Candidiasis

Source: Wikipedia, the free encyclopedia.
Candidiasis
Other namesCandidosis, moniliasis, oidiomycosis
Candida (a type of yeast)[4]
Risk factorsImmunosuppression (HIV/AIDS), diabetes, corticosteroids, antibiotic therapy [5]
MedicationClotrimazole, nystatin, fluconazole[6]
Frequency6% of babies (mouth)[7] 75% of women at some time (vaginal)[8]

Candidiasis is a

Candida (a yeast).[4] When it affects the mouth, in some countries it is commonly called thrush.[3] Signs and symptoms include white patches on the tongue or other areas of the mouth and throat.[3] Other symptoms may include soreness and problems swallowing.[9] When it affects the vagina, it may be referred to as a yeast infection or thrush.[2][10] Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina.[11] Yeast infections of the penis are less common and typically present with an itchy rash.[11] Very rarely, yeast infections may become invasive, spreading to other parts of the body.[12] This may result in fevers, among other symptoms.[12]

More than 20 types of Candida may cause infection with

low birth weight babies, people recovering from surgery, people admitted to intensive care units, and those with an otherwise compromised immune system.[16]

Efforts to prevent infections of the mouth include the use of

topical clotrimazole or nystatin is usually effective.[6] Oral or intravenous fluconazole, itraconazole, or amphotericin B may be used if these do not work.[6] A number of topical antifungal medications may be used for vaginal infections, including clotrimazole.[19] In those with widespread disease, an echinocandin such as caspofungin or micafungin is used.[20] A number of weeks of intravenous amphotericin B may be used as an alternative.[20] In certain groups at very high risk, antifungal medications may be used preventively,[16][20]
and concomitantly with medications known to precipitate infections.

Infections of the mouth occur in about 6% of babies less than a month old.

AIDS also develop the disease.[7] About three-quarters of women have at least one yeast infection at some time during their lives.[8] Widespread disease is rare except in those who have risk factors.[21]

Signs and symptoms

Skin candidiasis
Vaginal yeast infection
Nail candidiasis (onychomycosis)

Signs and symptoms of candidiasis vary depending on the area affected.

urinary tract,[26] and respiratory tract[26]
are sites of candida infection.

In immunocompromised individuals, Candida infections in the esophagus occur more frequently than in healthy individuals and have a higher potential of becoming systemic, causing a much more serious condition, a fungemia called candidemia.[23][29][30] Symptoms of esophageal candidiasis include difficulty swallowing, painful swallowing, abdominal pain, nausea, and vomiting.[23][31]

Mouth

Infection in the mouth is characterized by white discolorations in the tongue, around the mouth, and in the throat. Irritation may also occur, causing discomfort when swallowing.[32]

Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a few weeks.[33]

Genitals

Infection of the vagina or vulva may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray cottage cheese-like discharge. Symptoms of infection of the male genitalia (balanitis thrush) include red skin around the head of the penis, swelling, irritation, itchiness and soreness of the head of the penis, thick, lumpy discharge under the foreskin, unpleasant odour, difficulty retracting the foreskin (phimosis), and pain when passing urine or during sex.[34]

Skin

Signs and symptoms of candidiasis in the skin include itching, irritation, and chafing or broken skin.[35]

Invasive infection

Common symptoms of gastrointestinal candidiasis in healthy individuals are

red, papular, or ulcerative in appearance, and it is not considered to be a sexually transmitted infection.[36] Abnormal proliferation of the candida in the gut may lead to dysbiosis.[37] While it is not yet clear, this alteration may be the source of symptoms generally described as the irritable bowel syndrome,[38][39] and other gastrointestinal diseases.[27][40]

Neurological symptoms

Systemic candidiasis can affect the central nervous system causing a variety of neurological symptoms, with a presentation similar to meningitis.

