Candidiasis is a fungal infection that presents with lesions. This article discusses the clinical presentation and management of candidiasis.
An infection caused by the yeast (fungus), Candida albicans, is known as candidiasis. This infection is usually confined to the skin, nail, mucus membranes, and gastrointestinal tract. But, it can also infect internal organs and cause systemic disease.
Invasive candidiasis is a severe infection that affects blood, bones, eyes, and vital organs like the heart, brain, etc. It is different from chronic candidal infections in the oral cavity, vagina, and nails. The blood infection of candida is known as candidemia, a severe condition that requires immediate medical intervention.
Candida albicans is an oval yeast, which divides by budding. Apart from its yeast form, it can produce long chains of elongated cells (pseudohyphae) and occasionally continuous hyphae with cross walls. This ability to exist in hyphal and yeast forms is known as dimorphism. Both males and females are equally prone to get affected at all ages.
Facts About Candidiasis:
Candida albicans, the causative yeast, is an opportunist par excellence. It flourishes in the warmth and moisture provided by the body-folds, damaged nail cuticle due to prolonged contact with soap and water, altered vaginal pH, neonates, infants, malnourished, debilitated, and the immunocompromised (HIV infection, diabetes mellitus, leukemia, steroid or immunosuppressive therapy) individuals.
The typical presentation of candidiasis is redness, tiny superficial pustules (pus-filled lesions), erosions, and overlying curdy white discharge. Some of its common manifestations are oral thrush, vulvovaginitis, intertrigo, paronychia, and balanoposthitis.
Candida albicans, usually a harmless resident of the throat, gut, and vagina, is a barometer of defective immunity causing opportunistic clinical infection during the following conditions.
Maceration of the skin due to climate or clothing.
Dentures (oral candidiasis).
Moist and macerated axilla, genitocrural, interdigital, and inframammary folds predominantly involve itchy red areas with satellite vesicles and pustules.
a. Oral Candidiasis - Oral candidal involvement can be acute pseudomembranous or acute atrophic. Acute pseudomembranous (thrush) is white curd-like patches over the tongue, buccal mucosa, palate, and gingiva. It can be scraped off, leaving a raw, bright red surface, and is the most typical type.
a. Balanitis or Balanoposthitis - Small papules and pustules appear on the glans, prepuce, or coronal sulcus and soon break down to leave superficial erythematous erosions with a surrounding collarette of scales.
b. Vulvovaginal Candidiasis: Thick, creamy vaginal discharge associated with burning or itching.
a. Paronychia - Redness, swelling, and tenderness in the paronychial area.
In acute atrophic, raw erythematous areas are seen in people with HIV infection. Erythematous candidiasis is the most common manifestation in AIDS patients, affecting the dorsal tongue or palate presenting with bright red patches. Oral candidiasis is a common, early, and often an initial presentation of HIV.
Oral infections that may predict the onset of other serious opportunistic diseases are:
Angular cheilitis - fissuring of angles of the mouth.
Chronic hyperplasia - adherent white patches with surrounding erythema.
Median rhomboid glossitis - a central papillary atrophic condition of the tongue.
Black hairy tongue - hypertrophic papillae on the tongue
10% KOH (potassium hydroxide) mounts of the scrapings from the suspected site examined under a microscope reveal candida as oval budding and elongated filamentous cells connected in the sausage-like manner (pseudohyphae).
In Sabouraud dextrose agar (SDA), whitish mucoid colonies grow within two to five days.
1. Oral Candidiasis:
For oral candidiasis, Nystatin suspension (4,00,000 to 6,00,000 U) should be topically applied four times daily. It should be held in the mouth and then swallowed.
Local application of Clotrimazole mouth paint and Gentian violet 1% to 2% is also used to treat candidiasis.
Systemic treatment for oral candidiasis can be any one of the following:
Tablet Ketoconazole 200 mg per day for 1 to 2 weeks (in AIDS, the dose is 400 mg per day).
Tablet Fluconazole 50 mg to 100 mg per day for seven days.
Tablet Itraconazole 100 mg per day for 14 days.
2. Vulvovaginal Candidiasis:
For vulvovaginal candidiasis, Clotrimazole suppository 500 mg HS and tablet Fluconazole 150 mg stat.
3. Candidal Balanitis:
For balanitis, Clotrimazole topical cream and tablet Fluconazole 150 mg stat.
4. Candidiasis in Skin:
For skin, Nystatin cream and Miconazole cream topical.
For nails, Miconazole topical and oral Ketoconazole or Fluconazole.
For the treatment to be effective, correction of predisposing factors is essential, along with an exhibition of topical or systemic antifungals in unresponsive or immunocompromised patients.
