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What is Candidiasis?

Candidiasis is a fungal infection commonly occurring in persons with decreased immunity, especially in HIV positive individuals and diabetics.

Understanding Candidiasis

Candida is a yeast like fungus that is ubiquitous in nature (occurs everywhere). This is one of the normally occurring commensal flora in human skin. It is only when the innate immunity of the person falls, that the normally occurring fungus becomes a pathogen. In severely immuno-compromised individuals, this little fungus can produce life-threatening bloodstream infections.

Types of Candidiasis

  • Mucosal candidiasis
    • Oral thrush
    • Vulvo-vaginitis (curd-like vaginal discharge)
    • Esophageal
    • Balanitis and balanoposthitis (infection on the penis)
  • Cutaneous candidiasis
    • Infection of web spaces of the fingers
    • Nail infection
  • Invasive candidiasis

How common is Candidiasis?

Though the disease has been documented since age-old times, its incidence in recent years has been on the rise due to the global rise in HIV and diabetes. Both the conditions are known to reduce the ability of the body to defend itself. Since these conditions are more likely to be seen in older individuals than younger, the incidence of Candida infection among the elderly is high – as high as 20% in Indian elderly with a known immunity compromise.

What are the causes and risk factors for Candidiasis?

  • HIV
  • Diabetes mellitus (uncontrolled)
  • Post-menopausal female
  • Extremes of age (80 Years and above)
  • Steroid therapy (inhaled steroids predispose to oral thrush)
  • Broad spectrum antibiotic therapy over a longer period
  • Immuno-suppression in cancer patients and organ transplant recipients

The causative organism is Candida albicans. Uncommon candidial species are C. tropicalis, C. glabrata (blood stream infection and hospital acquired infection).

What are the symptoms of Candidiasis?

  • Curd-like white discharge from genital areas, painless, no itching, no foul smell
  • Painless, white, adherent patches on the oral mucosa (tongue, palate, and throat)
  • No or low fever
  • Itchy rash near anal opening or vagina
  • Painful swelling of the nail bed
  • In bloodstream infection (disseminated) there may be kidney/liver/multiple organ failure.

How is Candidiasis diagnosed?

  • Microscopy of the discharges from the affected sites show Candida
  • Fungal culture
  • Antigen detection (blood test)
  • KOH Mount Test (diagnostic and inexpensive test)

What is the treatment for Candidiasis?

Anti-fungal drugs are the mainstay of treatment which can be prescribed topical, oral or intravenous form according to the severity of the disease. It is best to show a dermatologist before taking any over-the-counter topical creams or medicines. However, the following types of treatments are given.

  • Cutaneous candidiasis – topical anti-fungal cream/lotion/powder
  • Esophageal or vulvovaginal candidiasis – oral fluconazole
  • Disseminated candidiasis – injectable amphotericin B

These medicines should be taken only under medical supervision as many of them may have side effects. It is advisable to complete the given course of treatment else there may be frequent recurrences.

What are the complications with Candidiasis?

Superadded bacterial infections can also occur in long-standing fungal infections.

Severe bloodstream infections can be a life-threatening infection with multiple organ failure.

Chronic candidiasis of oral mucosa, if long-standing, can lead to oral cancer.

What are the lifestyle changes recommended to prevent Candidiasis?

  • Regular follow up of diabetes and regular medication
  • Good personal hygiene
  • Keeping web spaces between fingers and toes, armpits and other folds of skin dry

 

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