Candidiasis

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

Thrush is caused by a fungus called Candida albicans. This organism lives in your mouth and is usually kept in check by healthy organisms that also live there. However, when your resistance to infection is low, the fungus can grow, leading to lesions in your mouth and on your tongue.

The following can lessen your resistance to infection and increase your chances of getting thrush:

• Taking antibiotics
• Having HIV infection 
• Receiving chemotherapy for cancer
• Being very old or very young
• Being in poor health
• Having diabetes

Symptoms and Signs

Thrush appears as whitish, velvety plaques in the mouth and on the tongue. Underneath the whitish material, there is red tissue that may bleed. The lesions can slowly increase in number and size.

If you are immunocompromised, the infection can spread to other organs, like the esophagus (causing pain with swallowing), or throughout your body, which can be fatal.

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

• Try using yogurt or acidophilus capsules when you take antibiotics.
• Treat any vaginal yeast infections that develop during pregnancy as soon as possible.
• If you smoke, ask your doctor about the best ways to quit.

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