or suppositories. These include butoconazole (Femstat),
clotrimazole (Gyne-Lotrimin), miconazole (Monistat 3 and others),
nystatin (Mycostatin and others), tioconazole (Trosyd) and
terconazole (Vagistat-1). A single dose of oral fluconazole can be
used, although this treatment is not recommended during pregnancy.
Sex partners usually do not need to be treated.
Deep candidiasis infection is usually treated with intravenous
amphotericin B (Abelcet) or fluconazole.
Candidiasis can also be treated at home by consuming or directly
applying yogurt, which
contains lactobacillus (probiotics, "friendly" bacteria that kill
yeast), acidophilus
tablets or salves, and even lightly crushed cloves of garlic, which
yield allicin, an antifungal. Boric acid has also been used to treat
yeast infections when gelcaps are filled with boric acid powder and
two are inserted at bedtime for three to four nights.
COMPLICATIONS
Candidiasis can spread from a local infection to
one affecting almost any organ system. Prompt treatment should be
instituted to decrease the chance of a systemic and possibly fatal
complication.
Complications include myocarditis, endophthalmitis (inflammation
of the interior of the eye), hepatosplenic abscess, and
occasionally death.
PREVENTION
There is no way of
preventing exposure to candida, but you can prevent it from
multiplying and spreading throughout the body. It is very important
to keep the skin clean and dry, to fallow a healthy lifestyle,
including proper nutrition.
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