Candidiasis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Candidiasis, also known as a yeast infection or thrush, is a fungal infection caused by Candida species, most commonly Candida albicans. It can affect various parts of the body, including the mouth, throat, genitals, and skin.

Aetiology

Candidiasis is caused by overgrowth of Candida species, which are normally present in small amounts on the skin and mucous membranes. The overgrowth can be triggered by various factors, including:

• Antibiotic use
• Immunosuppression
• Diabetes
• Hormonal changes (e.g., pregnancy, contraceptive use)
• Poor oral hygiene

Pathophysiology

The pathophysiology of candidiasis involves disruption of the normal microbial balance on the skin and mucous membranes, allowing Candida to overgrow. The fungus adheres to epithelial cells, invades tissues, and triggers an inflammatory response, leading to the symptoms of infection.

Risk Factors

• Antibiotic or corticosteroid use
• Immunosuppressive conditions (e.g., HIV/AIDS, cancer)
• Diabetes mellitus
• Pregnancy
• Oral contraceptive use
• Poor hygiene
• Warm, moist environments

Signs and Symptoms

The signs and symptoms of candidiasis vary depending on the site of infection:

• Oral Candidiasis (Thrush): White patches on the tongue, inner cheeks, roof of the mouth, and throat; redness and soreness; difficulty swallowing.
• Genital Candidiasis: Itching, redness, and swelling of the genital area; thick, white discharge; discomfort during intercourse or urination.
• Cutaneous Candidiasis: Red, itchy rash with scaling; commonly affects skin folds, such as under the breasts, in the groin, and between the fingers.

Investigations

Specific investigations to diagnose candidiasis include:

• Microscopic examination: Scraping from the affected area examined under a microscope.
• Culture: Swabs or samples from the affected area cultured to identify Candida species.
• Blood tests: In cases of systemic candidiasis a blood cultures can be performed.

Management

Primary Care Management

• Topical antifungals: Clotrimazole, miconazole, or nystatin creams or ointments for cutaneous and genital candidiasis.
• Oral antifungals: Fluconazole or itraconazole for oral and severe candidiasis.
• Good hygiene practices: Keeping the affected area clean and dry, wearing loose-fitting clothing.
• Addressing underlying risk factors: Managing diabetes, avoiding unnecessary antibiotic use.

Specialist Management

• Systemic antifungals: For invasive or systemic candidiasis, intravenous antifungals like amphotericin B or echinocandins (e.g., caspofungin).
• Referral to a specialist: For persistent or recurrent infections, or in immunocompromised patients, referral to an infectious disease specialist may be necessary.

References

1. NHS (2024) Oral thrush in adults. Available at: https://www.nhs.uk/conditions/oral-thrush-adults/ (Accessed: 24 June 2024).
2. British Association of Dermatologists (2024) Candidiasis. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=171&itemtype=document (Accessed: 24 June 2024).
3. Mayo Clinic (2024) Candidiasis. Available at: https://www.mayoclinic.org/diseases-conditions/candidiasis/symptoms-causes/syc-20351665 (Accessed: 24 June 2024).
4. Centers for Disease Control and Prevention (2024) Candidiasis. Available at: https://www.cdc.gov/fungal/diseases/candidiasis/index.html (Accessed: 24 June 2024).

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