Candidiasis (Yeast Infection)

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Yeast Infection Overview

Candidiasis is an infection caused by a group of microscopic fungi or yeast. There are more than 20 species of Candida, the most common being Candida albicans. These fungi live on all surfaces of our bodies. Under certain conditions, they can become so numerous they cause infections, particularly in warm and moist areas. Examples of such infections are vaginal yeast infections, thrush, skin and diaper rash, and nailbed infections.

• Candidal infections commonly occur in warm moist body areas, such as underarms. Usually your skin effectively blocks yeast, but any breakdown or cuts in the skin may allow this organism to penetrate.

• Typical affected areas in babies include the mouth and diaper areas.

• In adults, oral yeast infections become more common with increased age. Adults also can have yeast infections around dentures, under the breast and lower abdomen, nailbeds, and beneath other skin folds. Most of these candidal infections are superficial and clear up easily with treatment.

• Rarely, the yeast infection may spread throughout the body. In systemic candidal disease, up to 75% of people may die. Even common mouth and vaginal yeast infections can cause critical illness and can be more resistant to normal treatment.

• Yeast infections that return may be a sign of more serious diseases such as diabetes, leukemia, or AIDS.

Yeast Infection Causes

• In women, yeast infections are the second most common reason for vaginal burning, itching, and discharge. Yeasts are found in the vagina of most women and can overgrow if the environment in the vagina changes. Antibiotic and steroid use is the most common reason for yeast overgrowth. But pregnancy, menstruation, sperm, diabetes, and birth control pills also can contribute to getting a yeast infection. Yeast infections are more common after menopause.

• In people who have a weakened immune system because of cancer treatments, steroids, or diseases such as AIDS, candidal infections can occur throughout the entire body and can be life-threatening. The blood, brain, eye, kidney, and heart are most frequently affected, but the candidal fungus also can grow in the lungs, liver, and spleen. Candida is the leading cause of esophagitis (inflammation in the throat) in people with AIDS.

• Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida. These infections enter into the bloodstream through breakdowns or cuts in the skin or mucous membranes. Candidal organisms may build up in an area because of frequent use of strong antibiotics, which kill the bacteria that normally keep it under control.

• Use of devices implanted in the skin such as urinary catheters and IV ports also provide access for the yeast to enter the body. IV drug addicts using dirty needles may inject the yeast directly into their bloodstream or deep tissues.

Yeast Infection Symptoms and Signs

Signs and symptoms of a candidal infection can vary depending on the location of the infection.

• In women, signs and symptoms of a vaginal yeast infection are a white cheesy discharge that typically itches and irritates the vagina and surrounding outer tissues. On occasion there may be pain with sexual intercourse or burning with urination.
  
  
• In infants and adults, a candidal infection can appear many different ways.
  
  
  • Oral candidiasis is called thrush. Thick, white lacy patches on top of a red base can form on the tongue, palate, or elsewhere inside the mouth. These patches sometimes look like milk curds but cannot be wiped away as easily as milk can. If the white plaques are wiped away with a blade or cotton-tipped applicator, the underlying tissue may bleed. This infection also may make the tongue look red without the white coating. Thrush can be painful and make it difficult to eat. Care should be given to make sure a person with thrush does not become dehydrated.
    
    
  • Candidal organisms naturally live on the skin, but breakdown of the outer layers of skin promote the yeast's overgrowth. This typically occurs when the environment is warm and moist such as in diaper areas and skin folds. Superficial candidal skin infections appear as a red flat rash with sharp scalloped edges. There are usually smaller patches of similar appearing rash nearby, known as "satellite lesions." These rashes may cause itching or pain.

• In people with weakened immune systems, candidal infections can affect various internal organs and cause pain or dysfunction of the organ. Approximately 85% of people with AIDS contract a yeast infection called esophagitis in their upper gastrointestinal (GI) systems. This infection is similar to thrush but extends down the mouth and esophagus to the stomach. Candida esophagitis can cause painful ulcers throughout the GI system, making it too painful to swallow even liquids. If the infection spreads into the intestines, food may be poorly absorbed. People with this condition are in danger of becoming dehydrated.

• If Candida gets into your bloodstream, you may become sick with or without fever. If the infection spreads to your brain, you may have acute changes in mental function or behavior.

When to Seek Medical Care

When to call the doctor

For healthy children and adults, if you try a medication and it fails or symptoms worsen, then consult your doctor. All people with weakened immune systems should contact their doctors with any new symptoms or infections.

• Various conditions can cause nonmenstrual vaginal discharge in women, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis.
  
  
  • If vaginal discharge lasts for more than 1 week, consult your doctor.
    
    
  • If yeast infections recur, see your doctor for a more thorough work-up. Candidiasis that comes back may be a symptom of a hidden disease such as diabetes, leukemia, or AIDS.
    
    
  • Other symptoms such as bloody discharge, abdominal pain, fever, and increased urination also can indicate more serious problems, and you should seek medical help.
  
  
• Oral thrush needs a prescription medication and a quick visit to the doctor. If children take no fluids for longer than 12 hours, contact your doctor for possible IV fluid replacement. Any fever or prolonged problems with feeding also warrant a visit to a doctor.
  
  
• Diaper rash or other candidal infections on the skin can be treated with over-the-counterantifungal creams and lotions.
  
  nystatin powders (Mycostatin, Nilstat, Nystat-Rx, Nystex, O-V Staticin) or
  • If the rash worsens at any time, or if the lesions do not clear in 1-2 weeks, call your doctor.
    
