Candidiasis

Candidiasis is a fungal infection due to any species of the genus Candida (a yeast). In some countries, it is commonly called thrush when it affects the mouth. Signs and symptoms include white patches on the tongue or other mouth and throat areas. Other symptoms may include soreness and problems swallowing. When it affects the vagina, it may be referred to as a yeast infection or thrush. Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina. Yeast infections of the penis are less common and typically present with an itchy rash. Very rarely, yeast infections may become invasive, spreading to other body parts. This may result in fevers, among other symptoms. Finally, candidiasis of the esophagus is a significant risk factor for developing esophageal cancer in individuals with achalasia.

More than 20 types of Candida can lead to infections, with Candida albicans being the most prevalent. Oral infections are most frequent among children under one month old, the elderly, and those with weakened immune systems. Factors that contribute to a weakened immune system include HIV/AIDS, medications used after organ transplantation, diabetes, and the use of corticosteroids. Additional risk factors involve breastfeeding, post-antibiotic therapy, and wearing dentures. Vaginal infections are more common during pregnancy, in individuals with compromised immune systems, and following antibiotic use. People at risk for invasive candidiasis include low birth weight infants, individuals recovering from surgery, those admitted to intensive care units, and anyone with a generally weakened immune system.

Efforts to prevent mouth infections include using chlorhexidine mouthwash for individuals with poor immune function and rinsing the mouth after inhaling steroids. There is little evidence supporting the use of probiotics for prevention or treatment, even for those who experience frequent vaginal infections. For oral infections, treatment with topical clotrimazole or nystatin is generally adequate. Oral or intravenous fluconazole, itraconazole, or amphotericin B may be prescribed if these treatments fail. Various topical antifungal medications, including clotrimazole, can be used for vaginal infections. In cases of widespread disease, an echinocandin such as caspofungin or micafungin is administered. Alternative treatment may involve several weeks of intravenous amphotericin B. In specific high-risk groups, antifungal medications may be used as a preventive measure and in conjunction with drugs known to trigger infections.

Mouth infections occur in about 6% of babies under one month old. Approximately 20% of those undergoing chemotherapy for cancer and 20% of those with AIDS also develop the disease. Around three-quarters of women experience at least one yeast infection during their lives. Widespread disease is uncommon except among individuals with risk factors.

Signs and symptoms

Signs and symptoms of candidiasis vary based on the affected area. Most candidal infections lead to minimal complications, such as redness, itching, and discomfort; however, in specific populations, complications can be severe or even fatal if left untreated. In healthy (immunocompetent) individuals, candidiasis typically manifests as a localized infection of the skin, fingernails, or toenails (onychomycosis), or mucosal membranes, including the oral cavity and pharynx (thrush), esophagus, and genitalia (vagina, penis, etc.). Less commonly, in healthy individuals, the gastrointestinal tract, urinary tract, and respiratory tract can also be affected by Candida infections.

In immunocompromised individuals, Candida infections of the esophagus occur more frequently than in healthy individuals and have a greater potential to become systemic, leading to a much more serious condition known as candidemia. Symptoms of esophageal candidiasis include difficulty swallowing, painful swallowing, abdominal pain, nausea, and vomiting.

Mouth

Infection in the mouth is characterized by white discolorations in the tongue, around the mouth, and in the throat. Irritation may also occur, causing discomfort when swallowing.

Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a few weeks.

Genitals

Infection of the vagina or vulva may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray cottage cheese-like discharge. Symptoms of disease of the male genitalia (balanitis thrush) include red skin around the head of the penis, swelling, irritation, itchiness and soreness of the head of the penis, thick, lumpy discharge under the foreskin, unpleasant odour, difficulty retracting the foreskin (phimosis), and pain when passing urine or during sex.

Skin

Signs and symptoms of candidiasis in the skin include itching, irritation, and chafing or broken skin.

