CANDIDIASIS

Candidiasis or Candidosis OR Thrush is a yeast infection caused by any Candida species. Candida albicans is the most common agent causing infections in humans. The infection is commonly called ‘thrush’ or ‘moniliasis’.

Candida occurs freely everywhere and their infections can affect the body in many ways. From small localized areas of infection in some or fast-spreading multi-system infections in others, Candidal infections can be superficial or life-threatening.

Who gets Candidal infections?

Candida is normally present in most people. The organism is a commensal i.e. it naturally colonizes the human body without benefiting or damaging it.

A healthy immune system and the presence of other microorganisms, check its uncontrolled multiplication and thereby, infections.

It is an opportunistic organism causing an infection only when your immune defenses are lowered enough for it to multiply. Carriers generally don’t develop any symptoms so long as they are healthy. Yet, the incidence of Candidiasis is common among

• Infants
• Elderly people
• High sugar diets
• Women on oral contraceptive pills or Hormone Replacement Therapy
• Use of natural progesterone cream
• Pregnancy
• Dental mercury amalgam poisoning
• Smoking
• Other heavy metal poisonings e.g. lead, cadmium
• Chemical poisoning from the home, garden, workplace etc.
• Hormonal changes e.g. puberty, pregnancy, menopause

Most often these infections are localized. Many clinical/medical conditions also increase the risk of acquiring Candidiasis. In such cases where the immune system is lowered, the infection spreads through the blood stream and spreads to other organs as well.

A low immunity plus Candidiasis is possible in the following situations:

• Diabetes mellitus. Recurring infections in spite of proper treatment is a feature of diabetes. High glucose levels in the blood allow rapid spread of the infection to other body parts by the bloodstream.
• Use of broad-spectrum antibiotics. This usually kills the other organisms that compete with Candida for growth and allows the yeast to grow unchecked.
• Obesity. The moisture within skin folds provides a suitable environment for yeast growth.
• Intravenous drug abuse. Frequent, unhygienic insertion of drugs via the intravenous route, or long dwelling IV lines can introduce Candida into the bloodstream.
• Indwelling catheters in hospitalized patients.
• Severe burns. Loss of normal layers of skin leaves the body exposed to superadded infections like Candidiasis.
• Cancers of the blood cells.
• Reduced numbers of neutrophils (a component of the white blood cells which are the defense cells of our bodies).
• Neonates. Infants less than 7 days old.
• Prolonged steroid (corticosteroid) therapy.
• AIDS. People suffering from AIDS are very susceptible to Candidiasis.
• Stress and poor nutrition. These are known and proven immunosuppressant. It certainly lowers the body’s immune status making it vulnerable to infections.

Symptoms

Candidal infections are extremely common. It occurs in otherwise healthy people mostly as a well-localized infection and responds favorably to treatment.

Affected locations show a lot of itching, burning, and soreness. Generally, symptoms depend upon the organ involved.

• In the oral cavity, its presentation is called oral thrush. Most infections are seen in people having AIDS and in infants. Infants may suffer from
• Pain
• Poor feeding
• Crankiness
• Lethargy.
• It presents as discrete lesions on the penis and foreskin. Often the soft tissue of the glans penis has red, inflamed, painful sores and rarely a white discharge from the penis. A condition called ‘balanitis’.
• In infants and older children using diapers, it presents within the folds of the skin as ‘diaper (nappy) rash’.
• Nipples and surrounding tissues, in breastfeeding women.
• The ears. External ear often gets infected.
• Endophthalmitis, a condition wherein the inner eyeball is inflamed is typical of Candidal infection. The most common symptoms are:
• Pain
• Blurred vision
• Decreased vision
• Redness, especially after eye surgery
  Children with low birth weight or hospitalization for long periods are contributing factors.
• Nails. It causes chronic paronychia which is painful inflammation of the tissues around the nail. It also causes onychomycosis where the nail grows very poorly and appears disfigured.
• The skin surrounding the nose and margins of the nostrils can be affected.
• In women, a fairly common site is the vulva or vagina. The condition is referred to as vaginal Candidiasis or vaginal thrush.
• Intense itch and profuse creamy-white, curd-like or a whitish-yellow discharge from the vagina is the commonest symptom.
• Soreness and burning.
• Pain during sexual intercourse.
  The third trimester of pregnancy, broad-spectrum antibiotics, sexual activity (anal sex followed by vaginal sex, without proper cleaning), use of oral contraceptives and HIV infection are some of the most common factors causing vulvovaginal thrush.
• The skin folds are prone to a lot of moisture. Obesity, Diabetes, excessive sweating (hyperhidrosis) are common causes of Candidiasis in the skin folds.
  Lesions show the following characteristics

