Candidiasis

Content of This Page

1- Introduction

2- Causes

3- Symptoms

4- Types of Candidiasis

5- Complications

6- Treatment

Introduction

Candidiasis is a fungal infection caused by yeasts of the genus Candida, most commonly Candida albicans. These fungi are part of the normal flora of the skin, mouth, gastrointestinal tract, and vagina but can become opportunistic pathogens under certain conditions, leading to infection.

Candidiasis can range from superficial (e.g., oral thrush, vaginal yeast infection, intertrigo) to invasive/systemic disease, particularly in immunocompromised individuals such as those with HIV/AIDS, cancer, diabetes, or those on prolonged antibiotics or corticosteroids.

The infection occurs when there’s a disruption in the normal microbial balance or weakened host defenses, allowing Candida to overgrow. Candidiasis may present as localized mucocutaneous infection or, in severe cases, as disseminated candidiasis involving the bloodstream (candidemia), kidneys, liver, and other organs.

Oral Candidiasis © image from Wikimedia Commons

Causes

  1. Immunosuppression

    • HIV/AIDS

    • Cancer chemotherapy

    • Organ transplant recipients (on immunosuppressive drugs)

    • Use of corticosteroids

  2. Antibiotic Use

    • Broad-spectrum antibiotics disrupt the normal bacterial flora, allowing Candida to overgrow

  3. Diabetes Mellitus

    • High blood sugar promotes fungal growth

    • Impaired immune response in diabetic patients

  4. Hormonal Changes

    • Pregnancy

    • Use of oral contraceptive pills

    • Hormone replacement therapy

  5. Moisture and Occlusion

    • Poorly ventilated skin folds (e.g., under breasts, groin)

    • Wearing tight or damp clothing

    • Diaper use in infants

  6. Poor Oral Hygiene / Denture Use

    • Especially in elderly or debilitated individuals

  7. Malnutrition or Iron Deficiency

    • Affects immune function and mucosal integrity

  8. Hospitalization / Medical Devices

    • Central venous catheters

    • Urinary catheters

    • Mechanical ventilation

    • Total parenteral nutrition (TPN)

  9. Neonates and Elderly

    • Immature or weakened immune systems

  10. Mucosal Injury or Atrophy

  • Chemotherapy, radiation, or trauma to mucous membranes

© image from Wikimedia Commons

Symptoms

1. Oral Candidiasis (Thrush):

  • White, creamy plaques on the tongue, inner cheeks, gums, or palate

  • Redness and soreness underneath the plaques

  • Burning sensation in the mouth

  • Difficulty swallowing (in more severe or esophageal involvement)

2. Esophageal Candidiasis:

  • Painful swallowing (odynophagia)

  • Difficulty swallowing (dysphagia)

  • Retrosternal chest pain

  • Often associated with immunosuppression (e.g., HIV/AIDS)

3. Vaginal Candidiasis:

  • Thick, white, curd-like vaginal discharge

  • Itching, burning, or irritation of the vulva and vagina

  • Redness and swelling of the vaginal area

  • Pain during urination or intercourse

4. Cutaneous Candidiasis (Skin Folds, Diaper Rash, Intertrigo):

  • Red, moist, macerated rash with satellite pustules or papules

  • Common in warm, moist areas (e.g., under breasts, groin, axillae, buttocks)

  • Itching, burning, and discomfort

5. Candidal Onychomycosis (Nails):

  • Discoloration or thickening of the nail

  • Nail plate separation from the bed

  • Swelling and redness of the surrounding skin (paronychia)

6. Invasive/Systemic Candidiasis (Candidemia):

  • Fever and chills not responding to antibiotics

  • Hypotension, organ dysfunction (in severe sepsis)

  • May involve the kidneys, liver, eyes (endophthalmitis), brain, heart (endocarditis), and bones

