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Last updated:
May 18, 2009
Years published: 1987, 1990, 1996, 1998, 2002, 2009
Candida Albicans is a normally harmless yeast infection found in the mouth, intestinal tract, and vagina. Candidiasis is an infection caused by a fungus called Candida; most commonly the Candida albicans variety. The Candida infection (also known as a yeast infection) usually affects the skin and/or the mucous membranes of the mouth, intestines, or the vagina. Candida infections are rarely serious in otherwise healthy people. In rare cases, it may spread through other parts of the body if the patient’s immune system is not functioning properly. In the most severe cases it can affect the blood, the membrane lining the heart muscle (endocardium), or membranes around the brain (meninges).
A very wide range of symptoms can be caused by the Candida infection, from the mildest and more common forms that usually affect the mouth and vagina, to the most rare and severe forms which may affect the heart or brain:
DISORDER SUBDIVISIONS
1) Candidiasis of the Skin (Cutaneous Candidiasis or Cutaneous Moniliasis). Superficial skin infection is a common location for this fungal infection. The lesions appear as well-circumscribed, red, sometimes itchy patches of varying sizes and shapes. The lesions are usually rimmed with small, red-based pustules and they commonly appear in folds of the skin; i.e., the underarms, under the breasts, the navel, groin or the folds of the buttocks (e.g. diaper rash), or the webbing between the toes and the fingers. Crusts may form on the scalp, possibly causing hair loss. The infection may spread to the face, fingertips or the trunk. When the area around the anus is involved, the infection is called Perianal Candidiasis.
2) Vulvovaginitis or Vaginitis caused by Candida. Pregnant women or women with diabetes are especially prone to this common fungal infection. It usually first appears as a thick white or yellow vaginal discharge (leukorrhea) with itching and redness of the female genitalia (vagina and vulva).
3) Penis, infected by Candida. Infection of the tip of the penis (Glans Penis) with Candida bacteria is less common than Candidal Vaginitis. This infection may be seen in men whose sexual partners have Candidal Vulvovaginitis and in men with Diabetes Mellitus.
4) Oral Candidiasis (Thrush). This form of Candidiasis affects the mouth. It usually first appears as creamy white patches or sores on the tongue or mucous membranes of the mouth. When the corners of the mouth are red (inflamed), eroded and cracked because of a Candida infection, the condition is called Perleche.
5) Candida infection around the nails (Candidal Paronichia). This form of the disorder may begin as a painful swelling that later develops pus. The infections may occur under the nails (subungual) possibly causing loss of fingernails or toenails.
6) Chronic Mucocutaneous Candidiasis (Candida Granuloma). This is a rare and severe form of Candidiasis, characterized by chronic infection of the skin, nails, scalp, and mucous membranes. This type of Candidiasis usually develops during infancy. It is characterized by red, pustular, crusted and thickened lesions, especially on the nose and forehead.
7) Systemic Candidiasis. This is the most serious Candida infection. It affects many parts of the body and is usually caused by an immune deficiency. Inflammation of the membrane lining the heart (endocarditis), the membrane lining the skull (meningitis), or rarely inflammation of the bone (osteomyelitis) may also occur.
Candidiasis is caused by a normally harmless infection with the yeast fungus of the genus Candida, usually Candida albicans (Monilia albicans). The yeast is supposed to be present in healthy people. However, the fungus may multiply in the mouth or the bowels when a patient receives chemotherapy or broad spectrum antibiotics which suppress the bacterial flora which are normally present in the body. Other health conditions such as pregnancy or diabetes mellitus may also make the patient prone to a Candida infection.
Chronic Candidiasis usually affects people who are debilitated by predisposing health conditions such as diabetes mellitus, pregnancy or immune deficiencies. Newborn babies may also be affected with the disorder through maternal infection.
