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Candidiasis

Candidiasis

Candidiasis or thrush is a fungal infection (mycosis) of any of the Candida species (all yeasts), of which Candida albicans is the most common. Also commonly referred to as a yeast infection, candidiasis is also technically known as candidosis, moniliasis, and oidiomycosis.

 

A yeast infection results from an overgrowth of yeast (a type of fungus) anywhere in the body. Candidiasis is by far the most common type of yeast infection. There are more than 20 species of Candida, the most common being Candida albicans.

 

These fungi live on all surfaces of our bodies. Under certain conditions, they can become so numerous they cause infections, particularly in warm and moist areas. Examples of such infections are vaginal yeast infections, thrush (infection of tissues of the oral cavity), skin and diaper rash and nailbed infections.

 

  • Candidal infections commonly occur in warm moist body areas, such as underarms. Usually your skin effectively blocks yeast, but any breakdown or cuts in the skin may allow this organism to penetrate.

 

  • Typical affected areas in babies include the mouth and diaper areas.

 

  • Vaginal yeast infection, which is the most common form of vaginitis is often referred to as vaginal Candidiasis.

 

  • In adults, oral yeast infections become more common with increased age. Adults also can have yeast infections around dentures, in skin folds under the breast and lower abdomen, nailbeds, and beneath other skin folds. Most of these candidal infections are superficial and clear up easily with treatment. Infections of the nailbeds often require prolonged therapy.

 

  • Rarely, the yeast infection may spread throughout the body. In systemic candidal disease (in which the fungus enters the bloodstream and spreads throughout the body), up to 45% of people may die. Even common mouth and vaginal yeast infections can cause critical illness and can be more resistant to normal treatment.

 

  • Yeast infections that return may be a sign of more serious diseases such as diabetes, leukemia, or AIDS.

Symptoms

Signs and symptoms of a candidal infection can vary depending on the location of the infection.

 

  • In women, signs and symptoms of avaginal yeast infection are a white discharge that is thick and often described as having a cottage cheese appearance. The infection typically causes itching and irritates the vagina and surrounding outer tissues. On occasion there may be pain with sexual intercourse or burning with urination.

 

  • In infants and adults, a candidal infection can appear many different ways.

 

  1. Oral candidiasis is called thrush. Thick, white lacy patches on top of a red base can form on the tongue, palate, or elsewhere inside the mouth. These patches sometimes look like milk curds but cannot be wiped away as easily as milk can. If the white plaques are wiped away with a blade or cotton-tipped applicator, the underlying tissue may bleed. This infection also may make the tongue look red without the white coating. Thrush can be painful and make it difficult to eat. Care should be given to make sure a person with thrush does not become dehydrated. Thrush was formerly referred to as moniliasis, based upon an older name for Candid albicans (Monilia).
  2. Candidal organisms naturally live on the skin, but breakdown of the outer layers of skin promote the yeast's overgrowth. This typically occurs when the environment is warm and moist such as in diaper areas and skin folds. Superficial candidal skin infections appear as a red flat rash with sharp scalloped edges. There are usually smaller patches of similar appearing rash nearby, known as "satellite lesions". These rashes may cause itching or pain.

 

  • In people with weakened immune systems, candidal infections can affect various internal organs and cause pain or dysfunction of the organ. People with suppressed immune systems due to AIDS, chemotherapy, or other conditions may contract a yeast infection called esophagitis in their upper gastrointestinal (GI) systems. This infection is similar to thrush but extends down the mouth and esophagus to the stomach.Candida esophagitis can cause painful ulcers throughout the GI system, making it too painful to swallow even liquids. If the infection spreads into the intestines, food may be poorly absorbed. People with this condition are in danger of becomingdehydrated. There may be associated pain in the area of the sternum (breast bone), pain in the upper abdomen, and/or nausea and vomiting.

 

  • If Candida gets into the bloodstream, the person may become sick with or without fever. If the infection spreads to the brain, they may have acute changes in mental function or behavior.

