WHAT IS IT?
Candidiasis is an infection caused by Candida albicans. This yeast is normally present in the mouth, vagina, and feces, but the amount of yeast is controlled by bacteria in those areas. A yeast infection results when the bacteria population is disturbed by the use of antibiotics, or if other conditions are present that promote yeast growth, such as pregnancy, use of oral contraceptives or corticosteroids, diabetes, hypothyroidism, hypoparathyroidism, or
Addison's disease. The resulting infection can affect the genitals, skin, mucous membranes, and the esophagus.
Candida infection of the mouth is called thrush. It is most likely to affect individuals who are on long-term drug therapies, such as antibiotics, corticosteroids, or chemotherapy; have diabetes mellitus, anemia, acquired immune deficiency syndrome, or debilitating diseases; or who have a chronic, dry mouth caused by atrophy of the saliva glands (xerostomia).
Thrush is common among those who wear dentures. Men may develop candidiasis from an infected sexual partner or as a complication of diabetes mellitus.
Systemic candidiasis usually occurs in individuals with deficient or suppressed immune systems. The infection usually manifests as esophagitis, sepsis,
endocarditis, or meningitis.
HOW IS IT DIAGNOSED?
History varies based on the location of the infection. Women are more likely than men are to have symptoms of genital candidiasis.
The first symptom is itching of the vulva. Women may then notice a white or yellow discharge and the vaginal wall may be inflamed.
Some men may experience a discharge from the penis.
Physical exam of genital candidiasis may show a white, cheese-like vaginal discharge.
The glans penis may be reddish with small blisters or ulcers. In more severe cases, the foreskin may be swollen, causing it to tighten over the penis (phimosis).
Skin infections appear as red, slightly swollen patches that may itch and ooze.
Small red blisters may surround the patches.
Skin infections are most commonly located in the skin folds, such as the armpits, navel, groin, buttocks, between the toes and fingers, or beneath the breasts.
It may also affect the scalp and fingernails.
Fingernail infections start with painful red inflammation that may develop pus or it may be located beneath the fingernail, causing the fingernail to loosen to expose a noticeably white or yellow color underneath it.
Thrush appears as white or yellow curd-like patches in the mouth, usually starting with the tongue or inside the cheeks. When the patches are scraped off, the membranes are raw and bleed. It may spread to the rest of the mouth as well as the tonsils, throat, larynx, esophagus, and respiratory system.
Tests: A superficial lesion can be scraped and examined under the microscope to identify the yeast. Biopsy of a lesion may also reveal Candida. A culture obtained from the blood or cerebrospinal fluid can confirm a systemic infection.
HOW IS IT TREATED?
If candidiasis is associated with another disorder such as diabetes mellitus or hypothyroidism, the underlying disease must be treated.
If associated with use of antibiotics, medication should be stopped if possible.
For candidiasis affecting the vagina, treatment is an antifungal ointment or suppository placed in the vagina. Gentian violet solution or boric acid tablets may also be effective. If the woman is taking an antibiotic, and has a history of candidiasis, antifungal suppositories may be used at the same time to prevent a recurrence of candidiasis.
In men, an antifungal ointment may be used. If reinfection occurs, a person's sexual partner may need to be treated. Other predisposing factors, such as using oral contraceptives, may need to be reevaluated.
Antifungal drugs are used for skin and fingernail infections. The skin needs to be kept dry and exposed to the air as much as possible. If the fingernail infection is persistent and has caused the nail to be deformed, the nail may need to be removed.
Thrush is treated with antifungal mouth rinses. Antifungal powder may be used on dentures.
For systemic infections, intravenous or oral antifungal drugs are used. The underlying cause must be determined and treated, if possible.
WHAT MIGHT COMPLICATE IT?
Complications usually occur in those who are severely debilitated or whose immune systems are either deficient (AIDS) or suppressed (taking drugs to prevent rejection of an organ transplant). In such individuals, candidiasis may spread to the lungs, bladder, esophagus, and other internal organs.
PREDICTED OUTCOME
Prognosis may depend on the treatability of the condition that precipitated candidiasis.
ALTERNATIVES
Candidiasis must be differentiated from other skin infections such as intertrigo (dermatitis located in the skin folds), seborrheic dermatitis, tinea cruris ("jock itch"),
psoriasis, and erythrasma.
APPROPRIATE SPECIALISTS
Internist, gynecologist, dermatologist and infectious disease specialist (for systemic Candida infection).