Causes

Candida yeasts are generally present in healthy humans, frequently part of the human body's normal oral and intestinal flora, and particularly on the skin; however, their growth is normally limited by the human immune system and by competition of other microorganisms, such as bacteria occupying the same locations in the human body.[41] Candida requires moisture for growth, notably on the skin.[42] For example, wearing wet swimwear for long periods of time is believed to be a risk factor.[43] Candida can also cause diaper rashes in babies.[35] In extreme cases, superficial infections of the skin or mucous membranes may enter the bloodstream and cause systemic Candida infections.[citation needed]

Factors that increase the risk of candidiasis include

carbohydrates have been found to affect rates of oral candidiases.[49]

C. albicans was isolated from the vaginas of 19% of apparently healthy women, i.e., those who experienced few or no symptoms of infection. External use of detergents or

antibiotics are also linked to increased rates of yeast infections.[51]

In penile candidiasis, the causes include sexual intercourse with an infected individual, low immunity, antibiotics, and diabetes. Male genital yeast infections are less common, but a yeast infection on the penis caused from direct contact via sexual intercourse with an infected partner is not uncommon.[52]

Breast-feeding mothers may also develop candidiasis on and around the nipple as a result of moisture created by excessive milk-production.[14]

Vaginal candidiasis can cause congenital candidiasis in newborns.[53]

Diagnosis

Vaginal swab wet mount of candida (phase contrast) showing the pseudohyphae
Agar plate culture of C. albicans
candidal vulvovaginitis
PAS stain
Gram stain of Candida albicans from a vaginal swab; the small oval chlamydospores are 2–4 µm in diameter
Chromogenic agar can help in indicating the involved species of Candida versus similar fungi. (CHROMAgar shown)

In oral candidiasis, simply inspecting the person's mouth for white patches and irritation may make the diagnosis. A sample of the infected area may also be taken to determine what organism is causing the infection.[54]

Symptoms of vaginal candidiasis are also present in the more common bacterial vaginosis;[55] aerobic vaginitis is distinct and should be excluded in the differential diagnosis.[56] In a 2002 study, only 33% of women who were self-treating for a yeast infection were found to have such an infection, while most had either bacterial vaginosis or a mixed-type infection.[57]

Diagnosis of a yeast infection is confirmed either via microscopic examination or culturing. For identification by light microscopy, a scraping or swab of the affected area is placed on a

yeast cells typical of many Candida species.[citation needed
]

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then streaked on a culture medium. The culture is incubated at 37 °C (98.6 °F) for several days, to allow development of yeast or bacterial colonies. The characteristics (such as morphology and colour) of the colonies may allow initial diagnosis of the organism causing disease symptoms.[58] Respiratory, gastrointestinal, and esophageal candidiasis require an

colony-forming units per milliliter.[28]

Classification

Candidiasis may be divided into these types:

Prevention

A diet that supports the immune system and is not high in simple carbohydrates contributes to a healthy balance of the oral and intestinal flora.[41][49] While yeast infections are associated with diabetes, the level of blood sugar control may not affect the risk.[64] Wearing cotton underwear may help to reduce the risk of developing skin and vaginal yeast infections, along with not wearing wet clothes for long periods of time.[15][43] For women who experience recurrent yeast infections, there is limited evidence that oral or intravaginal probiotics help to prevent future infections.[17][65] This includes either as pills or as yogurt.[17]

Oral hygiene can help prevent oral candidiasis when people have a weakened immune system.[5] For people undergoing cancer treatment, chlorhexidine mouthwash can prevent or reduce thrush.[5] People who use inhaled corticosteroids can reduce the risk of developing oral candidiasis by rinsing the mouth with water or mouthwash after using the inhaler.[5] People with dentures should also disinfect their dentures regularly to prevent oral candidiasis.[54]

Treatment

Candidiasis is treated with

antifungal medications; these include clotrimazole, nystatin, fluconazole, voriconazole, amphotericin B, and echinocandins.[20] Intravenous fluconazole or an intravenous echinocandin such as caspofungin are commonly used to treat immunocompromised or critically ill individuals.[20]

The 2016 revision of the

clinical practice guideline for the management of candidiasis lists a large number of specific treatment regimens for Candida infections that involve different Candida species, forms of antifungal drug resistance, immune statuses, and infection localization and severity.[20] Gastrointestinal candidiasis in immunocompetent individuals is treated with 100–200 mg fluconazole per day for 2–3 weeks.[28]

Localized infection

Mouth and throat candidiasis are treated with antifungal medication. Oral candidiasis usually responds to topical treatments; otherwise, systemic antifungal medication may be needed for oral infections. Candidal skin infections

