diease

Candidiasis


OVERVIEW OF Candidiasis :

Candidiasis is an infection causes by the yeast which is termed as Candida. The infection is caused by Candida albicans. The candida is present on the surface of the skin, oral cavity , tongue, throat and vagina without causing any serious problems


CAUSES :

Causes:

Antibiotic usage:

      It is more common in women who take more amount of antibiotics. Broad spectrum antibiotics which kill a range of bacteria also kill healthy bacteria in the vagina leading to overgrowth of yeast.

Increased estrogen levels:

      Yeast infections are more common in women having higher estrogen levels such as pregnant women or women taking high dose estrogen birth contrl pills or estrogen hormone therapy.

Uncontrolled diabetes:

        Women with poorly controlled blood sugar level are at the higher risk of having the yeast infection.

 Impaired immune system:

        Women with immunosuppression such as the patient under the corticosteroid therapy or HIV infection are more prone for yeast infections.

 


PATHOPHYSIOLOGY :

Chronic mucocutaneous candidiasis:

This includes the lesions of the face, scalp, hands and nails. Chronic Mucocutaneous candidiasis is occasionally associated with oral thrush and vitiligo.

Oropharyngeal candiadiasis:

Individuals with oropharyngeal candidiasis (OPC) usually have a history of HIV infection, wear dentures, have diabetes mellitus or have been exposed to broad spectrum antibiotics or inhaled steroids. The main symptoms include sore and pianful mouth, burning mouth or tongue, dysphagia, thick whitish patches on the oral mucosa.

Physical examination reveals a diffuse erythema and white patches that appears on the surfaces of the buccal mucosa,throat,tongue and gums.

The following are the five types of oropharyngeal candidiasis:

Membranous Candidiasis: It shows creamy-white, curdlike patches on the mucosal surfaces.

Chronic Atrophic Candidiasis: It is also known as denture stomatitis. It is one of the most common forms of the disease. Presenting signs and symptoms include chronic erythema and edema of the portion of the palate that comes into contact with the dermatitis.

Erythematous Candidiasis: Associated with an erythematous patch on the hard and soft palates.

Angular cheilitis-Inflammatory reaction characterized by soreness, erythema and fissuring at the corners of the mouth.

Mixed: A combination of any of the above types is possible.

Esophageal candidiasis:

  • Normal oral mucosa (>50% of patients)
  • Dysphagia
  • Odynophagia
  • Retrosternal pain
  • Epigastric pain
  • Nausea and vomiting

Nasoesophageal Candidiasis:

  • Epigastric pain
  • Nausea and vomiting
  • Abdominal pain
  • Fever and chills
  • Abdominal mass

 

Genitourinary Tract Candidiasis:

 

  • Vulvovaginal candidiasis (VVC) - Erythematous vagina and labia; a thick, curdlike discharge; and a normal cervix upon speculum examination 
  • Candida balanitis - Penile pruritus and whitish patches on the penis
  • Candida cystitis - Many patients are asymptomatic, but bladder invasion may result in frequency, urgency, dysuria, hematuria, and suprapubic pain
  • Asymptomatic candiduria - Most catheterized patients with persistent candiduria are asymptomatic
  • Ascending pyelonephritis - Flank pain, abdominal cramps, nausea, vomiting, fever, chills and hematuria
  • Fungal balls - Intermittent urinary tract obstruction with subsequent anuria and ensuing renal insufficiency

Vaginal candidiasis:

  • Typical symptoms of VVC include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge

 

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • rashes
  • red or purple patches (area with an altered surface)
  • white, flaky substance over affected areas
  • scaling, or shedding of the skin with flakes
  • cracks in the skin
  • soreness
  • erythema, which results in areas of redness
  • maceration, or the appearance of soft white skin
  • creamy satellite pustules at margins of affected areas (pimples filled with pus)
  • red and white lesions in your mouth, as seen in oral thrush
  • white creamy like materials is seen in vagina and other regions.


DIAGNOSTIC :

  • Diagnosis:

             Diagnostic tests for candidiasis include the following:

  • Mucocutaneous candidiasis - For a wet mount, scrapings or smears obtained from skin, nails, or oral or vaginal mucosa are examined under the microscope; a potassium hydroxide smear, Gram stain, or methylene blue is useful for direct demonstration of fungal cells
  • Cutaneous candidiasis - Using a wet mount, scrapings or smears obtained from skin or nails can be examined under the microscope; potassium hydroxide smears are also useful
  • Genitourinary candidiasis - A urinalysis should be performed; evidence of white blood cells (WBCs), red blood cells (RBCs), protein, and yeast cells is common; urine fungal cultures are useful
  • Gastrointestinal candidiasis - Endoscopy with or without biopsy

 


TREATMENT AND PROGNOSIS :

  • Cutaneous candidiasis - Most localized cutaneous candidiasis infections can be treated with any number of topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin)
  • Chronic mucocutaneous candidiasis - This condition is generally treated with oral azoles
  • Oropharyngeal candidiasis - This can be treated with either topical antifungal agents or systemic oral azoles
  • Esophageal candidiasis - Treatment requires systemic therapy with fluconazole
  • VVC - Topical antifungal agents or oral fluconazole can be used [2]
  • Candida cystitis - In noncatheterized patients, Candida cystitis should be treated with fluconazole; in catheterized patients, the Foley catheter should be removed or replaced; if the candiduria persists after the catheter change, then patients can be treated with fluconazole


PROGNOSIS :

I superficial candiasis that the spread is confined only to the top most layer and the spread is not so deep, the infection can show better results. However the infection with deep origin might require

earlier treatment.


PREVENTION :

  • Not douching—douching can kill bacteria that actually controls fungus.
  • Avoiding the use of feminine deodorants.
  • Not using deodorant (scented) tampons or pads.
  • Changing out of wet clothing, especially bathing suits, as soon as you can.
  • Using water-based sexual lubricants.
  • Use tongue cleaner and maintain proper oral hygiene to stick out from oral candidiasis
  • Since the fungal infection has higher rate of recurrence keep the surroundings clean and tidy
  • Use proper antifungal course if infected with a fungal infection
  • Avoid using the inanimate objects of the person who is infected with the candidiasis


Medicines used in the Treatment :

clotrimazole,

econazole,

ciclopirox,

miconazole,

ketoconazole,

nystatin

fluconazole