Since Candida Albicans is supposed to be present in healthy people, treatment is very rarely needed. The American Academy of Allergy and Immunology has stated that the concept of yeast allergy or Candidiasis hypersensitivity is speculative and unproven. Health foods and vitamins are not effective treatments.
If the patient is taking a broad spectrum antibiotic, it is helpful to stop treatment so that the usual bacterial flora of the mucous membranes is restored. If possible, treatment with corticosteroids and immunosuppressive drugs should also be stopped. Patients who are particularly prone to Candidiasis infections (e.g., diabetics) should particularly try to avoid taking the types of drugs that encourage growth of fungus.
Treatment of Skin or Vaginal Candidiasis with local applications of nystatin, clotrimazole, or miconazole may be effective in many cases. To treat inflammation and itching simultaneously, antifungal and corticosteroid creams may be used together.
To prevent and treat Candidiasis of the mouth, good oral hygiene is imperative, especially by denture wearers. To treat acute pulpar alveolar cellulitis (an infection of the connective tissue lining the root canal), removal of decayed and foreign matter from the mucous surfaces, rinsing with warm salt water or baking soda solution can be helpful. Medications applied through the root canal have also proven to be effective in some cases.
Vaginal Candidiasis – Treatment of the vaginal discharge and itching in this type of infection consists of administering specific antifungal drugs. Proper hygiene habits and control of diabetes when applicable can help to avoid repeated infections in women who are particularly prone to this infection.
To prevent Candida infection of the Vagina or Penis from spreading when one sexual partner is infected, nystatin may be prescribed to both partners.
For candidal diaper rash, the skin should be kept dry by changing diapers frequently. Use of petroleum jelly and talcum powder should be avoided. In severe cases, plastic pants and plastic disposable diaper coverings should not be used. Certain creams and ointments may be prescribed by a physician.
For treatment of Chronic Mucocutaneous Candidiasis, amphotericin B, nystatin, clotrimazole, miconizole or 5-fluorocytosine are useful drugs. Antifungal and immune system-stimulating substances (such as the molecule that can transfer immunity from a sensitized to a non-sensitized individual) called transfer factor, thymosin, thymus epithelial cell transplantation, and levamisol, are also used in treatment. (For more information on these disorders, choose "immunodeficiency" as your search term in the Rare Disease Database.)
A new drug for the treatment of Candidiasis, Cryptococcal Meningitis, and other persons with weakened immune systems such as AIDS patients has recently been approved by the FDA. The drug diflucan (fluconazole) has been found effective against these types of infections in persons with weakened immune systems.
The drug amphotericin B lipid complex (Abelcet) has received an orphan drug designation for the treatment of Candidiasis. More studies are needed to determine the long-term safety and effectiveness of this drug for the treatment of Candidiasis. For more information, contact:
The Liposome Company, Inc.
One Research Way
Princeton. N. 08540
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
In 2002, the drug, Mycograb, was granted orphan status by the U.S. Food and Drug Administration (FDA). Mycograb is manufactured by NeuTec Pharma plc, of Manchester, United Kingdom. Phase II trials have been conducted at 38 hospitals in Europe and the U.S. Further testing is needed to determine the safety and effectiveness of Mycogab. For information, go to www.NueTecpharma.com.
ARTICLE
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Denning DW, et al. Efficacy and safety of voriconazole in the treatment of acute invasive aspergillos. Clin Infect Dis. 2002;34:563-71.
Granier F. Invasive fungal infections. Epidomiology and new therapies. Presse Med. 2000;29:2051-56.
Gibbs DL, et al. Fluconazole in the treatment of systemic candidiasis: an open-label, noncomparative, multinational study. Current Therapeutic Research. 1998;59:197-202.
A nontreatment for a nondisease. Consumer Reports Health Letter (April 1990).
Kirkpatrick CH. Host factors in defense against fungal infections. Am J Med. 1984;77:1-12.
Budtz-Jorgensen E. Clinical aspects of candida infection in denture wearers. J Amer Dental Assoc. 1978;96:474-79.
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