Definition

Candidiasis is a fungal infection caused by Candida species, with Candida albicans being the most common. Normally, Candida species live on the skin and other body parts like the mouth, throat, intestines, and vagina without causing issues. However, Candida can cause infections if it grows uncontrollably or enters the body.

Candidiasis can occur in the urinary tract, genital organs, mouth and surrounding areas, skin, and mucous membranes. In severe cases, the fungus can infect the brain membranes, eyes, heart, abdominal lining, bones, and joints, spreading throughout the body via the bloodstream.

Causes

Candida albicans is a natural inhabitant of our body. It usually doesn't cause problems unless it proliferates excessively.

Candida albicans is the most frequent cause of fungal infections. The species name "albicans" is derived from Latin, meaning "white," as the fungus appears white when cultured. In certain cases, Candida albicans manifests as white patches.

Risk factor

Some risk factors for candidiasis include:

• Women, particularly during pregnancy due to hormonal imbalance, typically in the third trimester
• Obesity, as larger and moist skin folds provide an ideal environment
• Weakened immune systems, such as in patients with diabetes, HIV/AIDS, or those undergoing chemotherapy
• Neutropenia, a reduction in white blood cells, making patients susceptible to infections. Commonly seen in chemotherapy or radiation therapy patients
• Long-term and improper use of antibiotics or corticosteroids
• History of hospitalization
• History of major surgery
• Use of medical devices inserted into the body like intravenous lines, feeding tubes, urinary catheters, or artificial heart valves
• Peritoneal dialysis, which involves blood filtration through an abdominal device
• Wearing dentures
• Wearing tight, synthetic clothing
• Poor hygiene or infrequent changing of underwear, including infrequent diaper changes in babies
• Use of birth control pills or hormone therapy
• Use of vaginal cleansing sprays

Symptoms

Urinary Tract Candidiasis

Mostly asymptomatic. General symptoms include:

• Frequent urination
• Painful or burning sensation during urination
• Abdominal or pelvic pain
• Blood in urine

Genital Candidiasis

Symptoms of genital candidiasis include:

• Burning sensation during intercourse or urination
• Itching or pain in the vagina or penis
• Redness, irritation, or swelling in the vagina or penis
• Abnormal discharge, either thin or thick, and white
• Rash around the vagina or penis

Oral Candidiasis

Common symptoms of oral candidiasis include:

• White spots in the mouth resembling cheese, which may bleed when touched
• Burning or pain in the mouth
• Redness inside or at the corners of the mouth
• Difficulty eating or swallowing
• Loss of taste
• Feeling of cotton in the mouth

Mucocutaneous Candidiasis

The most common symptom is a red rash. In some cases, blisters may also appear. The skin may thicken or produce a cheese-like substance.

Candidemia

Candidemia is a Candida infection in the bloodstream. Symptoms can mimic bacterial bloodstream infections, including:

• Fever
• Kidney failure
• Shock or severe drop in blood pressure due to impaired blood flow

Endophthalmitis Candidiasis

This condition can affect one or both eyes. The main symptom is eye inflammation, which can extend to the surrounding tissues.

Endocarditis Candidiasis

Endocarditis is a heart infection. Symptoms include:

• Fever
• Cough
• Difficulty breathing
• Overall body pain, sometimes in the lower limbs

Meningitis Candidiasis

Candida can infect the brain membranes, called meninges. Symptoms include:

• Headache
• Stiff neck
• Fever
• Nausea and vomiting
• Sensitivity to light
• Confusion

Intra-abdominal Candidiasis

Symptoms resemble bacterial peritonitis, including:

• Abdominal pain or bloating
• Fever
• Nausea and vomiting
• Fatigue
• Diarrhea
• Reduced appetite

Osteomyelitis and Arthritis Candidiasis

Candida infections can affect bones and joints. Symptoms include pain or swelling in the affected area, possibly accompanied by fever and limited joint movement.

Diagnosis

To diagnose candidiasis, the doctor will inquire about your medical history and symptoms. They will also ask about your immune status and recent antibiotic use.

Candidiasis is generally diagnosed through a physical examination. If the diagnosis remains uncertain, a sample from the affected area will be taken and cultured to identify the causative organism.

