Candidiasis or Candidiasis

Content

Introduction

Candidiasis or candidiasis is an "infection caused by a fungus belonging to the saccharomyces family, candida albicans, present everywhere in the environment and able to reproduce (replicate) giving rise to colonies (Video).

Normally, it does not cause significant disturbances (symptoms) affecting the colonized mucous membranes (mouth, terminal portion of the intestine and genital mucosa) as it is adequately controlled by the body's defense system (immune system) and by the presence of "harmless" bacteria (lactobacilli).

In conditions that lead to an alteration of the micro-environment such as, for example, prolonged antibiotic or corticosteroid therapy, the inadequate use of intimate detergents, stressful situations or metabolic alterations (diabetes mellitus), candida can grow uncontrollably, forming whitish, itchy streaks in the mouth (so-called thrush), vagina (vaginal candidiasis), glans (very rarely) or intestinal tract.

In severe forms of weakening of the body's defense system (immunodeficiency), including AIDS, or severe malnutrition, candida can spread to the esophagus, stomach, intestines and other organs (generalized mucocutaneous candidiasis ).

Candidiasis, therefore, can range from local mucosal infections to generalized (systemic) and invasive infections, extremely serious in people with weak (immunocompromised) immune defenses.

Invasive candidiasis is a major cause of mortality in people who have severe white blood cell deficiencies (neutropenias) or advanced cancers.

In particular, generalized candidiasis with candidemia ranks 4th as an infectious complication in serious blood diseases (haematological diseases), with a mortality rate greater than 50%.

In this context, it is often difficult to ascertain the disease at an early stage (early diagnosis) as in many cases the infection does not cause specific disturbances (symptoms) and blood tests (blood cultures) are frequently negative.

Since the evolution of candidiasis (prognosis) can be unfavorable in the advanced stages of infection, an antifungal treatment undertaken as soon as possible (early) can be decisive.

Symptoms

Candida infection generally manifests itself with the appearance of obvious, whitish and itchy streaks, at the level of the affected mucosa (Video).

Infection of the vulvo-vaginal and glans can also cause urinary burning and pain during sexual intercourse.

Candidiasis of the mouth (oral cavity), also called "thrush", can affect the tongue, the hard and soft palate and the tonsillar arch.

In the most serious cases, the involvement of the mucosa of the esophagus causes pain and difficulty in swallowing, while in the gastrointestinal level, disorders (symptoms) typical of gastritis (heartburn, sense of fullness and contraction of the stomach) and entero-colitis may appear. (bloating, painful spasms of the intestinal wall and diarrhea).

In the case of generalized mucocutaneous candidiasis with candidemia, moderate or high fever and a marked state of weakness (prostration) may also be present.

The symptoms (symptoms) caused by the infection can last several days or weeks and, if not properly treated, tend to persist for a long time, particularly in people with weakened immune defenses (immunosuppressed).

Causes

Candida is present everywhere in the environment and normally lives on the skin and mucous membranes of the body.

In particular conditions that lead to an alteration of the microenvironment of the mucous membranes such as, for example, prolonged antibiotic therapy, the inadequate use of intimate cleansers, stressful situations or metabolic alterations (diabetes mellitus), candida can develop and cause disorders.

This can also occur in cases of weakness in the body's defense system (immunodeficiency) caused by malnutrition, chronic diseases, including cancers, viral infections such as HIV / AIDS, measles and flu.

Candida can be transmitted by deep kissing or sexual intercourse unprotected by the male (condom) or female (femidom) condom but does not necessarily give rise to an infection that causes disturbances (symptoms).

If the infection occurs in the genital organs, it is still advisable to limit sexual intercourse (to avoid aggravating the symptoms) and use a condom to avoid the transmission of the fungus to the partner.

Diagnosis

In the presence of disorders (symptoms) or local lesions that suggest candidiasis, it is necessary to undergo a check-up visit to the general practitioner or specialist doctor (dermatologist, gynecologist) who will ascertain (diagnosis) the disease by observing the affected areas, identifying the fungus under a light microscope or by means of a cultural examination carried out by taking some material with a swab.

