Candidiasis

Risk: In individuals with weakened immune systems (due to cancer treatments, steroids, transplant recipients, or AIDS) candidal infections can affect the entire body and be life-threatening.

Also at higher risk are individuals who wear dentures, individuals who have a chronic dry mouth caused by atrophy of the saliva glands (xerostomia), and intravenous (IV) drug addicts who use dirty needles. The use of devices such as urinary catheters and IV ports also increases susceptibility.

If a woman is in her third trimester of pregnancy, past menopause, diabetic, or taking antibiotics, birth control pills, or corticosteroid medication, she is more likely to develop a genital yeast infection. Candida yeast can also spread through intimate or sexual contact.

Incidence and Prevalence: Genital candidiasis (vulvovaginitis) is the second most common cause of vaginitis in women. Approximately 75% of women have had at least one episode (Hidalgo). Up to 85% of HIV-infected individuals experience candidiasis of the mouth or throat.

In recent years, the incidence of Candida albicans in the bloodstream (candidemia) has noticeably increased, partly because more individuals are at risk and partly because awareness of the condition has increased (Hidalgo).

History: Symptoms vary based on the location of the infection. Oral thrush causes a white coating to cover the tongue. In the esophagus (esophagitis), candidiasis may cause painful ulcers throughout the gastrointestinal system. If the infection progresses into the intestines, food may be improperly absorbed, and there is a danger of dehydration.

Genital candidiasis in women (vulvovaginitis) results in a white vaginal discharge and swelling, redness, itching, and irritation of the genital area. Symptoms are typically more intense the week preceding the onset of menstrual bleeding. Genital candidiasis in men (balanitis) may produce a discharge from the penis.

Candidiasis in the bloodstream may produce fever and chills, lesions on the trunk, arms, and legs, and changes in mental function or behavior.

Physical exam: Thrush appears as white or yellow curd-like patches in the mouth, usually starting with the tongue or inside the cheeks. When the patches are scraped off, the membranes are raw and bleed. The corners of the mouth may be inflamed. Infection may spread to the rest of the mouth as well as the tonsils, throat, larynx, esophagus, and respiratory system.

Vulvovaginitis is indicated by a white cheese-like vaginal discharge, the presence of pustular lesions in the vaginal area, and redness and swelling. The cervix typically appears normal. In men, the glans penis may be reddish with small blisters or ulcers. In more severe cases, the foreskin may be swollen, causing it to tighten over the penis (phimosis).

Skin infections appear as red, slightly swollen patches that may itch and ooze. Small red blisters may surround the patches. Skin infections are most commonly located in the skin folds, such as the armpits, navel, groin, or buttocks; between the toes and fingers; or beneath the breasts. Candidiasis may also affect the scalp and fingernails.

Fingernail infections start with painful red inflammation that may develop pus, or it may be located beneath the fingernail, causing the fingernail to loosen and expose a noticeably white or yellow color underneath it.

Tests: Discharge from the vagina or penis and scrapings from a thrush-coated tongue or from a superficial skin or nail lesion can be examined under a microscope to identify the yeast. A tissue biopsy of a lesion may also be examined microscopically for Candida. The diagnosis is confirmed by culture of the scrapings or discharge. Blood or tissue cultures are performed to rule out invasive candidiasis. Blood cultures, however, are negative in 50% of individuals with invasive infection (Hidalgo). In these cases, tissue culture is necessary.