Thrush

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Oral thrush Aphthae Candida albicans

Candidiasis

Candidiasis (Yeast Infection or Thrush)

• Candidiasis, frequently referred to as yeast infection or thrush, is a fungal infection brought about by the Candida species. Among these, Candida albicans is perhaps the most prevalent.

Locations

Candidiasis primarily manifests in specific areas, especially in immunocompetent individuals. These areas are generally exposed and moist, such as:

• The oral cavity (oral thrush)
• The vagina (termed as vaginal candidiasis or simply thrush)
• Skin folds in the diaper region (diaper rash)

For men, candidiasis can also appear on the male genitals, especially among uncircumcised individuals. Among its presentations, candidiasis ranks as the second predominant cause of vaginal irritation or vaginitis. In immunocompromised individuals, the Candida infection can extend to the esophagus and even become systemic, leading to a critical condition known as fungemia.

Notably, children aged between 3 and 9 years may experience recurrent oral yeast infections, though these are rare. Typically, this manifests as white patches around the mouth.

Causes

The yeast organisms responsible for candidiasis exist naturally in all humans but are generally held in check by other naturally occurring microorganisms. A shift in this balance can lead to an "overgrowth" or unregulated multiplication of yeast, resulting in noticeable symptoms.

A vast majority of women—around three-quarters—will experience candidiasis at some point in their lives. Although Candida albicans is a natural resident of most women's vaginas and usually doesn't cause any issue, certain conditions can disturb the balance with other "normal flora", such as lactobacilli. Factors like pregnancy, the use of oral contraceptives, certain antibiotics, and conditions like diabetes mellitus can elevate the risk of yeast infections.

Symptoms

Candidiasis symptoms encompass severe itching, burning, soreness, and irritation in the vagina and/or vulva. A distinctive whitish or whitish-gray discharge might also be present, which may emanate a "yeasty" odor akin to beer or baking bread. This discharge, termed garria, can resemble the consistency of cottage cheese.

A notable concern is the frequent misdiagnosis of candidiasis. Many women, misconceiving their symptoms, erroneously treat themselves for yeast infections when, in reality, they might be dealing with bacterial vaginosis or a mixed-type infection. Current methodologies require a physician to diagnose bacterial vaginosis.

Diagnosis

Diagnosing candidiasis involves a KOH (potassium hydroxide) preparation. In this method, a sample from the affected area is placed on a microscope slide and treated with a 10% KOH solution. This solution dissolves skin cells, leaving only the Candida visible under a microscope.

Swab and culture is another diagnostic method where a sterile swab is used to collect a sample from the infection. This sample is cultured, and after a few days of incubation, yeast and/or bacterial colonies are observed, aiding in a presumptive diagnosis.

Treatment

While some individuals report success with home remedies for treating candidiasis, severe infections usually necessitate over the counter or prescription antifungal medications. Home remedies include applying or consuming yogurt (rich in yeast-killing lactobacillus), acidophilus salves or tablets, and even crushed garlic for its antifungal property allicin. Boric acid and bicarbonate of soda are other potential home treatments.

However, it's crucial for individuals to recognize the severity of their infection. Often, the best course of action is to consult a medical professional. Commonly prescribed antifungal drugs include clotrimazole, nystatin, fluconazole, and ketoconazole. For more acute cases, drugs like amphotericin B, caspofungin, or voriconazole may be prescribed.

Furthermore, any underlying causes should be identified and addressed. For instance, oral candidiasis might be linked to inhaled corticosteroids used in asthma medication. Persistent yeast infections might hint at other concerns like high sugar intake or extended antibiotic treatments.

Prevention

Ensuring optimal vulvovaginal health can be instrumental in preventing vaginal candidiasis. Proactive steps can include utilizing vaginal suppositories or medicated douches.

External Links

• InteliHealth page on candidiasis - Reviewed by Harvard Medical School
• National Institute of Allergies and Infections fact sheet on vaginitis/vaginal infections
• The yeast infection homepage
• Links to pictures of Yeast Infection (Hardin MD/Univ of Iowa)

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