The identification of candida with the optical microscope is carried out by direct observation of the suspect material.

The exam culture from swab instead, it consists in taking the material to be analyzed with a swab, sowing it in special media containing substances suitable for developing candida and, after a few days, checking if the spores and colonies have grown.

The assessment of invasive candidiasis is based on the disorders detected by the doctor during the visit (clinical evidence), on instrumental tests such as, for example, gastroscopy and colposcopy, and on the search for the fungus in the blood by verifying its possible growth in the laboratory (blood culture).

Since blood cultures are frequently negative, it is important to carry out analyzes (tests) for the research of fungus proteins (candida antigens) and molecular tests for the research of genetic material (DNA) in blood samples at the same time.

Therapy

Once ascertained (diagnosed), candida infection can be treated with specific anti-fungal drugs (imidazoles, nystatin, cyclopyroxolamine, amphotericin B) for a period ranging from a few days to several weeks.

Depending on the severity and distribution of the lesions, the drugs can be taken by mouth (orally) or for local use by applying creams, vaginal pessaries / candles, medicated solutions or gels.

Intensive care by injection (injection), preferably to be carried out in hospital, may be necessary in the most severe cases, when the infection affects multiple organs (generalized mucocutaneous candidiasis) or if candidemia is present.

In the case of involvement of the sexual organs, the treatment can also be administered preventively to the sexual partner.

Prevention

Candida, in general, is present (colonizes) on the mucous membranes of the body and lives in equilibrium with other microorganisms, such as lactobacilli, which normally live there.

To prevent local infection, therefore, it is necessary to favor hygienic habits and personal cleaning products that do not modify or damage the local microenvironment and do not break the existing balance that prevents the development of the disease.

It is equally important to follow a healthy lifestyle, limiting smoking and alcoholic beverages and reducing the opportunities for psycho-physical stress that negatively affect the body's defense system (immune system).

The weakened state of the body's defense system (immunodeficiency), which can occur in persistent (chronic) diseases, including cancers, or in human immunodeficiency virus (HIV) infection, can be adequately combated by careful and timely assumption of the treatment prescribed by the doctor for such diseases.

In addition, to avoid getting sick, it is advisable to use a male (condom) or female (femidom) condom in sexual relations with people who do not know each other or when there are signs that suggest an infection in the genital organs.

Complications

In the absence of treatment, the alterations and disorders (symptoms) caused by the candida infection tend to persist for a long time in the affected mucous membranes, causing a state of chronic inflammation that can create significant damage in the infected parts and extend to the surrounding areas.

In addition, if there is a weakened state of the body's defense system (immunodeficiency) caused by a persistent (chronic) disease or human immunodeficiency virus (HIV), the infection can spread throughout the body, resulting in to severe generalized mucocutaneous candidiasis with candidemia (genralized candidiasis).

Living with

Candida infection requires the administration of treatments prescribed by the doctor and verification of the disappearance of alterations and disorders.

In case of involvement of the genital organs, it is advisable to limit sexual activity, in order not to aggravate the disorders and to use condoms, male or female, to avoid the transmission of the candida fungus.

If the infection, local or generalized, is associated with a severe weakened state of the immune system caused by a chronic disease or by the human immunodeficiency virus (HIV) it is essential to control the evolution of the disease by carefully observing the doctor's instructions. caring.

Severe forms of generalized candidiasis require hospitalization for the immediate administration of adequate care aimed at avoiding life-threatening complications.

Bibliography

United Against AIDS (ISS). HIV and other sexually transmitted infections

In-depth link

Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review [Summary]. European Journal of Internal Medicine. 2016, 34 (October): 21-28

Millsop JW, Fazel N. Oral candidiasis [Summary]. Clinics in Dermatology. 2016, 34: 487-94

Peter G et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2016, 62: e1 – e50

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