Causes

  • In women, yeast infections are the second most common reason for vaginal burning, itching, and discharge. Yeasts are found in the vagina of 20% to 50% of healthy women and can overgrow if the environment in the vagina changes. Antibiotic and steroid use is the most common reason for yeast overgrowth. But pregnancy, menstruation, sperm, diabetes and birth control pills also can contribute to getting a yeast infection. Yeast infections are more common after menopause.

 

  • In people who have a weakened immune system because of cancer treatments, steroids, or diseases such as AIDS, candidal infections can occur throughout the entire body and can be life-threatening. The blood, brain, eye, kidney, and heart are most frequently affected, but Candida also can grow in the lungs, liver and spleen. Candida is a leading cause of esophagitis (inflammation in the swallowing tube) in people with AIDS.

 

  • Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida. These infections enter into the bloodstream through breakdowns or cuts in the skin or mucous membranes. Candidal organisms may build up in an area because of frequent use of antibiotics, which kill the bacteria that normally keep them under control.

 

  • Use of devices implanted in the skin such as urinary catheters and IV ports also provide access for the yeast to enter the body. IV drug users utilizing dirty needles may inject the yeast directly into their bloodstream or deep tissues.

Treatment

Self-Care at Home

 

Most candidal infections can be treated at home with over-the-counter (OTC) remedies or prescription medications and can clear within a week. But if some other disease has weakened your immune system, consult a doctor for any new symptoms before attempting self-treatment. You may risk getting an infection. 

 

Yeast infections

 

  • Most women can treat yeast infections at home with over-the-counter medications. A number of OTC remedies are available: 

          - miconazole (Micon 7, Monistat 3, Monistat 5, Monistat 7, M-Zole Dual Pack);

          - tioconazole (Monistat-1, Vagistat-1);

          - butoconazole (Gynazole 1);

          - clotrimazole (Femcare, Gyne-Lotrimin, Mycelex-G).

 

  • Massage these remedies into your vagina and surrounding tissues for 1-7 days depending on the formulation. If increased irritation occurs to the area, discontinue the medication immediately. 

 

  • If you are pregnant, consult your doctor before using these treatments.

 

  • If a single dose of fluconazole (Diflucan) - (see medical treatments) is as effective as topical antifungal creams. 

 

  • If symptoms are recurrent or continue for more than 1 week, consult your health care practitioner.

 

  • Thrush.

 

  • In thrush, swish the antifungal agent nystatin (Bio-Statin, Mycostatin, Mycostatin Pastilles, Nilstat) around in the mouth. Take care to maintain excellent oral hygiene. 

 

  • All objects put into a child's mouth should be sterilized after each use. 

 

  • Women who are breastfeeding should be evaluated for Candida of the breast. 

 

  • If a person wear dentures, clean them thoroughly after each use and practice good oral hygiene. 

 

  • Adults have several treatment options not available to babies, such as troches (antifungal lozenges) or pills such as fluconazole (Diflucan), to help clear the infection in addition to nystatin.

 

Skin and diaper rash 

 

  • Clotrimazole (Mycelex Troche) creams and lotions can be applied to superficial skin infections. Other medications need a prescription and a visit to a health care practitioner. 

 

  • The affected area should be kept clean and dry. 

 

  • For diaper rashes, frequent diaper changes and the use of barrier creams will speed recovery.

 

If the individual's immune system is weak, the doctor may handle minimal local infections with home care. More serious infections may need IV medications administered at the hospital.

 

Medical Treatment

 

A wide array of treatment options is available to treat candidiasis. Options include creams, lotions, pills, troches (lozenges), and vaginal suppositories. Talk to your doctor to find the option that is right for you.

 

  • Azole medications are a family of antifungal drugs that end in the suffix "-azole". They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast die. Fortunately, ergosterol is not a component of human membranes, and azoles do not harm human cells. Examples include miconazole, tioconazole, clotrimazole, fluconazole and butoconazole.

 

  • Polyene antifungals include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast-wall that causes the yeast to leak and die.
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