What is Candidiasis?
Candidiasis is an infection caused by a type of fungi called Candida, which is similar to yeast. This type of infection often occurs in people whose immune systems are compromised. Several names for candidiasis include candidosis, moniliasis, and thrush. Candida organisms can live in the mouth, digestive tract, and on our reproductive organs without causing problems. However, they can create infections when conditions allow them to grow excessively. These infections can affect various parts of the body like the mouth, where it’s known as thrush, and the reproductive organs, which is often referred to as a yeast infection.
Oral thrush can take different forms, such as pseudomembranous, erythematous, and chronic hyperplastic candidiasis. Pseudomembranous candidiasis often affects people who are chronically ill or infants and looks like soft, white, slightly elevated patches in the mouth. Erythematous candidiasis, also known as antibiotic sore mouth, is usually found after usage of broad-spectrum antibiotics or steroids. Chronic hyperplastic candidiasis, also known as candidal leukoplakia, is seen as firm white patches on your lips, tongue, or the inside of your cheeks, which can remain for many years and may develop into cancer.
Vaginal candidiasis often causes itching, burning, and a white discharge similar to cottage cheese. Men can also get yeast infections, but this is less common and usually just results in an itchy rash. In rare cases, yeast infections can spread throughout the body, leading to a fever and other symptoms.
Oral thrush is commonly caused by Candida albicans, a type of yeast that naturally exists in the mouth in about 30% to 50% of people. The different forms of oral candidiasis can take many shapes and affect both healthy individuals and those with compromised immune systems. These can range from minor infections to severe or even fatal diseases. However, the most prevalent form is superficial candidiasis.
What Causes Candidiasis?
Candidiasis is a type of infection that can happen when the naturally occurring yeast, Candida albicans, overgrows. This yeast is usually found in the mouths, throats, and stomachs of healthy people. However, in people with weaker immune systems, such as those with leukemia or lymphoma, or those taking corticosteroids or strong drugs for cancer, the yeast can grow too much and cause an infection.
Using antibiotics, undergoing chemotherapy for cancer, and changes in the gut’s bacteria balance can increase the risk of Candidiasis. These changes to the gut can lead to Candida moving from being harmless to causing an infection. You also have a higher chance of getting this infection if you have diabetes, if you’re pregnant, or if you’re using birth control pills.
Oral Candidiasis, a form of this infection that occurs in the mouth, is very common in people with HIV. In fact, more than 90% of people with HIV get this form of Candidiasis.
Candidiasis has other risk factors too. These include tuberculosis, diseases that affect the body’s hormone levels like myxedema, hypoparathyroidism, and Addison’s disease, vitamin deficiencies (like vitamin A, B6, and iron), smoking, and poor dental hygiene. Things that are left in the body for a while, like IV tubes and catheters, are risky as well. It’s also more likely at the very beginning and end of life – in infants and older folks – as well as during pregnancy. Lastly, conditions that dry out your mouth can make you more susceptible to Candidiasis because your mouth begins to lack the antifungal proteins, such as histatin and calprotectin, which a normal saliva flow would provide.
Risk Factors and Frequency for Candidiasis
Candidiasis, or thrush, is a condition that is particularly common during infancy and old age. In the US, about 37% of newborns can experience thrush within the first few months. The condition also has a higher occurrence among children who use inhaled steroids. Thrush is often seen in women during pregnancy and may be the first symptom of a HIV infection. It is universally found in both males and females and is more frequent among poorly nourished populations.
The most common cause of candidiasis is the Candida albicans species. However, we are seeing a rise in cases caused by non-Candida species. This is significant as treatments can vary depending on the species causing the infection. For example, some non-albicans Candida might be resistant to the medication fluconazole.
- Of the different Candida species, Candida albicans is the most common (approximately 44.21% of cases).
- Candida lusitaniae is the second most common (around 18.95% of cases).
- Candida parapsilosis is third (about 13.69% of cases).
- The remaining species, including Candida glabrata, Candida kefyr, Candida famata, Candida africana, and Candida orthopsilosis, contribute to the remaining cases.
Worldwide, there has been an increase in severe candidiasis infections that spread throughout the body, particularly among individuals with weakened immune systems.
Signs and Symptoms of Candidiasis
Vulvovaginitis is a condition that can cause intense itching and discomfort in the vaginal and vulvar areas. Symptoms can often include a burning sensation during urination that can be mistaken for a urinary tract infection, soreness or pain in the vagina, a dry red rash, and a discharge that looks like thick white curd.
Candida, a type of yeast, can also cause an oral infection known as thrush. This condition is characterized by a white or yellowish, not easily removable, rash on the tongue and the mouth’s lining. Other signs include redness and soreness with cracking at the mouth corners. Patients may also experience pain when swallowing if the infection spreads to the back of the throat. This infection is most often seen in babies, elderly individuals, and people with weakened immune systems. When candida becomes systemic (spreads throughout the body), it can cause symptoms like fever, chills, low blood pressure, and confusion.
Laryngeal candida infection, which affects the voice box, is a rare condition. It predominantly affects women, who might notice symptoms such as changes in their voice. This condition is often associated with acid reflux or a history of inhaled corticosteroid use. The presence of abnormal white patches on the vocal cords can also indicate this type of infection.
