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Candidiasis

Overview

Candidiasis is also called thrush, candidosis, moniliasis or oidomycosis. It is an infectious disease caused by a specific family of fungus called Candida. Most of the fungal infections are caused by genus candida. It includes five species named Candida albicans, Candida Glabrata, Candida tropicalis, Candida parapsilosis and candida krusei. Among these, the most common is Candida albicans. We normally have different fungi in the body playing an important role in the normal flora. It is available in small amounts in the mouth, belly, and skin. Pathology occurs when it gets a favorable environment, dividing rapidly, causing infection.

Candidiasis is also called thrush, candidosis, moniliasis or oidomycosis. It is an infectious disease caused by a specific family of fungus called Candida. Most of the fungal infections are caused by genus candida. It includes five species named Candida albicans, Candida Glabrata, Candida tropicalis, Candida parapsilosis and candida krusei. Among these, the most common is Candida albicans. We normally have different fungi in the body playing an important role in the normal flora. It is available in small amounts in the mouth, belly, and skin. Pathology occurs when it gets a favorable environment, dividing rapidly, causing infection.

Types And Causes

1)Thrush (Oropharyngeal Candidiasis)

When yeast infection occurs in the throat and mouth, it is called oral thrush or oropharyngeal Candidiasis. In this type of infection, Candida locally invades and spreads in the mucosa of the mouth and throat. It is a very common condition in immunocompromised individuals, diabetics, older adults, and newborns. Patients who are taking treatment for cancer are also prone to thrush. Taking corticosteroids and antibiotics may also cause it. Some people can get it by wearing dentures, injuring oral mucosa, and making it vulnerable to infection. It is a mild infection that can be treated by over the counter medicines. Candida infection can be an acute or chronic infection. It includes:

Acute pseudomembranous Candidiasis: There are white patches on the gums and tongue.

Acute atrophic candidiasis: There are red, painful ulcers in the mouth.

Chronic atrophic Candidiasis: Red swollen mucosa is common in people using dentures.

Angular cheilitis: Dry lips with sore, inflamed angles of the mouth.

Chronic hyperplastic candidiasis: Lumps inside the cheeks and tongue. It can be malignant. It is common in smokers.

Chronic mucocutaneous Candidiasis

Median rhomboid glossitis

       Some common symptoms of thrush include:

  • Patches or spots (yellowish or whitish) in the mouth.
  • Inflammation (redness or pain) in the mouth and pharynx.
  • The Angles of the mouth are cracked.
  • Painful swallowing if the infection is widespread in the throat.
  • Aguesia (loss of taste)

Other examples of cutaneous candidiasis include athlete's foot, nail fungus, jock itch, and diaper rash.

2) Genital yeast infection (genital candidiasis)

Genital Candidiasis is a common infection in adults. It is more common in women than men. It occurs in 3 out of four women. Vaginal yeast infection is also called vaginal Candidiasis, vulvovaginal candidiasis or candidal vaginosis. Excessive growth of yeast results in an imbalance of normal and abnormal counts. Yeast infection of the penis is called candidal balanitis or balanitis thrush. They are not very common. Genital yeast infections can be aggravated by a weak immune system, pregnancy, diabetes, birth control pills usage, broad-spectrum antibiotics, and some vaginal sprays. Spermicides and lubricants can trigger it as well. Infection can transmit from person to person through sexual intercourse.

Some common symptoms of genital Candidiasis include:

  • Itchy vagina or penis
  • Inflammation of the vagina.
  • Painful burning sensation while urinating.
  • Painful intercourse.
  • Cottage cheese discharge per vagina.

3)Invasive Candidiasis

It is a serious candidal infection caused by candida Auris that can involve the heart, brain, eyes, bones, blood, and other systems of the body. Candida infection of the bloodstream is referred to as candidemia. In the United States, Candidemia is one of the causes of death in patients who stay for an extended period in the hospital to treat chronic debilitating diseases. Common symptoms of invasive candidiasis are fever and chills. Health professionals can be carriers of candida on their hands after managing Candida patients.