For suspected candidemia, a blood sample is collected. In endophthalmitis, diagnosis involves a retinal examination and analysis of eye fluid samples. Suspected meningitis requires spinal and brain fluid samples for culture. Intraabdominal candidiasis is diagnosed via abdominal fluid examination. Diagnosing fungal endocarditis is challenging due to symptoms resembling bacterial endocarditis.

Management

Common Candida infections, such as vaginal and skin infections, are localized and can be treated with antifungal medications. Untreated Candida infections can lead to systemic infections or spread to other organs.

Urinary Tract Candidiasis

Treatment is recommended only for symptomatic patients. Antifungal medication such as fluconazole is prescribed. If using a catheter, it must be removed.

Genital Candidiasis

Mild or moderate infections can be treated with over-the-counter or prescription antifungal creams or pills.

Oral Candidiasis

Oral candidiasis is treated with antifungal pills, liquids, or tablets such as nystatin or clotrimazole. Oral fluconazole may be prescribed for more severe cases.

Mucocutaneous Candidiasis

Antifungal creams like clotrimazole, miconazole, and econazole are used for skin infections. The skin should remain dry during treatment. For extensive infections, oral fluconazole may be prescribed.

Candidemia

Treatment depends on the Candida species causing the infection. Generally, it includes intravenous fluconazole, caspofungin, micafungin, or amphotericin B. Catheters should also be removed.

Endophthalmitis

Treatment may involve amphotericin B with flucytosine or fluconazole.

Meningitis

The recommended treatment is amphotericin B with flucytosine.

Intraabdominal Candidiasis

Treatment includes antifungal medications such as fluconazole, amphotericin B, caspofungin, or micafungin. Catheters should be removed.

Osteomyelitis

Treatment involves antifungals like amphotericin B and fluconazole.

Endocarditis

Treatment involves intravenous fluconazole or amphotericin B, removal of infected medical devices, or surgical removal of fungi from heart tissues.

Complications

Pregnant women are more susceptible to vaginal candidiasis, which can lead to systemic infections in the fetus, low birth weight, or premature birth.

Intertrigo, an inflammation of skin folds caused by Candida, manifests as painful and itchy rashes, affecting the quality of life. Risk factors include obesity, diabetes mellitus, and weakened immune conditions. Candida intertrigo is typically treated with nystatin cream and azole antifungals.

Untreated Candida infections can cause systemic infections, spreading to other organs and leading to sepsis.

Intestinal candidiasis can result from oral antibiotic therapy. Bronchopulmonary candidiasis is a rare complication of pre-existing lung disease. Septicemia, endocarditis, and meningitis are terminal complications in patients with immune disorders and leukemia. Systemic candidiasis in leukemia patients appears as prolonged neutropenia.

Prevention

Early detection prevents symptom worsening and complications. Other prevention measures include:

• Low-sugar diet, as fungi thrive on sugar and starch
• Maintain an ideal weight. Overweight or obese individuals have larger, moist skin folds conducive to fungal growth
• Manage diabetes. High blood sugar in diabetic patients promotes fungal growth, increasing infection risk. Control blood sugar with regular checkups, medication, and a diabetic diet
• Wear sweat-absorbing clothing. Fungi thrive in warm, moist environments. Wear loose, sweat-absorbing clothes and change out of wet clothes promptly after exercise
• Avoid scented genital products that can irritate the delicate genital skin. Gently and thoroughly dry the genital area after bathing
• Avoid douching, as it kills beneficial bacteria that control fungi
• Clean the vagina front to back to prevent spreading fungi from the anus to the vagina
• Change pads or tampons frequently
• Use protection during sex with someone with genital candidiasis. Both partners need treatment if both show infection symptoms to break the transmission cycle
• Consume probiotics. Good bacteria help control fungi
• Use antibiotics as prescribed
• Avoid hot baths or soaking

When to see a doctor? 

If you experience candidiasis symptoms, consult a doctor for diagnosis and appropriate treatment. The doctor will also rule out other possible infection causes. Follow up if the infection does not respond to treatment.

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