Candidiasis
What is Candidiasis?Candidiasis is an infection caused by Candida fungi, especially Candida albicans. These fungi are found almost everywhere in the environment. Some may live harmlessly along with the abundant "native" species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina. Usually, Candida is kept under control by the native bacteria and by the body's immune defenses. If the native bacteria are decreased by antibiotics or if the person's immune system is weakened by illness (especially AIDS or diabetes), malnutrition, or certain medications (corticosteroids or anticancer drugs), Candida fungi can multiply to cause symptoms. Candida infections can cause occasional symptoms in healthy people. Candidiasis can affect many parts of the body, causing localized infections or larger illness, depending on the person and his or her general health.
Symptoms
Candidiasis causes different symptoms, depending on the site of infection.
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Thrush — Thrush causes curdlike white patches inside the mouth, especially on the tongue and palate and around the lips. If you try to scrape off this whitish surface, you will usually find a red, inflamed area, which may bleed slightly. There may be cracked, red, moist areas of skin at the corners of the mouth. Sometimes thrush patches are painful, but often they are not.
Esophagitis — Candida esophagitis may make swallowing difficult or painful, and it may cause chest pain behind the breastbone (sternum).
Cutaneous candidiasis — Cutaneous candidiasis causes patches of red, moist, weepy skin, sometimes with small pustules nearby.
Vaginal yeast infections — Vaginal yeast infections may cause the following symptoms: vaginal itch and/or soreness; 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 — When Candida spreads to the bloodstream, it may cause a wide range of symptoms, from unexplained fever to shock and multiple organ failure.
Expected Duration
In otherwise healthy people who have thrush, cutaneous candidiasis, or vaginal yeast infections, Candida infections usually can be eliminated with a short treatment (sometimes a single dose) of antifungal medication. However, in people with AIDS or other diseases that weaken the immune system, Candida infections can be difficult to treat and can return after treatment. In people with weakened immune systems, candidiasis can be life threatening if it passes into the blood and spreads to vital organs.
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Prevention
In general, you can prevent most Candida infections by keeping your skin clean and dry, by using antibiotics only as your doctor directs, and by following a healthy lifestyle, including proper nutrition. People with diabetes should try to keep their blood sugar under tight control.
If you have HIV or another cause of recurrent episodes of thrush, antifungal drugs, such as clotrimazole (Lotrimin, Mycelex), can help to minimize flare-ups.
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Treatment
Treatment of candidiasis varies, depending on the area affected:
Thrush — Doctors treat thrush with topical, antifungal medications such as nystatin (Mycostatin and others) and clotrimazole. For mild cases, a liquid version of nystatin can be swished in the mouth and swallowed, or a clotrimazole lozenge can be dissolved in the mouth. For more severe cases, ketoconazole (Nizoral) or fluconazole (Diflucan) can be taken once a day by mouth.
Esophagitis — Candida esophagitis is treated with ketoconazole, itraconazole (Sporanox) or fluconazole. (Fluconazole is the most effective medication for people with HIV/AIDS).
Cutaneous candidiasis — This skin infection can be effectively 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 — Vaginal yeast infections can be treated with 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 — This infection is usually treated with intravenous amphotericin B (Abelcet) or fluconazole.
When To Call A Professional
Call your doctor whenever you have symptoms of candidiasis, especially if you have a chronic illness or a weakened immune system caused by cancer, HIV or medications that suppress the immune system.
Typically, in otherwise healthy people with superficial candidiasis, a properly treated infection goes away without leaving permanent damage. Candidiasis is unlikely to return as long as the person remains healthy and well nourished. In people with chronic illnesses or weakened immune systems, episodes of candidiasis may be more resistant to treatment and may return after treatment ends. In people with deep candidiasis, those who are diagnosed quickly and treated effectively have the best prognosis, especially if their infection can be stopped before it spreads to major organs.
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