Systemic symptoms

Candida spreads throughout the body and causes a multitude of symptoms. Extent of infection, severity, and their consequences largely depend upon the individual infected.

• Candidiasis of the esophagus (food pipe) along with mouth infection is highest in people suffering from AIDS.
• Respiratory system involvement is mostly seen in the form of a cough and fever.
• Candidal infection can cause prolonged fevers (fevers of unknown origin) in absence of other specific symptoms.
• Symptoms of gastrointestinal infection largely include Distention
• Flatulence
• Constipation or diarrhea
• Bloated feeling
• Itching in the anal area
• Severe, widespread infection will show symptoms of shock and kidney failure (decreased urine output) and severe blood coagulation problems (disseminated intravascular coagulation – ‘DIC’). This condition often resembles bacterial sepsis.
• Recurrence of urinary tract infections in spite of antibiotic treatment is often indicative of Candidiasis, especially in women.
• Non-specific body pains, joint pains and muscular weakness in the absence of other symptoms are suggestive of possible Candidal infection.
• Women can often complain of menstrual irregularities.
• Nervousness, poor memory, aggressive behavior, anxiety, confusion, fuzzy or foggy thinking (brain fog) with unexplained mood swings.
• Candidiasis that affects the gut can make people vulnerable to many food allergies.
• Persistent, widespread symptoms affecting the nails, mucous membranes and skin especially in children.
• Addison’s disease, Underactive thyroid disorder, and Diabetes can promote the growth of Candida.

Diagnosis

Culture Studies

Materials used to obtain cultures are:

• Skin scrapings
• Urine samples
• Bronchial washings.
• Sputum cultures.

However, since Candida is a commensal, a positive culture test need not be diagnostic of widespread invasive infection. The key to a positive diagnosis lies in the identification of a Candidal skin lesion and its histopathological study revealing the presence of growing yeast cells.

Positive cultures of cerebrospinal fluid (CSF), pericardium or pericardial fluid, blood, or tissue biopsy specimens provide definitive evidence that systemic therapy is needed.

Sanitation

The importance of maintaining a high standard of personal hygiene cannot be disregarded.

• Wear loose clothes and undergarments must have a cotton crotch.
• After toilet, wipe from front to back only. This prevents contamination of the vagina with anal microorganisms.
• Maintain good oral hygiene. Brush twice daily, especially in the night within four hours after meals. Floss regularly (at least twice a week) or use mouthwashes. Try using warm, salted-water gargles to relieve mouth & throat symptoms.
• Keep the vaginal area always dry. Especially after a bath or shower. Be sure to wash the area thoroughly when in a bath or shower. Avoid very strong soaps.
• If you exercise or swim, change out of the clothes immediately after the workout.
• Douching should be avoided.
• Avoid using highly perfumed scents or soaps.
• Undergarments must be washed in warm water and softeners should be used sparingly.
• Scented sanitary pads or tampons are best avoided. Change the pads frequently, keeping the area dry.
• Avoid sharing towels, razors and other toiletries.

Practice safe sex

Genital Candidiasis often spreads through infected sexual partners. Often both partners need to undergo treatment.

• Both partners should clean themselves before and after having sex.
• Use a condom if either partner is infected or undergoing treatment.
• Avoid vaginal sex immediately after anal sex and never without washing.
• Use lubricants when the natural secretions are insufficient.
• Always use water-based lubricants only.