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en google: candidiasis and Hardvard university
www.ehendrick.org/healthy/000254.htm
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The
Harvard Guide to Women's Health. Harvard University Press,
1996. ... 1996):
729-734. Tobin, Marla J. "Vulvovaginal candidiasis: Topical vs. ...
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Candidiasis
Definition Definition
Candidiasis is an infection caused by a
species of the yeast Candida, usually Candida albicans. This is
a common cause of vaginal infections in women. Also, Candida may cause
mouth infections in people with reduced immune function, or in patients
taking certain antibiotics. Candida
can be found in virtually all normal people but causes problems in only a fraction.
In recent years, however, several serious categories of candidiasis have
become more common, due to overuse of antibiotics, the rise of AIDS, the increase in organ
transplantations, and the use of invasive devices (catheters, artificial
joints and valves)-all of which increase a patient's susceptibility to
infection. Description
Vaginal
candidiasis Over one million women in the United States
develop vaginal yeast infections each year. It is not life-threatening, but
it can be uncomfortable and frustrating. Oral candidiasis This disorder, also known as thrush, causes
white, curd-like patches in the mouth or throat. Deep organ
candidiasis Also known as invasive candidiasis, deep organ
candidiasis is a serious systemic infection that can affect the esophagus,
heart, blood, liver, spleen, kidneys, eyes, and skin. Like vaginal and oral
candidiasis, it is an opportunistic disease that strikes when a person's
resistance is lowered, often due to another illness. There are many
diagnostic categories of deep organ candidiasis, depending on the tissues
involved. Causes and symptoms
Vaginal
candidiasis Most women with vaginal
candidiasis experience severe vaginal itching. They also have
a discharge that often looks like cottage cheese and has a sweet or
bread-like odor. The vulva and vagina can be red, swollen, and painful.
Sexual intercourse can also be painful. Oral candidiasis Whitish
patches can appear on the tongue, inside of the cheeks, or the palate. Oral
candidiasis typically occurs in people with abnormal immune systems. These
can include people undergoing chemotherapy for cancer, people taking
immunosuppressive drugs to protect transplanted organs, or people with HIV
infection. Deep organ candidiasis Anything
that weakens the body's natural barrier against colonizing
organisms-including stomach surgery, burns, nasogastric tubes, and
catheters-can predispose a person for deep organ candidiasis. Rising numbers
of AIDS patients, organ transplant recipients, and other individuals whose
immune systems are compromised help account for the dramatic increase in deep
organ candidiasis in recent years. Patients with granulocytopenia (deficiency
of white blood cells) are particularly at risk for deep organ candidiasis. Diagnosis
Often clinical appearance gives a strong
suggestion about the diagnosis. Generally, a clinician will take a sample of
the vaginal discharge or swab an area of oral plaque, and then inspect this
material under a microscope. Under the microscope, it is possible to see
characteristic forms of yeasts at various stages in the lifecycle. Fungal blood cultures should be taken for
patients suspected of having deep organ candidiasis. Tissue biopsy may be
needed for a definitive diagnosis. Treatment
Vaginal candidiasis In most cases, vaginal candidiasis can be
treated successfully with a variety of over-the-counter antifungal creams or
suppositories. These include Monistat, Gyne-Lotrimin, and Mycelex. However,
infections often recur. If a women has frequent recurrences, she should
consult her doctor about prescription drugs such as Vagistat-1, Diflucan, and
others. Oral candidiasis This is usually treated with prescription
lozenges or mouthwashes. Some of the most-used prescriptions are nystatin
mouthwashes (Nilstat or Nitrostat) and clotrimazole lozenges. Deep organ candidiasis The recent increase in deep organ candidiasis
has led to the creation of treatment guidelines, including, but not limited
to, the following: Catheters should be removed from patients in whom these
devices are still present. Antifungal chemotherapy should be started to
prevent the spread of the disease. Drugs should be prescribed based on a
patient's specific history and defense status. Alternative treatment
Home remedies for vaginal
candidiasis include vinegar douches or insertion of a paste made from Lactobacillus
acidophilus powder into the vagina. In theory, these remedies will make
the vagina more acidic and therefore less hospitable to the growth of Candida.
Fresh garlic (Allium sativum) is believed to have antifungal action,
so incorporating it into the diet or inserting a gauze-wrapped, peeled garlic
clove into the vagina may be helpful. The insert should be changed twice
daily. Some women report success with these remedies; they should try a
conventional treatment if an alternative remedy isn't effective. Prognosis
Vaginal candidiasis Although most cases of vaginal candidiasis are
cured reliably, these infections can recur. To limit recurrences, women may
need to take a prescription anti-fungal drug such as terconazole (sold as
Terazol) or take other anti-fungal drugs on a preventive basis. Oral candidiasis These infections can also recur, sometimes
because the infecting Candida develops resistance to one drug.