  • Common in hospitalized or immunocompromised patients with central lines

Types of Candidiasis

1. Oral Candidiasis (Thrush)

  • Infection of the mucous membranes of the mouth and throat

  • Common in infants, elderly, and immunocompromised individuals

  • Includes pseudomembranous, erythematous, and chronic hyperplastic types

2. Esophageal Candidiasis

  • Infection of the esophagus

  • Often seen in immunosuppressed patients (e.g., HIV/AIDS)

  • Causes painful swallowing and chest discomfort

3. Vaginal Candidiasis (Vaginal Yeast Infection)

  • Infection of the vulva and vagina

  • Common in women of reproductive age

  • Causes itching, discharge, and irritation

4. Cutaneous Candidiasis

  • Infection of the skin, especially in warm, moist areas (intertrigo)

  • Also includes diaper rash in infants and candidal paronychia (around nails)

5. Candidal Onychomycosis

  • Fungal infection of the nails

  • Causes thickened, brittle, discolored nails

6. Invasive or Systemic Candidiasis

  • Occurs when Candida enters the bloodstream (candidemia)

  • Can spread to organs such as kidneys, liver, eyes, heart, and brain

  • Common in hospitalized, immunocompromised, or critically ill patients

7. Chronic Mucocutaneous Candidiasis

  • Persistent or recurrent candidiasis involving skin, nails, and mucous membranes

  • Often due to underlying immune defects

Complications

  • Disseminated (Invasive) Candidiasis

    • Spread of Candida into the bloodstream (candidemia) and multiple organs

    • Can cause sepsis, organ failure, and death if untreated

    • Common sites affected include kidneys, liver, spleen, eyes (endophthalmitis), heart (endocarditis), bones, and brain

  • Chronic Mucocutaneous Candidiasis

    • Persistent or recurrent infection of skin, nails, and mucous membranes due to immune dysfunction

    • May cause scarring and disfigurement

  • Esophageal Stricture

    • From repeated or severe esophageal candidiasis leading to narrowing of the esophagus and swallowing difficulties

  • Secondary Bacterial Infection

    • Superimposed bacterial infection of the affected mucosa or skin due to breakdown of natural barriers

  • Oral Candidiasis-Related Nutritional Problems

    • Pain and difficulty swallowing may lead to poor oral intake and weight loss

  • Nail Deformity

    • Chronic nail infections can cause permanent changes in nail shape and function

  • Psychosocial Impact

    • Chronic or visible candidiasis (e.g., oral thrush, diaper rash) can cause distress or social embarrassment

Treatment

1. Topical Antifungal Therapy

Used for mild, localized mucocutaneous infections:

  • Oral candidiasis (mild):

    • Nystatin suspension or lozenges

    • Clotrimazole troches

    • Miconazole gel

  • Vaginal candidiasis:

    • Clotrimazole or miconazole creams or suppositories

    • Nystatin vaginal tablets

  • Cutaneous candidiasis:

    • Clotrimazole, miconazole, or ketoconazole creams

    • Keep affected areas dry and clean

2. Systemic Antifungal Therapy

Required for moderate to severe infections, esophageal candidiasis, invasive disease, or immunocompromised patients:

  • Fluconazole:

    • First-line oral agent for most candidiasis types

    • Dose and duration depend on infection site and severity

  • Itraconazole:

    • Alternative to fluconazole, especially in refractory cases

  • Amphotericin B:

    • Used for severe systemic infections or fluconazole-resistant strains

    • Usually given intravenously

  • Echinocandins (Caspofungin, Micafungin, Anidulafungin):

    • Used for invasive candidiasis, especially in hospitalized patients

    • Intravenous administration

  • Posaconazole and Voriconazole:

    • Used in resistant or complicated cases

3. Supportive Measures

  • Control predisposing factors (e.g., diabetes, antibiotic use)

  • Maintain good hygiene and dryness of affected areas

  • Proper denture care for oral candidiasis

  • Avoid irritants and tight clothing in cutaneous infections

4. Special Situations

  • Neonates: Use nystatin or fluconazole carefully under pediatric guidance

  • Recurrent vaginal candidiasis: Consider longer antifungal courses and investigate underlying causes

  • Immunocompromised patients: Often require prolonged systemic therapy and monitoring

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