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Candidiasis

Candidiasis

Definition

Candidiasis is an infection caused by a species of the yeast Candida, usually the Candida albicans fungus. Candida is found on various parts of the bodies of almost all normal people but causes problems in only a few. Candidiasis can affect the skin, nails, and mucous membranes throughout the body including the mouth (thrush), esophagus, vagina (yeast infection), intestines, and lungs.

Description

Candida may cause yeast mouth infections (also known as thrush) in children with reduced immune function or in children taking certain antibiotics . Antibiotics may upset the balance of microorganisms in the body and allow an overgrowth of Candida. The use of inhaled steroids for the treatment of asthma has also been shown to cause oral candidiasis. Many infants acquire candidiasis from their mothers during the process of birth, when the baby comes in contact with naturally existing Candida found in the mother's vagina. Candidiasis is not considered harmful to infants unless it lasts more than several weeks after birth. These yeast mouth infections cause creamy white, curd-like patches on the tongue, inside of the mouth, and on the back of the throat. Under the whitish material, there are red lesions that may bleed.

Candida also may infect an infant's diaper rash , as it grows rapidly on irritated and moist skin. Children who suck their thumbs or other fingers may also develop candidiasis around their fingernails, causing redness on the nail edges.

Candida is a common cause of vaginal infections in adolescent girls, especially when the normal populations of the bacteria Lactobacilli have been reduced due to antibiotic use, allowing the overgrowth of Candida. A candidiasis infection in the vagina results in itching , burning, soreness, and a thick, white vaginal discharge.

Other risk factors for candidiasis include obesity , heat, and excessive sweating that result in the formation of moist skin areas where the yeast organism can grow.

In the early 2000s, several serious categories of candidiasis have become more common, due to overuse of antibiotics, the rise of AIDS , the increase in incidence of organ transplantations, the use of chemotherapy in cancer treatment, and the implantation of invasive devices (e.g., nasogastric tubes, catheters, and artificial joints and valves) into the bodyall of which increase a patient's susceptibility to infection. Diabetics are especially susceptible to candidiasis, as they have high levels of sugar in their blood and urine and a low resistance to infection, both of which are conditions that favor the growth of yeast. 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 child's resistance is lowered, often due to another illness. Children with granulocytopenia (deficiency of white blood cells) are particularly at risk for deep organ candidiasis. There are many diagnostic categories of deep organ candidiasis, depending on the tissues involved.

In the past candidiasis was referred to as moniliasis.

Demographics

Candidiasis is an extremely common infection. Thrush occurs in approximately 25 percent of healthy newborns and occurs in a slightly higher percentage of infants during their first year of life.

Over 1 million adult women and adolescent girls in the United States develop vaginal yeast infections each year. It is not life-threatening, but the condition can be uncomfortable and frustrating.

Causes and symptoms

Candidiasis is caused by a species of the yeast Candida, usually the Candida albicans fungus.

In oral candidiasis, the disease is characterized by whitish patches that appear on the tongue, inside of the cheeks, or on the palate. Pain or difficulty in swallowing may indicate a fungal infection in the throat, which is a potential complication of AIDS. Most adolescent girls with vaginal candidiasis experience severe vaginal itching and 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. The infected skin in diaper rash that includes infection with Candida appears fiery red with areas that may have a raised red border.

Effects of deep organ or systematic candidiasis include meningitis , arthritis, fungemia (fungi in the blood, causing fever and possibly leading to sepsis), endocarditis (heart infection), endophthalmitis (infection and scarring in the eye that can affect vision), and renal or bladder bezoars (colonization and blockage of the urinary tract by Candida, which can cause urinary tract infections and kidney failure.

Diagnosis

Often clinical appearance and visual examination give a strong suggestion about the diagnosis. Generally, a doctor takes a sample of the vaginal discharge or swabs an area of oral or skin lesions, and then inspects this material under a microscope, where it is possible to see characteristic forms of yeasts at various stages in the lifecycle.

Fungal blood and stool cultures for detection of the Candida organism should be taken for patients suspected of having deep organ candidiasis. Tissue biopsy may be needed for a definitive diagnosis.

When to call the doctor

The doctor should be called if a child exhibits any symptoms of the various types of candidiasis.

Treatment

Treatment of candidiasis is primarily accomplished through the use of antifungal drugs. Oral candidiasis is usually treated with prescription lozenges or mouthwashes. Some of the most-used prescriptions are nystatin mouthwashes (Nilstat or Nitrostat) and clotrimazole lozenges. Skin infections can be treated with topical antifungal creams. Highly inflamed skin lesions can also be treated with corticosteroid creams.

For infants with oral candidiasis, pacifiers should be sterilized or discarded. Bottle nipples should be discarded and new ones used as the infant's mouth begins to heal.