Candidiasis in the oral cavity can be avoided by doing the following:
Maintaining good oral hygiene.
When wearing dentures, it should be adequately removed and cleaned to prevent candidiasis formation.
Rinsing the oral cavity after taking inhaled corticosteroids.
Wear cotton underwear.
Avoid tight-fitting underwear, pants, or skirts.
Avoid bathing in hot waters or hot tubs.
Do not stay in wet clothing for a long time.
Make sure to change sanitary napkins or tampons frequently.
Avoid using deodorants or pads and tampons that contain deodorants.
Always wash underwear in high temperatures to remove microbes, if present.
Although not supported by research, the use of vaginal Boric acid suppositories and yogurt application provides some relief from candidiasis.
Resistance to antifungal drugs developed by the candida species is rendering a problem in treating candidiasis. About 7% of candidal infections that have been diagnosed tend to have resistance against an antifungal drug called Fluconazole. There are several cases of antifungal resistance to Echinocandins. When there is an antifungal resistance to Fluconazole and Echinocandins, Amphotericin B remains the only remaining option, thus creating a shortage of treatment options.
Candidiasis is a fungal infection that can be best treated with antifungal drugs. However, misuse of these drugs should be avoided to prevent antifungal resistance. Also, following adequate precautionary guidelines can help prevent the incidence of candidiasis.
The Candida infection varies from localized infections of the mucous and skin membranes to life-threatening systemic infections. The common symptoms of infection include:
- Skin redness.
- Lumpy white patches.
- Pain, soreness, or discomfort.
- Burning sensation.
- Vaginal discharge.
- Abdominal pain and distension.
- Absent bowel sounds
- Rebound tenderness.
- Localized mass.
Candidiasis infections are of three types, which includes:
- Vaginal Candidiasis.
- Invasive candidiasis.
- Infections of the oral cavity, throat, and esophagus.
Cinically candidasis is classified as:
- Mucosal candidiasis.
- Systemic candidiasis.
- Cutaneous candidiasis.
- Antibiotic candidiasis.
Invasive candidiasis can lead to a high risk of complications with long-term health effects, like endocarditis (inflammation of the heart's inner lining) and endophthalmitis (an infection of the tissues of the eye and intraocular fluids), leading to vision loss.
The candidiasis appearance varies depending on its location of occurrence. Mostly it causes white patches in the oral mouth, redness, crusting or flaking of the skin, and thick, white, orderless vaginal discharge that can look like cottage cheese in the genital area.
The healthcare provider may provide antifungal prophylaxis if an individual is at high risk for developing invasive candidiasis which prevents candidiasis infection. Other preventive measures are:
- Keep the skin clean.
- Check for early infection signs, like redness or pain at the site of the catheter or IV insertion.
- Make sure that anyone who touches you washes their hands first, including healthcare workers.
- Wear loose fitting, cotton underwear.
- Do not douche.
- Control diabetes.
- Take antibiotics only when required.
- Do not wear wet clothes.
There are more than 350 subspecies of Candida. Around 90% of all such infections are caused due to five species, which includes Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei.
Candida cells adhere to the surface of host cell surfaces and trigger the yeast-to-hypha transition, which is then proposed as the second mechanism of invasion, i.e., penetration into host cells by breaking down the barriers. The attachment of yeast cells into host cells aids in the formation of biofilms with yeast cells. In addition, several fitness traits affect fungal pathogenicity.
If Candida is left untreated, it gets into the bloodstream and causes candidemia. Severe candidemia can cause invasive candidemia, which can be life-threatening as it affects internal organs.
Candidiasis is not transmitted from the toilet. They occur when there is a trigger in the vagina's natural bacteria. They cannot be transmitted by casual contact and items like toilet seats, towels, etc.
To detect candidiasis IgG, IgA, and IgM tests are done. When the levels of these antibodies are high, it indicates an overgrowth of Candida.
Candida spp is the most important sexually transmitted fungal infection that affects the semen leading to male infertility and could alter oocyte fertilization.
As most living organisms are active at night, candidiasis is also active at night and affects the sleep of the individual. As the inflammation increases, the cortisol levels and cortisol will wake you awake.
Candidiasis is more common in men as the causative fungus is normally present on the skin, especially if the skin is moist. In addition, other contributing factors, like having sex with a partner with a vaginal yeast infection, can lead to the overgrowth of candida infection.
Last reviewed at:
05 Sep 2022 - 5 min read
Query: Hi doctor, I am a 40 year male. Since last one month, I have been suffering from irritation of foreskin. The skin has become tight and cannot be pulled back. There has been a whitish discharge from the penis and constant irritation. I have tried using Candid B cream but there has been no improvemen... Read Full »
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