Therefore, a physician may need to prescribe a different drug. Deep organ candidiasis The prognosis depends on the category of
disease as well as on the condition of the patient when the infection
strikes. Patients who are already suffering from a serious underlying disease
are more susceptible to deep organ candidiasis that speads throughout the
body. 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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Candidiasis
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· Symptoms |
What Is It?
Candidiasis is an infection caused
by species of Candida fungi, especially Candida albicans. These
fungi are found almost everywhere in the environment, and some may live
harmlessly along with the abundant "native" species of bacteria that
normally colonize the mouth, gastrointestinal tract and vagina. In these
situations, the overgrowth of Candida is prevented by the presence of
the native bacteria and by the body's immune defenses. If the population of
native bacteria is decreased by antibiotics, or if the patient's immune
defenses are weakened by illness (especially AIDS or diabetes), malnutrition or certain medications
(corticosteroids or anticancer drugs), Candida fungi can multiply enough
to cause symptoms. Candida infections can create occasional symptoms in
healthy people as well. Candidiasis can affect many different parts of
the body, causing either localized infections or overwhelming illness,
depending on the patient and his or her underlying health.
·
Thrush — Thrush is the common name for a mouth infection caused by the Candida
albicans fungus. It affects moist surfaces around the lips, inside the
cheeks and on the tongue and palate. Thrush is common in people with diseases
such as cancer and AIDS, which suppress the immune system. It also can develop
in people with normal immune systems, particularly people who have diabetes or
who have long-lasting irritation from dentures.
·
Esophagitis
— Candida infections of the mouth
can spread to the esophagus, causing esophagitis. This infection is most common
in people with AIDS and people receiving chemotherapy for cancer.
·
Cutaneous (skin) candidiasis — Candida can cause skin infections, including diaper rash, in
areas of skin that receive little ventilation and are unusually moist. Some
common sites include the diaper area; the hands of those who routinely wear
rubber gloves; the rim of skin at the base of the fingernail, especially for
hands that are exposed to moisture; areas around the groin and in the crease of
the buttocks; and the skin folds under large breasts in women. Involvement of
the skin is a Candida infection that can affect people who are in good
health.
·
Vaginal yeast
infections — Vaginal yeast infections are not
usually transmitted sexually. During a lifetime, 75 percent of all women are
likely to have at least one vaginal Candida infection, and up to 45
percent have two or more. Women may be more susceptible to vaginal yeast
infections if they are pregnant or have diabetes. The use of antibiotics, use
of birth-control pills, or frequent douching also can promote yeast infections.
·
Deep candidiasis (for example, candida sepsis) — In deep candidiasis, Candida
fungi contaminate the bloodstream and spread throughout the body, causing
severe infection. This type of candidiasis is especially common in newborns
with very low birth weights and in patients with severely depleted immune
systems or severe medical problems. In these people, Candida fungi may
access the bloodstream through skin catheters, tracheostomy sites, ventilation
tubing or surgical wounds. Deep candidiasis also may occur in healthy people if
Candida fungi enter the blood through intravenous drug abuse, severe
burns or wounds caused by trauma.
Symptoms
Candidiasis produces different
symptoms, depending on the site of infection.
·
Thrush — Thrush causes curdlike white patches inside the mouth, especially on
the tongue and palate and around the lips. If you try to scrape off the whitish
surface of a patch, you will usually find a red, inflamed area, which may bleed
slightly. There may also be cracked, red, moist areas of skin at the corners of
the mouth. Sometimes thrush patches are painful, but often they are not.
·
Esophagitis — Candida esophagitis may make swallowing difficult or painful,
and it may sometimes cause a type of chest pain that centers behind the sternum
(breastbone).
·
Cutaneous candidiasis — Cutaneous candidiasis causes patches of red, moist, weepy skin,
sometimes with small pustules nearby.
·
Vaginal yeast
infections — Vaginal yeast infections may cause the
following symptoms: vaginal itch and/or soreness; a thick cheeselike vaginal
discharge; a burning discomfort around the vaginal opening, especially if urine
contacts the area; and pain or discomfort during sexual intercourse.
·
Deep candidiasis — When Candida spreads to the bloodstream, it may cause a wide
range of symptoms, from unexplained fever to shock and multiple organ failure.
Diagnosis
Your doctor will ask you about your
medical history, including diabetes, cancer, HIV and other chronic illnesses.
He or she also will ask you about your diet and about your recent use of
antibiotics or medications that can suppress the immune system. If your doctor
suspects cutaneous candidiasis, he or she may ask about how you care for your
skin and about conditions that expose your skin to excessive moisture, such as
occlusive clothing or rubber gloves.