The risk of diaper rash complicated with candidiasis can be reduced by preventing irritating dermatitis through the use of absorbent diapers and prevention of excessive exposure to urine or feces through frequent changing of diapers. The use of plastic pants that do not allow air circulation over the diaper area is not recommended. Children may still attend child care; however, childcare providers should follow good hygienic practices, including thorough hand washing and disposal of materials that may contain nasal and oral secretions of infected children, in order to prevent transmitting the infection to other children.

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

The early 2000s 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 children with candidiasis.
  • Antifungal therapy may be used during chemotherapy to prevent candidiasis.
  • Drugs should be prescribed based on a child's specific history and immune defense status (this is especially critical for children with AIDS). Stronger antifungal drugs, such as ketoconazole or fluconazole, may be necessary.
  • Diabetes mellitus should be controlled with appropriate medication and dietary changes.

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 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; however, they should try a conventional treatment if an alternative remedy is not effective.

Prognosis

Oral and skin candidiasis, though painful, are usually cured with the use of antifungal medications. However, in premature infants, in children with poor or compromised immune systems, or in children with deep organ or systematic infections, eradication of the infections may be more difficult to achieve. Mortality in low birth-weight premature infants with systemic candidiasis may reach 50 percent.

Prevention

Often candidiasis can be prevented through good sanitation procedures, such as keeping the body cool and dry, wearing natural fabric underclothes, changing underclothes frequently, wiping from front to back after bowel movements, and washing hands often. For children who are susceptible to candidiasis because of immune deficiencies, the regular use of antifungal drugs to prevent infections may be required.

Parental concerns

Parents need to practice good hygienic procedures as they care for their children, in order to prevent the development of candidiasis.

KEY TERMS

Biopsy The surgical removal and microscopic examination of living tissue for diagnostic purposes or to follow the course of a disease. Most commonly the term refers to the collection and analysis of tissue from a suspected tumor to establish malignancy.

Granulocytopenia A condition characterized by a deficiency of white blood cells.

Nasogastric tube A long, flexible tube inserted through the nasal passages, down the throat, and 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 Relating to an entire body system or the body in general.

Resources

BOOKS

Martin, Jeanne Marie, and Rona P. Soltan. Complete Candida Yeast Guidebook: Everything You Need to Know about Prevention, Treatment, and Diet. New York: Prima Lifestyles, 2000.

The Official Patient's Sourcebook on Invasive Candidiasis. San Diego, CA: Icon Health Publications, 2002.

WEB SITES

Greenberg, Michael E. "Candidiasis." eMedicine, September 1, 2004. Available online at <www.emedicine.com/ped/topic312.htm> (accessed December 7, 2004).

Judith Sims Richard H. Lampert

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Sims, Judith; Lampert, Richard. "Candidiasis." Gale Encyclopedia of Children's Health: Infancy through Adolescence. 2006. Encyclopedia.com. 25 Jul. 2016 <http://www.encyclopedia.com>.

Sims, Judith; Lampert, Richard. "Candidiasis." Gale Encyclopedia of Children's Health: Infancy through Adolescence. 2006. Encyclopedia.com. (July 25, 2016). http://www.encyclopedia.com/doc/1G2-3447200107.html

Sims, Judith; Lampert, Richard. "Candidiasis." Gale Encyclopedia of Children's Health: Infancy through Adolescence. 2006. Retrieved July 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3447200107.html

Candidiasis

Candidiasis

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 organismsincluding stomach surgery, burns, nasogastric tubes, and catheterscan 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.

RACHEL FULLER BROWN (18981980)

Rachel Fuller Brown was born on November 23, 1898 in Springfield, Massachusetts. Brown was the oldest of two children born to Annie (Fuller) and George Hamilton Brown. In 1912, her father left their family in Missouri and her mother moved the family back to Springfield. Brown double majored in history and chemistry at Mount Holyoke, receiving her A.B. degree in 1920. She also earned her M.A. degree from the University of Chicago. Brown began her doctoral studies at the University, but she experienced financial difficulties and took a job before she received her Ph.D. She worked at the Division of Laboratories and Research of the New York State Department of Health as an assistant chemist for seven years and finally returned to Chicago and completed her Ph.D.

In 1948, Brown and Elizabeth Hazen began researching fungal infections found in humans due to antibiotic treatments and diseases. Some of the antibiotics they discovered did indeed kill the fungus; however, they also killed the test mice. Finally, Hazen located a microorganism on a farm in Virginia, and Brown's tests indicated that the microorganism produced two antibiotics, one of which proved effective for treating fungus and candidiasis in humans. Brown purified the antibiotic which was patented under the name nystatin. In 1954, the antibiotic became available in pill form. Brown and Hazen continued their research and discovered two other antibiotics. Brown received numerous awards individually and with her research partner, Elizabeth Hazen. Rachel Brown passed away on January 14, 1980.

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.

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.

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.

Resources

PERIODICALS

Greenspan, Deborah, and John S. Greenspan. "HIV-Related Oral Disease." The Lancet 348 (September 14, 1996): 729-734.

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Lampert, Richard. "Candidiasis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 25 Jul. 2016 <http://www.encyclopedia.com>.