Invasive infection

Common symptoms of gastrointestinal candidiasis in healthy individuals include anal itching, belching, bloating, indigestion, nausea, diarrhea, gas, intestinal cramps, vomiting, and gastric ulcers. Perianal candidiasis may cause anal itching, and the lesions can appear red, papular, or ulcerative; however, it is not classified as a sexually transmitted infection. An abnormal increase of candida in the gut can lead to dysbiosis. While still unclear, this alteration may contribute to symptoms typically associated with irritable bowel syndrome and other gastrointestinal diseases.

Neurological symptoms

Systemic candidiasis can affect the central nervous system, causing various neurological symptoms with a presentation similar to meningitis.

Causes

Wikipedia article: Candida (fungus)

Candida yeasts are commonly found in healthy humans and are often part of the normal oral and intestinal flora, particularly on the skin. However, their growth is typically kept in check by the human immune system and by competing microorganisms, such as bacteria that inhabit similar areas of the body. Candida requires moisture for growth, especially on the skin. For example, wearing wet swimwear for long periods is considered a risk factor. Additionally, Candida can cause diaper rashes in infants. In severe cases, superficial infections of the skin or mucous membranes may enter the bloodstream and lead to systemic Candida infections.

Factors that increase the risk of candidiasis include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress, antibiotic therapy, diabetes, and nutrient deficiencies. Hormone replacement therapy and infertility treatments may also be predisposing factors. The use of inhaled corticosteroids raises the risk of oral candidiasis. When inhaled corticosteroids are combined with other risk factors, such as antibiotics, oral glucocorticoids, failure to rinse the mouth after using inhaled corticosteroids, or high doses of inhaled corticosteroids, individuals face an even greater risk. Treatment with antibiotics can eliminate the yeast's natural competitors for resources in the oral and intestinal flora, thereby worsening the condition. A weakened or underdeveloped immune system and metabolic illnesses are significant predisposing factors for candidiasis. Nearly 15% of individuals with weakened immune systems develop a systemic illness caused by Candida species. Diets high in simple carbohydrates have been shown to influence the rates of oral candidiasis.

C. albicans was isolated from the vaginas of 19% of apparently healthy women, indicating those who experienced few or no symptoms of infection. The external use of detergents or douches, along with internal disturbances, whether hormonal or physiological, can disrupt the normal vaginal flora, which includes lactic acid bacteria like lactobacilli, leading to an overgrowth of Candida cells and causing infection symptoms such as local inflammation. Pregnancy and oral contraceptive use have been identified as risk factors. Diabetes mellitus and antibiotic use are also linked to higher rates of yeast infections.

In penile candidiasis, the causes include sexual intercourse with an infected individual, low immunity, the use of antibiotics, and diabetes. While male genital yeast infections are less common, a yeast infection on the penis resulting from direct contact during sexual intercourse with an infected partner is not unusual.

Breastfeeding mothers may also develop candidiasis on and around the nipple due to moisture created by excessive milk production.

Vaginal candidiasis can cause congenital candidiasis in newborns.

Prevention

A diet that bolsters the immune system and is low in simple carbohydrates helps maintain a healthy balance of oral and intestinal flora. Although yeast infections are associated with diabetes, controlling blood sugar levels may not affect the risk. Wearing cotton underwear can reduce the likelihood of skin and vaginal yeast infections, particularly by avoiding damp clothing for long periods. For women who experience recurrent yeast infections, limited evidence indicates that oral or intravaginal probiotics can help prevent future infections. This includes both pills and yogurt.

Maintaining oral hygiene can help prevent oral candidiasis, especially in individuals with weakened immune systems. For those undergoing cancer treatment, using chlorhexidine mouthwash can help prevent or reduce the occurrence of thrush. After inhalation, individuals who use inhaled corticosteroids can lower their risk of developing oral candidiasis by rinsing their mouths with water or mouthwash. Additionally, individuals with dentures should regularly disinfect them to prevent oral candidiasis.