    
  • Fever, chills, nausea, vomiting, or the rash spreading to other parts of your body may be a sign of a more serious illness.
  
  
• People with weakened immune systems must take all forms of candidiasis seriously and treat them aggressively. The infection may indicate that your immune system is functioning poorly. Your doctor should evaluate any symptoms of candidal infections.
  
  
  • If you already are being treated for a candidal infection and the symptoms worsen or do not improve, notify your doctor.
    
    
  • Fevers, chills, vomiting, general illness, or worsening rash needs to be investigated promptly.

When to go to the hospital

Most cases of candidiasis do not have to be treated in the hospital. People with weakened immune systems may have more serious infections, however, and may need to be hospitalized.

• Women should go to the hospital when fever, chills, nausea and vomiting, or abdominal pain accompanies vaginal discharge. These symptoms can indicate a more serious problem such as kidney infections, appendicitis, or pelvic inflammatory disease. These potential conditions need to be investigated promptly.

• If thrush interferes with drinking liquids or eating for long periods of time, people may need to be hospitalized for more aggressive medications and reestablishing body fluids.

• Candidal skin infections rarely require hospital treatment.

• People with weak immune systems run the risk of the candidal organisms growing in their blood or internal organs, which can cause life-threatening illness. IV medication may be necessary to combat this systemic illness. Your doctor should promptly investigate symptoms of illness or general malaise.

Exams and Tests

For healthy people, most physicians can diagnose a candidal infection without laboratory tests. Occasionally, if the infection won't go away or involves the entire body, more extensive tests may need to be performed.

• The only definitive way to diagnose a vaginal yeast infection is to complete a full gynecologic exam.
  
  
  • This exam includes a speculum exam, using a specialized instrument to hold open your vagina. The exam can be uncomfortable because of pressure against the tissues. The doctor will take a swab of the discharge and may obtain other cultures to rule out other diseases. The swab for yeast will be mixed with a drop of potassium hydroxide and will be placed on a slide. If yeast are present, a specific branching pattern will be seen through the microscope.
    
    
  • The doctor then may insert 2 fingers into your vagina and gently press on your uterus, ovaries, and surrounding areas to check for any tenderness or other problems. The doctor also may take blood and urine specimens after this exam. You should not douche or have sexual intercourse 1-2 days before the exam, because doing so may make the diagnosis more difficult.
  
  
• In healthy children and adults, a quick exam in the mouth or of the skin usually confirms the diagnosis of candidiasis. If there is any confusion about the diagnosis, the doctor may obtain a small scraping of the area, which will be placed on a slide with potassium hydroxide and examined for a branching pattern consistent with yeast.
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• In people with weakened immune systems, oral, vaginal, and skin candidal infections usually can be diagnosed by sight. When you become sick, the doctor may perform more invasive tests to confirm the diagnosis. Specimen collection may be necessary to check for Candida in the blood and urinary tracts. People with catheters may have their catheters changed and the catheter tips sent for culture. If a CT scan or MRI indicates candidiasis of the brain, doctors may take a biopsy to distinguish between Candida and other diseases. Usually doctors give IV antibiotics for serious systemic infections.

Yeast Infection Treatment

Self-Care at Home

Most candidal infections can be treated at home with over-the-counter or prescription medication and can clear within a week. But if some other disease has weakened your immune system, consult your doctor for any new symptoms before attempting self-treatment. You may risk getting an infection.

• Yeast infections
  
  
  • Most women can treat yeast infections at home with over-the-counter medications:
    
    
    • Miconazole (Monistat-Derm, Monistat Vaginal)
      
      
    • Tioconazole (Vagistat Vaginal)
      
      
    • Butoconazole (Femstat)
      
      
    • Clotrimazole (Femizole-7, Gyne-Lotrimin)
    
    
  • Massage these remedies into your vagina and surrounding tissues for 1-7 days depending on the formulation. If increased irritation occurs to the area, discontinue the medication immediately.
    
    
  • If you are pregnant, consult your doctor before using these treatments.
    
    
  • If symptoms continue for more than 1 week, consult your doctor.

• Thrush
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  • In thrush, swish the antifungal agent nystatin around in your mouth. Take care to maintain excellent oral hygiene.
    
    
  • All objects put into a child's mouth should be sterilized after each use.
    
    
  • Breastfeeding mothers should be evaluated for Candida of the breast.
    
    
  • If you wear dentures, clean them thoroughly after each use and practice good oral hygiene.
    
    
  • Adults have several treatment options not available to babies, such as troches (antifungal lozenges) or pills such as fluconazole (Diflucan), to help clear the infection in addition to nystatin.

• Skin and diaper rash
  
  
  • Clotrimazole creams and lotions can be applied to superficial skin infections. Other medications need a prescription and a visit to your doctor.
    
    
  • The affected area should be kept clean and dry.
    
    
  • For diaper rashes, frequent diaper changes and the use of barrier creams will speed recovery.

• If your immune system is weak, your doctor may handle minimal local infections with home care. More serious infections may need IV medications given at the hospital.

Medical Treatment

A wide array of treatment options is available to treat candidiasis. Options include creams, lotions, pills, troches (lozenges), and vaginal suppositories. Talk to your doctor to find the option that is right for you.

• Azole medications are a family of antifungal drugs that end in the suffix "-azole." They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast die. Fortunately, ergosterol is not a component of human membranes, and azoles do not harm human cells.

• Polyene antifungals include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast-wall that causes the yeast to leak and die.