Risk Factors

Following risk factors predispose to yeast infection:

1. Broad-spectrum antibiotics: The use of certain antibiotics kills good bacteria within the flora, resulting in yeast infection.

2. Excessive Estrogen: Women who are pregnant or use estrogen birth control pills get frequent yeast infections.

3. Diabetes mellitus: Uncontrolled blood sugar is favorable for yeast growth, causing infection.

4. Immunodeficiency: Low immunity due to HIV or using corticosteroid therapy for certain diseases like asthma, Low platelet count, and organ transplant can predispose the individual to severe yeast infections.

5. Long hospital stays, Multiple surgeries, and central venous catheter insertion can be major risk factors for invasive candidiasis.

6. Smoking can cause thrush as it distorts normal flora.

7. Infants and babies develop diaper rash with candida( cutaneous candidiasis).

8. Conditions that cause dry mouth.

9. Hot and humid weather

10. Obesity

11. Tight clothing

12. Hypothyroidism or underactive thyroid gland.

Epidemiology

In the United States, Candidemia is one of the causes of death in patients who stay for a long period in hospital for the treatment of chronic debilitating diseases. Vaginal infection is the second commonest type of infection after bacterial vaginal infections. Over 1.5 million patients visit annually with a complaint of vaginal Candidiasis in the United States.

In the United States, Candidemia is one of the causes of death in patients who stay for a long period in hospital for the treatment of chronic debilitating diseases. Vaginal infection is the second commonest type of infection after bacterial vaginal infections. Over 1.5 million patients visit annually with a complaint of vaginal Candidiasis in the United States.

Diagnosis

  • For thrush, laboratory testing under a microscope of tiny samples from the mouth and pharynx is helpful. If it is widespread, for instance, up to the esophagus, then endoscopy is suggested.
  • Microscopic examination or culture of the sample of vaginal discharge can help in the diagnosis of genital Candidiasis. Although, culture can give false-positive results.
  • Diagnosis of invasive candidiasis is mainly based on medical history, examination, and laboratory tests. Drawing samples from infected body sites and examining them to see candidal growth is also reliable.
  • Examination of skin scrapings, nail clippings, or plucked hair from the affected area.

Treatment

  • Thrush can be treated with antifungal medications like nystatin, clotrimazole, fluconazole. Fujian tablets dissolve in the mouth. Some mouthwashes and lozenges can provide immediate relief in throat pain and can also help in the prevention of infection in immunocompromised individuals. Unsweetened yogurt can be probiotic(lactobacillus) and helps relieve thrush by maintaining good bacteria of normal flora.
  • Application of antifungal creams for mild genital fungal infection. Antifungal medications that can be applied in the vagina include Flucocytosine, nystatin, and boric acid.
  • Antifungal creams include clotrimazole (Mycelex), miconazole (monistat) and fluconazole (vagistat).
  • Antifungal medications continuous dose is used orally for chronic genital candidiasis. Fluconazole is one of the very effective oral antifungal drugs.

Differential Diagnosis

Some of the diseases presenting like candidiasis are:

  • Leukoplakia
  • Lichen planus
  • Angular cheilitis
  • Squamous cell carcinoma
  • Dermatitis
  • Folliculitis
  • Fordyce spots
  • Denture stomatitis
  • Aphthous stomatitis

Prevention

Candidiasis can be prevented by adopting the following lifestyle changes;

  • Good oral hygiene.
  • Avoid smoking
  • Strictly following denture hygiene.
  • Keeping genitals clean and dry.
  • Rinsing the mouth after using inhaled corticosteroids.
  • Use of unsweetened yogurt (probiotic: lactobacillus)containing active cultures to maintain flora.
  • Avoid feminine hygiene sprays.
  • Change sanitary pads or tampons frequently.
  • Wear breathable undergarments.
  • Avoid hot baths.
  • Lifestyle modification to manage obesity and diabetes.