Gentian violet can be used for thrush in breastfeeding babies.[14] Systemic treatment with antifungals by mouth is reserved for severe cases or if treatment with topical therapy is unsuccessful. Candida esophagitis may be treated orally or intravenously; for severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.[6]

Vaginal yeast infections are typically treated with topical antifungal agents.[20] Penile yeast infections are also treated with antifungal agents, but while an internal treatment may be used (such as a pessary) for vaginal yeast infections, only external treatments – such as a cream – can be recommended for penile treatment.[67] A one-time dose of fluconazole by mouth is 90% effective in treating a vaginal yeast infection.[68] For severe nonrecurring cases, several doses of fluconazole is recommended.[20] Local treatment may include vaginal suppositories or medicated douches. Other types of yeast infections require different dosing. C. albicans can develop resistance to fluconazole, this being more of an issue in those with HIV/AIDS who are often treated with multiple courses of fluconazole for recurrent oral infections.[69]

For vaginal yeast infection in pregnancy, topical imidazole or triazole antifungals are considered the therapy of choice owing to available safety data.[70] Systemic absorption of these topical formulations is minimal, posing little risk of transplacental transfer.[70] In vaginal yeast infection in pregnancy, treatment with topical azole antifungals is recommended for seven days instead of a shorter duration.[70]

For vaginal yeast infections, many complementary treatments are proposed, however a number have side effects.[71] No benefit from probiotics has been found for active infections.[18]

Blood-borne infection

intravenous antifungal medications.[72] Examples include intravenous fluconazole or an echinocandin such as caspofungin may be used.[20] Amphotericin B is another option.[20]

Prognosis

In hospitalized patients who develop candidemia, age is an important prognostic factor. Mortality following candidemia is 50% in patients aged ≥75 years and 24% in patients aged <75 years.[73] Among individuals being treated in intensive care units, the mortality rate is about 30–50% when systemic candidiasis develops.[74]

Epidemiology

Oral candidiasis is the most common fungal infection of the mouth,

AIDS also develop the disease.[7]

It is estimated that 20% of women may be asymptomatically colonized by vaginal yeast.[77] In the United States there are approximately 1.4 million doctor office visits every year for candidiasis.[78] About three-quarters of women have at least one yeast infection at some time during their lives.[8]

Esophageal candidiasis is the most common esophageal infection in persons with AIDS and accounts for about 50% of all esophageal infections, often coexisting with other esophageal diseases. About two-thirds of people with AIDS and esophageal candidiasis also have oral candidiasis.[31]

Candidal sepsis is rare.[79] Candida is the fourth most common cause of bloodstream infections among hospital patients in the United States.[80] The incidence of bloodstream candida in intensive care units varies widely between countries.[81]

History

Descriptions of what sounds like oral thrush go back to the time of Hippocrates circa 460–370 BCE.[22]

The first description of a fungus as the causative agent of an oropharyngeal and oesophageal candidosis was by Bernhard von Langenbeck in 1839.[82]

Vulvovaginal candidiasis was first described in 1849 by Wilkinson.[83] In 1875, Haussmann demonstrated the causative organism in both vulvovaginal and oral candidiasis is the same.[83]

With the advent of antibiotics following World War II, the rates of candidiasis increased. The rates then decreased in the 1950s following the development of nystatin.[84]

The colloquial term "thrush" refers to the resemblance of the white flecks present in some forms of candidiasis (e.g., pseudomembranous candidiasis) with the breast of the bird of the same name.[85] The term candidosis is largely used in British English, and candidiasis in American English.[83] Candida is also pronounced differently; in American English, the stress is on the "i", whereas in British English the stress is on the first syllable.[citation needed]

The

nomen conservandum, which means the name is authorized for use by the International Botanical Congress (IBC).[86]

The genus Candida includes about 150 different species. However, only a few are known to cause human infections. C. albicans is the most significant pathogenic species. Other species pathogenic in humans include C. auris, C. tropicalis, C. parapsilosis, C. dubliniensis, and C. lusitaniae.