Your doctor often can diagnose
thrush, cutaneous candidiasis or vaginal yeast infection by a simple physical
examination. However, if the diagnosis is in question, your doctor may scrape
the surface to obtain cells to examine under the microscope, or might culture a
skin sample to identify fungus or yeast in the sample. If your doctor suspects
that you may be suffering from an undiagnosed medical illness that increases
your risk for candidiasis — such as diabetes, cancer or HIV infection — blood
tests or other types of diagnostic procedures may be necessary.
To diagnose Candida
esophagitis, your doctor will examine your esophagus with an endoscope, a
flexible instrument that is passed into your esophagus to allow direct viewing
of the area. During this examination, called endoscopy, your doctor will take a
sample of tissue (either a biopsy, or a "brushing") from
your esophagus to be examined in the laboratory.
To diagnose deep candidiasis, your
doctor will draw a sample of blood for blood culture — blood samples are
checked in the laboratory for growth of Candida fungi or other
infectious agents.
Expected
Duration
In otherwise healthy people who have
thrush, cutaneous candidiasis or vaginal yeast infections, Candida
infections usually can be eliminated with a short treatment (sometimes a single
dose) of antifungal medication. However, in people with AIDS or other diseases
that weaken the immune system, Candida infections can be difficult to
treat and can recur after treatment is complete. In people with weakened immune
systems, candidiasis can be life-threatening if it passes into the blood and
spreads to vital organs.
Prevention
In general, you can prevent most Candida
infections by keeping your skin clean and dry, by using antibiotics only as
your doctor directs and by following a healthy lifestyle with proper nutrition.
People with diabetes should try to keep their blood sugar under tight control.
If you have HIV or another cause of
recurrent episodes of thrush, antifungal drugs, such as clotrimazole (Lotrimin,
Mycelex) can help to minimize flares.
Treatment
Treatment of candidiasis varies,
depending on the area affected:
·
Thrush — Doctors treat thrush with topical, antifungal medications such as
nystatin and clotrimazole. For mild cases of thrush, a suspension of nystatin
can be swished in the mouth and swallowed, or a clotrimazole lozenge can be
dissolved in the mouth. For more severe cases, ketoconazole (Nizoral) or
fluconazole (Diflucan) can be taken once a day by mouth.
·
Esophagitis — Candida esophagitis is treated with ketoconazole, itraconazole
(Sporanox) or fluconazole (most effective medication in patients with
HIV/AIDS).
·
Cutaneous candidiasis — This skin infection can be effectively treated with a variety of
antifungal powders and creams. The affected area must also be kept clean and
dry and protected from chafing.
· Vaginal yeast infections — Vaginal yeast
infections can be treated with antifungal medications that are administered
directly into the vagina as tablets, creams, ointments or suppositories. These
medications include butoconazole (Femstat), clotrimazole (Gyne-Lotrimin),
miconazole (Monistat 3 and others), nystatin (Mycostatin and others), tioconazole
(Trosyd) and terconazole (Vagistat-1). A single dose of oral fluconazole also
can be used, although this treatment is not recommended during pregnancy. Treatment of sex
partners is not usually necessary.
·
Deep candidiasis — This infection is usually treated with intravenous amphotericin B
(Abelcet) or fluconazole.
When To Call A Professional
Call your doctor whenever you have
symptoms of candidiasis, especially if you have a chronic illness or have
weakened immune defenses caused by cancer, HIV or medications that suppress the
immune system.
Prognosis
Typically, in otherwise healthy
people with superficial candidiasis, a properly treated infection resolves
without leaving permanent damage, and it is unlikely to return as long as the
patient remains healthy and well nourished. In patients with chronic illnesses
or weakened immune systems, episodes of candidiasis may be more resistant to
treatment and may eventually recur when treatment ends. In patients with deep candidiasis,
those who are diagnosed quickly and treated effectively have the best
prognosis, especially if their infection can be stopped before it spreads to
major organs.
Additional Info
Centers
for Disease Control and Prevention (CDC)
1600 Clifton Rd., NE
Atlanta, GA 30333
Phone: (404) 639-3534
Toll-Free: (800) 311-3435
http://www.cdc.gov/
National
Oral Health Information Clearinghouse
NIDCR Public Information & Liaison Branch
45 Center Drive, MSC 6400
Bethesda, MD 20892-6400
Phone: (301) 496-4261
Fax: (301) 907-8830
TTY: (301) 656-7581
E-Mail: nidcrinfo@mail.nih.gov
www.aerie.com/nohicweb
Last
updated August 20, 2003