Definition

Candidiasis is an infection caused by a species of the yeast Candida, usually Candida albicans. This is a common cause of vaginal infections in women. Also, Candida may cause mouth infections in people with reduced immune function, or in patients taking certain antibiotics. Candida can be found in virtually all normal people but causes problems in only a fraction. In recent years, however, several serious categories of candidiasis have become more common, due to overuse of antibiotics, the rise of AIDS, the increase in organ transplantations, and the use of invasive devices (catheters, artificial joints and valves)-all of which increase a patient's susceptibility to infection.

  Description

Vaginal candidiasis

Over one million women in the United States develop vaginal yeast infections each year. It is not life-threatening, but it can be uncomfortable and frustrating.

Oral candidiasis

This disorder, also known as thrush, causes white, curd-like patches in the mouth or throat.

Deep organ candidiasis

Also known as invasive candidiasis, deep organ candidiasis is a serious systemic infection that can affect the esophagus, heart, blood, liver, spleen, kidneys, eyes, and skin. Like vaginal and oral candidiasis, it is an opportunistic disease that strikes when a person's resistance is lowered, often due to another illness. There are many diagnostic categories of deep organ candidiasis, depending on the tissues involved.

  Causes and symptoms

Vaginal candidiasis

Most women with vaginal candidiasis experience severe vaginal itching. They also have a discharge that often looks like cottage cheese and has a sweet or bread-like odor. The vulva and vagina can be red, swollen, and painful. Sexual intercourse can also be painful.

Oral candidiasis

Whitish patches can appear on the tongue, inside of the cheeks, or the palate. Oral candidiasis typically occurs in people with abnormal immune systems. These can include people undergoing chemotherapy for cancer, people taking immunosuppressive drugs to protect transplanted organs, or people with HIV infection.

Deep organ candidiasis

Anything that weakens the body's natural barrier against colonizing organisms-including stomach surgery, burns, nasogastric tubes, and catheters-can predispose a person for deep organ candidiasis. Rising numbers of AIDS patients, organ transplant recipients, and other individuals whose immune systems are compromised help account for the dramatic increase in deep organ candidiasis in recent years. Patients with granulocytopenia (deficiency of white blood cells) are particularly at risk for deep organ candidiasis.

  Diagnosis

Often clinical appearance gives a strong suggestion about the diagnosis. Generally, a clinician will take a sample of the vaginal discharge or swab an area of oral plaque, and then inspect this material under a microscope. Under the microscope, it is possible to see characteristic forms of yeasts at various stages in the lifecycle.

Fungal blood cultures should be taken for patients suspected of having deep organ candidiasis. Tissue biopsy may be needed for a definitive diagnosis.

  Treatment

Vaginal candidiasis

In most cases, vaginal candidiasis can be treated successfully with a variety of over-the-counter antifungal creams or suppositories. These include Monistat, Gyne-Lotrimin, and Mycelex. However, infections often recur. If a women has frequent recurrences, she should consult her doctor about prescription drugs such as Vagistat-1, Diflucan, and others.

Oral candidiasis

This is usually treated with prescription lozenges or mouthwashes. Some of the most-used prescriptions are nystatin mouthwashes (Nilstat or Nitrostat) and clotrimazole lozenges.

Deep organ candidiasis

The recent increase in deep organ candidiasis has led to the creation of treatment guidelines, including, but not limited to, the following: Catheters should be removed from patients in whom these devices are still present. Antifungal chemotherapy should be started to prevent the spread of the disease. Drugs should be prescribed based on a patient's specific history and defense status.

  Alternative treatment

Home remedies for vaginal candidiasis include vinegar douches or insertion of a paste made from Lactobacillus acidophilus powder into the vagina. In theory, these remedies will make the vagina more acidic and therefore less hospitable to the growth of Candida. Fresh garlic (Allium sativum) is believed to have antifungal action, so incorporating it into the diet or inserting a gauze-wrapped, peeled garlic clove into the vagina may be helpful. The insert should be changed twice daily. Some women report success with these remedies; they should try a conventional treatment if an alternative remedy isn't effective.

  Prognosis

Vaginal candidiasis

Although most cases of vaginal candidiasis are cured reliably, these infections can recur. To limit recurrences, women may need to take a prescription anti-fungal drug such as terconazole (sold as Terazol) or take other anti-fungal drugs on a preventive basis.

Oral candidiasis

These infections can also recur, sometimes because the infecting Candida develops resistance to one drug. Therefore, a physician may need to prescribe a different drug.

Deep organ candidiasis

The prognosis depends on the category of disease as well as on the condition of the patient when the infection strikes. Patients who are already suffering from a serious underlying disease are more susceptible to deep organ candidiasis that speads throughout the body.

  Prevention

Because Candida is part of the normal group of microorganisms that co-exist with all people, it is impossible to avoid contact with it. Good vaginal hygiene and good oral hygiene might reduce problems, but they are not guarantees against candidiasis.

Because hospital-acquired (nosocomial) deep organ candidiasis is on the rise, people need to be made aware of it. Patients should be sure that catheters are properly maintained and used for the shortest possible time length. The frequency, length, and scope of courses of antibiotic treatment should also be cut back.

   Key Terms:

Biopsy The removal and examination of tissue from a live body. Colonize To become established in a host. Granulocytopenia A condition characterized by a deficiency of white blood cells. Nasogastric Tube inserted through the nasal passages into the stomach. Opportunistic Infection caused by microorganisms that are usually harmless, but which can cause disease when a host's resistance is lowered. Systemic Afflicting an entire body system or the body in general.

   Resources:

Books

• Carlson, K. J., S. A. Eisenstat, and T. Ziporyn. The Harvard Guide to Women's Health. Harvard University Press, 1996.

Periodicals

• Greenspan, Deborah, and John S. Greenspan. "HIV-Related Oral Disease." The Lancet 348 (14 Sept. 1996): 729-734.
• Tobin, Marla J. "Vulvovaginal candidiasis: Topical vs. Oral Therapy." American Family Physician 51 (15 May 1995): 1715-1723.