The name Candida was proposed by Berkhout. It is from the Latin word toga candida, referring to the white toga (robe) worn by candidates for the Senate of the ancient Roman republic.[83] The specific epithet albicans also comes from Latin, albicare meaning "to whiten".[83] These names refer to the generally white appearance of Candida species when cultured.

Alternative medicine

A 2005 publication noted that "a large pseudoscientific cult"[87] has developed around the topic of Candida, with claims stating that up to one in three people are affected by yeast-related illness, particularly a condition called "Candidiasis hypersensitivity".[88] Some practitioners of alternative medicine have promoted these purported conditions and sold dietary supplements as supposed cures; a number of them have been prosecuted.[88][89] In 1990, alternative health vendor Nature's Way signed an FTC consent agreement not to misrepresent in advertising any self-diagnostic test concerning yeast conditions or to make any unsubstantiated representation concerning any food or supplement's ability to control yeast conditions, with a fine of $30,000 payable to the National Institutes of Health for research in genuine candidiasis.[89]

Research

High level Candida colonization is linked to several diseases of the gastrointestinal tract including Crohn's disease.[90][91]

There has been an increase in resistance to antifungals worldwide over the past 30–40 years.[92][93]

References

  1. ^ .
  2. ^ a b "Vaginal Candidiasis". Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. Archived from the original on 29 December 2014. Retrieved 24 Dec 2019.
  3. ^ a b c "Candida infections of the mouth, throat, and esophagus". Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. Archived from the original on 9 January 2019. Retrieved 24 Dec 2019.
  4. ^ a b "Candidiasis". Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. Archived from the original on 29 December 2014. Retrieved 24 Dec 2019.
  5. ^ a b c d e f g "Risk & Prevention". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  6. ^ a b c d e "Treatment & Outcomes of Oral Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  7. ^ a b c d e "Oral Candidiasis Statistics". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  8. ^ a b c "Genital / vulvovaginal candidiasis (VVC)". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  9. ^ "Symptoms of Oral Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  10. ^ "Thrush in men and women". nhs.uk. 9 January 2018. Archived from the original on 25 September 2018. Retrieved 16 March 2020.
  11. ^ a b "Symptoms of Genital / Vulvovaginal Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  12. ^ a b "Symptoms of Invasive Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  13. ^ "Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  14. ^
    S2CID 27801867
    .
  15. ^ a b "People at Risk for Genital / Vulvovaginal Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  16. ^ a b "People at Risk for Invasive Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  17. ^
    PMID 22670239
    .
  18. ^ .
  19. ^ "Treatment & Outcomes of Genital / Vulvovaginal Candidiasis". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  20. ^
    PMID 26810419
    .
  21. ^ "Invasive Candidiasis Statistics". cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. Retrieved 28 December 2014.
  22. ^ .
  23. ^ a b c d e f g h i j k l m n o p q r s t Hidalgo JA, Vazquez JA (18 August 2015). "Candidiasis: Clinical Presentation". Medscape. WebMD. Archived from the original on 1 June 2016. Retrieved 22 June 2016.
  24. from the original on 2008-12-01.
  25. ^ .
  26. ^ (PDF) from the original on 2017-08-17. Retrieved 2019-09-24. Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients but also related to nosocomial infections and even in healthy individuals. There is a wide variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome.
