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Candidiasis - Symptoms & Treatment

Also known as candidosis and moniliasis, this usually mild, superficial fungal infection can lead to severe disseminated infections and fungemia in an immunocompromised patient. In most cases, the causative fungi infect the nails (paronychia), skin (diaper rash), or mucous membranes, especially the oropharynx (thrush), vagina (vaginitis), esophagus, and Gl tract.

These fungi may enter the bloodstream and invade the kidneys, lungs, endocardium, brain, or other structures, causing serious systemic infection. Such systemic infection predominates among drug abusers and facility patients (particularly diabetic and immunosuppressed patients).

The prognosis varies, depending on the patient's resistance. The incidence of candidiasis continues to increase because of increasing use of I.V. antibiotic therapy and increasing numbers of immunocompromised patients in the acute care setting.

Causes

Most cases of candidiasis result from infection with Candida albicans or C. tropicalis, although eight other potentially disease-causing strains exist among the more than 150 species of Candida. One of the normal flora of the Gl tract, mouth, vagina, and skin, C. albicans causes infection when some change in the body permits their sudden proliferation. The changes may be triggered by increasing glucose levels from diabetes mellitus, lowered resistance from such diseases as cancer, immunosuppressant drug therapy, radiation, aging, or irritation from dentures.

The infecting organism may enter the body through I.V. or urinary catheterization, drug abuse, total parenteral nutrition, or surgery. The most common precipitator is the use of broad-spectrum antibiotics such as tetracycline. These agents decrease the number of normal bacterial flora. which permits the number of fungi, including candidal organisms, to increase.

A mother with vaginitis can transmit the organism (as oral thrush) to the neonate during vaginal delivery.

Signs and symptoms

  • Creamy white patches in the mouth or on the throat
  • Painful cracks at the corners of the mouth
  • Skin rashes, patches, and blisters found most commonly in the groin, between fingers and toes, and under the breasts
  • Vaginal itching and irritation with a curd like discharge

Diagnostic tests

Detection of candidal organisms by a Gram stain of skin, vaginal scrapings, pus, or sputum or on skin scrapings prepared in potassium hydroxide solution confirms the diagnosis.

Tests for systemic infection include blood and tissue cultures.

Treatment

Initial treatment aims to improve the underlying condition that predisposes the patient to candidiasis. For example, measures may be taken to control diabetes or to discontinue antibiotic therapy or catheterization, if possible.

For superficial candidiasis, the doctor may prescribe an antifungal medication such as nystatin. Clotrimazole, fluconazole, and miconazole are effective in mucous membrane and vaginal candidiasis. Ketoconazole or fluconazole is the primary choice for chronic candidiasis of the mucous membranes.

Treatment for systemic infection consists mainly of I.V. amphotericin B, but flucytosine or miconazole may be added.

Removing infected prostheses (including, for example, cardiac valves or prosthetic joints) or catheters is essential. Draining abscesses surgically or percutaneously is also recommended.

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.



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