CANDIDIASIS OVERVIEW
The "Chronic Candidiasis Syndrome" also known as the "Candidiasis Related Complex" (CRC) 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.
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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.
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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
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
PREVENTION
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