Candidiasis

What is Candidiasis?

o             Candidiasis is a result of a fungal infection that occurs when there is an
         overgrowth of fungus called Candida

o             Candidiasis is also known as a “yeast infection”

o             Candida is found on skin or mucous membranes

o             Candida is always present in the body in small amounts

o             However, when an imbalance occurs the organism can multiply.

o             It also can cause problems if it enters the bloodstream and spreads

         throughout the body

o             There are 3 classifications of Candidiasis

1. Oropharyngeal Candidiasis, Esophageal Candidiasis (OPC)

What is OPC?

            OPC is candidiasis of the mouth and throat.  If the environment inside the mouth
or throat becomes imbalanced the Candida will multiple.  Candida overgrowth can also
develop in the esophagus, and is called Candida esophagitis, or esophageal candidiasis.

What is most at risk for OPC?

• Normal newborns
• People with dentures
• People who use inhaled corticosteroids (used for symptoms of asthma)
• It occurs more frequently in persons with weakened immune systems i.e.
• People with AIDS
• People undergoing cancer treatment
• In healthy individuals this condition is unusual

How do I get OPC?

            Most cases of OPC are caused by a person’s own Candida organisms which 
normally live in the mouth or digestive tract.  When an overgrowth of the organism occurs the
onset of symptoms generally follow.

What are the symptoms of OPC?

• Some people with an OPC infections have white patches in the mouth that are usually
  painless
• Others may have redness and soreness inside the mouth
• Cracking of the corners of the mouth may occur
• Symptoms of Candida esophagitis may in clued pain and difficult swallowing
• There are other conditions that can cause similar symptoms so it is important to see
  Dr. Cleaver to avoid other complications

How will Dr. Cleaver diagnose OPC?

            OPC is usually diagnosed based on the clinical appearance of the mouth and by
taking a scraping of the white patched and looking at if under a microscope.  Because
the Candida organism is a normal inhabitant of the human body a culture of the mouth alone
is not enough to make a diagnosis.

How can I treat OPC?

• Prescription treatments include clotramazole lozenges and nystatatin suspension
  (“swish and swallow”)
• Oral fluconazole which works by killing the fungus or yeast, or preventing its growth
• If the infection does not respond to these treatments there are a number of other
  antifungal drugs that are available through Dr. Cleaver

Is there anything else I should know?

• If you do not seek treatment the symptoms may persist making you uncomfortable and
  in rare cases invasive candidiasis may occur
• OPC and Candida esophagitis can become resistant to antifungal treatment over time
  so it is important to see Dr. Cleaver for an evaluation if you thing you have OPC or Candida esophagitis

2. Genital/ Volvovaginal Candidiasis (VVC)

What is genital candidiasis/VCC?

• VCC is candidiasis of the vaginal most commonly known by many women as a
  yeast infection
• When the normal acidity of the vagina changes or when the hormonal balance changes
  the Candida can multiply
• In rare cases, Candida can be passed from person to person, such as through sexual
  intercourse
• There are some conditions that may predispose a woman to genital candidiasis:

o       Pregnancy

o       Diabetes mellitus

o       Use of broad- spectrum antibiotics

o       Use of corticosteroid medications

What are the symptoms of genital candidiasis/VCC?

• Women with VVC usually experience genital itching or burning
• A “cottage cheese-like” vaginal discharge may occur as well
• Males with genital candidiasis may experience an itchy rash on the penis

How is genital candidiasis/VVC diagnosed?

• The symptoms of genital candidiasis are similar to those of many other genital infections
• Usually the diagnosis is made by taking a sample of the vaginal secretions and
  looking at it under a microscope to see if Candida organisms are present

How is genital candidiasis/VVC treated?

• There are several antifungal drugs available to treat genital candidiasis/VVC, most
  commonly used are vaginal suppositorities and creams ranging from a single dose
  to 7 day doses.
• Uncomplicated VVC may also be treated with single-dose or oral fluconazole
  (this should be avoided in pregnancy).
• Short course treatment should be avoided in recurrent or resistant infections

Are the over-the-counter (OTC) treatments available?

• Over- the- counter treatments (OTC) are available
• Because of OTC drugs more women are diagnosing themselves with VVC and
  using one of many family drugs called “axoles” for therapy
• However, the risk of misdiagnosis is common and 2/3 of all OTC drugs to treat
  VVC were used by women without the disease.
• Using drugs when they are not needed may lead to a resistant infection, which
  are very difficult to treat with the currently available medications for VVC
• To be safe if you think you have genital candidiasis/VVC talk to Dr. Cleaver about the
  treatment that is best for you

Is there anything else I should know?

• If you do not seek treatment your symptoms may persist which can be very uncomfortable. 
  There is also a risk that you can pass the infection between sex partners
• Because VVC and urinary tract infections share similar symptoms, such as burning
  sensations while urinating, it is important to see Dr. Cleaver and obtain laboratory
  testing to get a correct diagnosis and treat it effectively
• Nearly 75% of all adult women have had at least one genital “yeast infection” in their lifetime
• Men may also experience genital candidiasis but it is rare
• VCC occurs more frequently and more severely in people with a weakened immune system. 

3. Invasive Candidiasis (VVC)

What is invasive candidiasis?

• Invasive candidiasis is a fungal infection that occurs when the Candida organism enters the
  blood, causing a bloodstream infection and then spreading throughout the body
• Invasive candidiasis is extremely rare in persons without risk factors
• In people at risk for invasive candidiasis, an infection may result when the person’s own
  Candida organisms, normally found in the digestive tract, enter the bloodstream
• In rare occasions an infection can occur when medical equipment or devices become
  contaminated with Candida
• In either case, the infection may spread throughout the body

How common is invasive candidiasis?

• One form of invasive candidiasis, candidemia is the fourth most common bloodstream
  infection among hospitalized patients in the United States.
• People at high risk for candidemia are:
• Very low birth weight babies
• Surgical patients
• Hospitalized patients with a central venous catheter
• People with a weakened immune system

What are the symptoms of invasive candidiasis?

• The symptoms of invasive candidiasis are not specific
• Fever and chills that do not improve after antibiotic therapy are the most common
  symptoms
• If the infection spreads to deep organs such as kidneys, liver, bones, muscles, joints,
  spleen, or eyes, additional specific symptoms may develop.  These symptoms will vary
  depending on the site of infection
• If the infection does not respond to treatment, the patient can suffer organ failure an death

How is invasive candidiasis diagnosed?

• Invasive candidiasis is usually diagnosed by either culture of blood or tissue or by
  examining samples of infected tissue under the microscope

How is invasive candidiasis treated?

• There are a number of antifungal drugs available to treat invasive candidiasis
• Fluconazole can be taken by mouth or given intravenously (IV)
• Echinocandins are also commonly used to treat invasive candidiasis there are
  3 different types all of which are given through an IV
• All of these are effective in treating invasive candidiasis

All information gathered from http://www.cdc.gov/nczved/dfbmd/disease_listing/candidiasis_gi.html#11