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[Candida + -iasis]
Fungal infection with any species of Candida, but chiefly Candida albicans. Candida species are part of the body's normal flora. Candida grows in warm, moist areas, causing superficial infections of the mouth, vagina, nails, and skinfolds in healthy people. In patients with immunodeficiencies, central venous lines, and burns, or those receiving peritoneal dialysis, it can invade the bloodstream, causing disseminated infections.
SYN: SEE: candidosis
CANDIDIASIS ; SEE: normal flora; SEE: thrush
Candida infections are due to a disruption in the composition of normal flora or a change in host defenses. Antibiotic therapy, which destroys the bacteria in normal flora, and inhaled or systemic corticosteroid therapy, which decreases white blood cell activity, are common treatments that may cause candidiasis. Vulvovaginal candidiasis is common during pregnancy, possibly as the result of increased estrogen levels. Infections of the nail beds (paronychia) can occur in those whose hands are frequently in water or who wear occlusive gloves or who are receiving chemotherapy. Elevated glucose levels can be the predisposing factor in patients with diabetes mellitus. Chronic mucocutaneous candidiasis is common in patients with AIDS or other immunosuppressant illnesses. Systemic fungal infections may be present in any organ, including the brain, heart, kidneys, and eyes.
Oral lesions (thrush) are raised, white patches on the mucosa and tongue that can be easily scraped off, revealing an underlying red, irritated surface. Skin lesions are red and macerated, and are usually located in skinfolds of the groin or abdomen and under pendulous breasts. Vaginal infections are characterized by itching and a thick, cheesy discharge. Blurred vision is the first symptom noticed in ocular candidiasis. The symptoms produced in systemic infections depend on the extent of the infection and the organs affected, i.e., whether Candida invades the heart, esophagus, meninges, kidneys, or lungs. Candida septicemia can cause chills, fever, and shock with oliguria leading to renal failure.
Oral candidiasis is treated with a single dose of fluconazole or with clotrimazole lozenges or nystatin oral solution (which must be held in the mouth for several minutes before swallowing) for 14 days. Topical forms of amphotericin B, clotrimazole, econazole, nystatin, or miconazole are effective for skin infections. Echinocandins, azoles, or amphotericin are used to treat patients with bloodstream or deep-seated infections. Pregnant women should consult their health care providers before taking or applying these drugs.
Patients with thrush need explanations about the need to swish nystatin solution in their mouths for several minutes before swallowing to obtain maximum benefit. A nonirritating mouthwash and a soft toothbrush are provided to loosen tenacious secretions without causing irritation. A topical anesthetic helps relieve mouth discomfort, and a soft diet may be helpful. The patient's intake is monitored: mouth pain may interfere with nutritional intake, esp. in those recovering from surgery, trauma, or severe infection. The patient is weighed twice a week to assess nutritional status.
Patients who are obese or incontinent of urine are at special risk for Candida infection, esp. if they are receiving antibiotics. Skin folds should be carefully washed and dried, and antifungal cream or powder applied, usually three to four times a day. When possible, the affected area should be exposed to the air.
Patients with vulvovaginal candidiasis should be reminded not to wear constricting clothing such as panty hose and to wear cotton underwear. If there is pain after intercourse (dyspareunia), the patient is counseled that sexual impairment should resolve as the infection subsides, and to complete the full course of medication as prescribed. Although the sexual partners of infected patients usually will not need treatment, partners of patients with recurrent vaginal infections should be examined and treated if indicated to prevent ongoing reinfections.
Patients with systemic candidiasis require inpatient care for intravenous or intrathecal drug administration, monitoring of laboratory findings, and assessment to identify and manage adverse drug effects and to treat infection extension to other sites and complications. Vital signs are monitored because of the risk of septic shock. Supportive care includes premedication with antipyretics, antihistamines, or corticosteroids to minimize hypersensitivity reactions if the patient is receiving intravenous amphotericin B. Multiple factors affect whether or not immunocompromised patients will develop or die from candidiasis. These include the severity of their underlying illness, nutritional status, history of alcohol abuse, diabetes mellitus, renal or liver failure, illicit drug use, or other comorbid conditions. Immunosuppressed individuals should be encouraged to or reduce risk factors for infection. The patient should be encouraged to eat a nutritious diet, balance activity with rest, reduce stressors, and manage time realistically. All high-risk hospitalized patients, esp. those receiving antibiotic therapies, should be assessed for indications of candidiasis superinfection.