Testing for Candidiasis
To discover if someone has vaginal candidiasis, which is a yeast infection, doctors often take a sample of vaginal discharge and look at it under a microscope or send it to a laboratory to be tested. The yeast could be seen budding under a microscope.
Mouth thrush is another type of yeast infection that’s typically diagnosed based on symptoms, but can also be confirmed by examining skin scrapings under a microscope. For a more severe yeast infection that has spread throughout the body, also known as systemic candidiasis, a blood sample is often taken for further testing.
Treatment Options for Candidiasis
Candida infections are typically treated with antifungal medications. These could include various medicines like nystatin, clotrimazole, amphotericin B, and miconazole. Mild or average genital Candida infections are usually treated with antifungal creams that can be used in the vagina. These creams can be used as a 1, 3, or 7-day treatment. Doctors can also prescribe a single dose of econazole or fluconazole taken orally.
Oral and topical (applied on the skin) treatments are generally equally effective, but oral medications tend to be more costly. It’s important to note that fluconazole should not be prescribed during the first trimester of pregnancy. For repeated vaginal candida infections, fluconazole is given on days 1, 4, and 7, and then once weekly for six months. The same type of treatment can be used for oral thrush, but in this case, patients can use oral lozenges as an alternative.
Patients with severe Candida infections that have spread through the body will need oral or intravenous (injected into a vein) antifungal medications. These could include caspofungin, fluconazole, and amphotericin B.
In situations where Candida infection has caused inflammation in the mouth of someone who wears dentures, known as denture stomatitis, the individual should stop using their dentures for at least two weeks. They should also apply an antifungal medication topically. If the infection is causing cracks at the corners of the mouth, known as angular cheilitis, new dentures with proper measurements are necessary once the infection has cleared up. Consuming probiotics, which are beneficial bacteria, orally can be a helpful supplement in treating oral candidiasis.
What else can Candidiasis be?
Spongiform pustulation, a condition that presents in skin diseases like psoriasis and impetigo, can also be found in other conditions like subcorneal pustulosis and acute generalized subcorneal pustulosis. Special medical tests are needed to rule out a fungal cause in psoriasis.
Impetigo, a contagious bacterial skin infection, also displays spongiform pustulation. With the aid of what’s known as a Gram stain test, bacteria in impetigo can be identified. However, this test doesn’t pick up on fungal forms of the condition.
Spongiform pustulation is a key feature of skin infections like tinea cruris and corporis (commonly known as jock itch and ringworm, respectively). Special tests can show septate hyphae, which are segments of the fungus. This is different from candida, a yeast, as it doesn’t display budding. The challenge is that these conditions can be difficult to distinguish from one another. Usually, candida infiltrates the keratinized epithelial layer of the skin while dermatophytosis often only involves the outermost layer of the skin, known as the stratum corneum.
Diagnosing laryngeal candidiasis, a yeast infection of the throat, can be hard for ear, nose, and throat specialists (otolaryngologists). To manage this, they need to be alert for this condition, especially in patients with risk factors who present with suspicious lesions.
What to expect with Candidiasis
Vaginal and skin infections are the most common types of Candida infections and these are usually localized. As a result, they can be effectively treated with antifungal medications, leading to full recovery and good health outcomes. Neglected Candida infections may spread to other parts of the body, resulting in a more widespread infection.
The chances of long-term recovery from such a systemic candidiasis infection relies on various factors. These include how serious the infection is, where it’s located, the overall health of the person infected, and how quickly it’s diagnosed and treated.
Nearly one-third of people with a blood-borne Candida infection can develop a severe condition known as septic shock. Whether this happens or not often depends more on the person’s age and where the infection started, rather than the severity of the infecting organisms.
Possible Complications When Diagnosed with Candidiasis
Pregnancy can increase the chance of a woman developing a Candida infection in her vagina. Candida is a type of yeast, and this condition is one of the common fungal infections often seen in pregnant women. This infection can potentially expose newborns, particularly those with low birth weight or those born prematurely, to systemic infections after birth.
Intertrigo is another condition that can occur from Candida due to certain mechanical and environmental factors. It’s a skin infection that happens when skin surfaces rub together, causing pain and itchiness, which can reduce a person’s quality of life. People who are obese, have diabetes, or have conditions that suppress the immune system are at higher risk of getting and recurring this disease. Intertrigo from Candida is typically treated with topical medications, like nystatin and the azole group of antifungals.
If not treated, Candida can cause severe systemic infections, affecting other organs and possibly leading to sepsis, a dangerous bloodstream infection. Oral antibiotic therapy may result in intestinal candidiasis, while bronchopulmonary candidiasis, a rare lung-related complication, can follow pre-existing lung disease. In people with weakened immune systems, like those with leukemia, candidiasis can cause critical conditions, such as bloodstream infection, heart infection, or brain inflammation. In leukemia patients, systemic candidiasis often presents as long-lasting low white blood cell count and fever that doesn’t respond to antibiotics.
Preventing Candidiasis
The symptoms of a yeast infection can look like those of other health issues, which is why it’s crucial to have a physical examination and lab tests. Certain factors can increase your chance of getting a yeast infection, such as the use of antibiotics, having diabetes, being pregnant, using hormonal birth control, and having a weakened immune system. Conditions that can weaken your immune system include HIV, undergoing chemotherapy, or taking certain medications. It’s very important to make sure that the diagnosis is correct when you have bothersome symptoms, and before starting any kind of treatment.