Lampert, Richard. "Candidiasis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (July 25, 2016). http://www.encyclopedia.com/doc/1G2-3451600316.html

Lampert, Richard. "Candidiasis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved July 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451600316.html

Candidiasis

Candidiasis

Candidiasis is an infection that is caused by members of the fungal genus Candida.

The two most common species associated with Candidiasis are Candida albicans and Candida glabrata. Less commonly, but still able to cause the infection, are Candida tropicalis, Candida parapsilosis, Candida guilliermondi, and Candida krusei.

The fungus is a normal resident of the body, typically in the mouth and the gastrointestinal tract. In these habitats, the microorganism normally colonizes the cell surface. In healthy people in the United States, Candida species colonize more than half of these individuals. The presence of the fungus is beneficial. Invading bacteria are recognized by the Candida cells and are destroyed. Thus, the fungi complement the immune system and other defenses of the body against infection.

When the body is in proper balance with respect to the microbial flora, the fungi exist as a so-called yeast form. These are not capable of invasion. However, Candida can infect areas of the body that are warm and moist. These include the eye (conjunctivitis), fingernails, rectum, folds in the skin, and, in infants, the skin irritation in infants known commonly as diaper rash. Typically, such infections are more of an inconvenience than a dangerous health concern.

However, in people whose immune systems are compromised in some way, or when the normal balance of the microbial flora has been disrupted by, for example, antibiotic therapy, Candida can establish an infection. For example, an infection of the mouth region, which is referred to as oropharyngeal infection, was a very common infection in those whose immune system was deficient due to infection with the Human immunodeficiency virus . More aggressive antiviral therapy has reduced the incidence of the infection.

Such infections are associated with the change from the Candida cells from the yeast form to a so-called mycelial fungal form. The mycelia produce long, root-like structures that are called rhizoids. The rhizoids can penetrate through the mucous cells that line the inside of the mouth and vagina, and through the epithelial cells that line the intestinal tract. This invasion can spread the infection to the bloodstream. As well, the microscopic holes that are left behind in the cell walls can be portals for the entry of toxins, undigested food, bacteria, and yeast.

In countries around the world where fungal infections are widespread in the populations, Candida species have over-taken Cryptococcus species as the most common cause of infections that affect the central nervous system of immunocompromised people.

Besides the oropharyngeal infection, Candida can also commonly cause a vaginal infection. Both infections are evident by the development of a fever and chills that, because of the fungal genesis of the infections, are unaffected by antibacterial therapy. Visually, white patches appear on the surface of the cells lining the mouth and oral cavity and the vagina. More rarely, the infections may spread to the bloodstream. Examples of the infections that can result include the kidney, spleen, nerve cells (meningitis ), heart (endocarditis). Arthritis may even develop. Immunocompromised individuals are especially susceptible to these infections.

The contamination of the bloodstream by Candida occurs most commonly in the hospital setting, where a patient is being treated for Candidiasis or other malady. Indeed, this type of bloodstream infection is the fourth most common cause of hospital-acquired bloodstream infections in the United States. The death rate from the infection can approach 40 per cent.

Treatment for Candida infections consist of the administration of antifungal drugs. Examples of the drugs of choice include amphotericin B, fluconazole, ketoconazole, and nystatin. The real possibility of the development of irritative side effects makes monitoring during therapy a prudent precaution.

See also Fungi; Immunodeficiency

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Candidiasis

CANDIDIASIS

Candidiasis (thrush, monilia infection) is caused by a fungus that most commonly infects the mouth (usually of infants or persons with weakened immune systems), or the vagina (yeast infection). Another form of candidiasis causes painful inflammation under the fingernails (paronychia). It also occurs as an opportunistic infection in the late stages of HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), as a nosocomial infection after catheterization; and it can invade the spinal canal and meninges, where it is obviously much more serious.

Candidiasis is transmitted by close contact of an infected with an uninfected mucous membrane. Infants acquire it as they pass through the birth canal. Topical application of antifungal paint or ointment can usually eliminate the infection and thus prevent transmission. Management is more difficult in debilitated and immunocompromised patients, in whom the condition can be very stubborn.

John M. Last

(see also: Fungal Infections; Fungicides )

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candidiasis

candidiasis (kăn´dĬdī´əsĬs), infection of the mucous membranes caused by the fungus Candida albicans. Other terms for candidiasis are yeast infection, moniliasis (after a former name of the fungal genus), and thrush, the latter term usually being reserved for infection of the mucous membrane of the mouth. The fungus is a normal inhabitant of the mouth and vagina, and its growth is usually kept in check by certain bacteria that also live in these areas. When the balance of these organisms is disturbed by antibiotic treatment, by hormonal imbalances, or by a weakening of the body's resistance to disease (as occurs in AIDS), the fungus can begin to proliferate. Candidiasis of the penis (usually traceable to a female with the infection) is called balanitis. Candidal infections are treated with antifungal drugs such as nystatin and miconazole.

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