Treatment

Candidiasis is treated with antifungal medications, which include clotrimazole, nystatin, fluconazole, voriconazole, amphotericin B, and echinocandins. Intravenous fluconazole or an intravenous echinocandin, such as caspofungin, is commonly used to treat immunocompromised or critically ill individuals.

The 2016 revision of the clinical practice guideline for managing candidiasis presents a wide range of specific treatment regimens for Candida infections, considering various Candida species, forms of antifungal drug resistance, immune statuses, and the localization and severity of infections. Gastrointestinal candidiasis in immunocompetent individuals is treated with 100–200 mg of fluconazole daily for 2–3 weeks.

Localized infection

Mouth and throat candidiasis are treated with antifungal medications. Oral candidiasis typically responds to topical treatments; however, systemic antifungal medications may be required for more severe oral infections. Candidal skin infections in skin folds (candidal intertrigo) generally respond well to topical antifungal treatments, such as nystatin or miconazole. For breastfeeding mothers, topical miconazole is the most effective option for treating candidiasis on the breasts. Gentian violet can be used for thrush in breastfeeding infants. Systemic treatment with oral antifungals is reserved for severe cases or when topical therapy is ineffective. Candida esophagitis may be treated orally or intravenously; treatment with amphotericin B may be required for severe or azole-resistant esophageal candidiasis.

Vaginal yeast infections are usually treated with topical antifungal agents. Penile yeast infections are also managed with antifungal agents, but while an internal treatment, like a pessary, may be used for vaginal yeast infections, only external treatments—such as creams—are recommended for penile infections. A single oral dose of fluconazole is 90% effective in treating vaginal yeast infections. For severe, nonrecurring cases, several doses of fluconazole are recommended. Local treatment may involve vaginal suppositories or medicated douches. Different types of yeast infections require varying dosing. C. albicans can develop resistance to fluconazole, which is more of a concern for individuals with HIV/AIDS who often receive multiple courses of fluconazole for recurrent oral infections.

For vaginal yeast infections during pregnancy, topical imidazole or triazole antifungals are regarded as the preferred treatment due to available safety data. The systemic absorption of these topical formulations is minimal, which presents little risk of transplacental transfer. In cases of vaginal yeast infections in pregnancy, treatment with topical azole antifungals is recommended for seven days rather than a shorter duration.

For vaginal yeast infections, many complementary treatments are proposed, however a number have side effects. No benefit from probiotics has been found for active infections.

Blood-borne infection

Candidemia occurs when any Candida species infects the blood (Fungemia). Its treatment typically consists of oral or intravenous antifungal medications. Examples include intravenous fluconazole or an echinocandin such as caspofungin. Amphotericin B is another option.

Prognosis

In hospitalized patients with candidemia, age serves as a significant prognostic factor. The mortality rate following candidemia is 50% for patients aged 75 years and older and 24% for those younger than 75 years. Among individuals receiving treatment in intensive care units, the mortality rate is approximately 30% to 50% when systemic candidiasis occurs.

Epidemiology

Oral candidiasis is the most common fungal infection of the mouth, and it is also the most prevalent opportunistic oral infection in humans. Approximately 6% of infants under one month old experience mouth infections. Additionally, around 20% of individuals undergoing chemotherapy for cancer and 20% of those with AIDS develop this condition.

It is estimated that 20% of women may be asymptomatically colonized by vaginal yeast. In the United States, there are approximately 1.4 million doctor office visits yearly for candidiasis. About three-quarters of women experience at least one yeast infection at some point.

Esophageal candidiasis is the most prevalent esophageal infection in individuals with AIDS, accounting for approximately 50% of all esophageal infections and often occurring alongside other esophageal diseases. Around two-thirds of people with AIDS and esophageal candidiasis also have oral candidiasis.

Candidal sepsis is rare. Candida is the fourth most common cause of bloodstream infections among hospital patients in the United States. The incidence of bloodstream candida in intensive care units varies widely between countries.

More information is available at [ Wikipedia:Candidiasis ]

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