  27. ^ . In addition, GI fungal infection is reported even among those patients with normal immune status. Digestive system-related fungal infections may be induced by both commensal opportunistic fungi and exogenous pathogenic fungi. The IFI in different GI sites have their special clinical features, which are often accompanied by various severe diseases. Although IFI associated with digestive diseases are less common, they can induce fatal outcomes due to less specificity of related symptoms, signs, endoscopic and imaging manifestations, and the poor treatment options. ... Candida sp. is also the most frequently identified species among patients with gastric IFI. ... Gastric IFI is often characterised by the abdominal pain and vomiting and with the endoscopic characteristics including gastric giant and multiple ulcers, stenosis, perforation, and fistula. For example, gastric ulcers combined with entogastric fungal infection, characterised by deep, large and intractable ulcers,[118] were reported as early as the 1930s. ... The overgrowth and colonisation of fungi in intestine can lead to diarrhoea.
  28. ^ . Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms. ... For routine SIFO in an immunocompetent host, a 2–3 week oral course of fluconazole 100–200 mg will suffice.
  29. .
  30. .
  31. ^ .
  32. ^ "Candida infections of the mouth, throat, and esophagus | Fungal Diseases | CDC". www.cdc.gov. 2019-04-17. Archived from the original on 2019-01-09. Retrieved 2019-08-01.
  33. ^ "Thrush". 2011. Archived from the original on 2011-02-10. Retrieved 2011-04-08.
  34. ^ NHS: Symptoms of thrush in men (balanitis thrush) Archived 2013-11-01 at the Wayback Machine
  35. ^ a b "Candida infection of the skin: MedlinePlus Medical Encyclopedia". medlineplus.gov. Archived from the original on 2019-08-06. Retrieved 2019-08-06.
  36. .
  37. .
  38. S2CID 35882838. Archived from the original
    (PDF) on 2019-12-05. Retrieved 2017-10-24.
  39. .
  40. .
  41. ^ from the original on 2024-02-24. Retrieved 2008-11-23.
  42. .
  43. ^ a b MedlinePlus Encyclopedia: Vaginal yeast infection
  44. S2CID 24662417
    .
  45. ^ a b Saag KG, Furst ME, Barnes PJ. "Major side effects of inhaled glucocorticoids". UpToDate. Archived from the original on 2020-07-27. Retrieved 2019-08-02.
  46. PMID 21144007
    .
  47. .
  48. from the original on 2011-07-16.
  49. ^ .
  50. .
  51. ^ .
  52. .
  53. ^ .
  54. ^ a b "Oral thrush - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Archived from the original on 2019-08-06. Retrieved 2019-08-06.
  55. ^ Warren T (2010). "Is It a Yeast Infection?". Archived from the original on 2011-02-25. Retrieved 2011-02-23.
  56. S2CID 8304009
    .
  57. .
  58. .
  59. ^ Hidalgo JA, Vazquez JA (18 August 2015). "Candidiasis: Workup". Medscape. WebMD. Archived from the original on 11 June 2016. Retrieved 22 June 2016.
  60. (PDF) from the original on 2015-05-18.
  61. .
  62. .
  63. from the original on 2016-04-30.
  64. from the original on 2017-09-06.
  65. . Thus, the available evidence for the use of probiotics for prevention of recurrent VVC is limited
  66. .
  67. ^ "Male thrush: everything you need to know". medino. Archived from the original on 2021-05-19. Retrieved 2021-05-19.
  68. PMID 14693534
    .
  69. .
  70. ^ .
  71. .
  72. ^ "Systemic candidiasis". NIH.gov. U.S. DHHS, National Institute of Health. Oct 2014. Archived from the original on April 27, 2015. Retrieved April 19, 2015.
  73. from the original on 2023-05-18. Retrieved 2023-10-26.
  74. .
  75. .
  76. .
  77. .
  78. .
  79. S2CID 86182033. Archived from the original
    (PDF) on 10 February 2020.
  80. ^ "Candida" (PDF). CDC.gov. Center of Disease Control. Archived (PDF) from the original on April 27, 2015. Retrieved April 19, 2015.
  81. from the original on 2024-02-24. Retrieved 2021-05-29.
  82. .
  83. ^ .
  84. .
  85. ^ Scully C (2018-09-24). "Mucosal Candidiasis". Medscape. WebMD LLC. Archived from the original on 2 November 2013. Retrieved 8 September 2013.
  86. ISBN 978-3-904144-22-3. Archived from the original on 2008-12-02. Retrieved 2008-11-23.{{cite book}}: CS1 maint: location missing publisher (link
    )
  87. .
  88. ^ a b Barrett S (October 8, 2005). "Dubious "Yeast Allergies"". Quackwatch. Archived from the original on May 13, 2008.
  89. ^ a b Jarvis WT. "Candidiasis Hypersensitivity". National Council Against Health Fraud. Archived from the original on 1 February 2014. Retrieved 18 January 2014.
  90. PMID 21802979
    .
  91. ]
  92. ^ "Growing resistance to antifungal drugs 'a global issue'". BBC News. 17 May 2018. Archived from the original on 21 May 2018. Retrieved 18 May 2018.
  93. S2CID 12502541
    .

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