What Is It?

Candidiasis is an infection caused by species of Candida fungi, especially Candida albicans. These fungi are found almost everywhere in the environment, and some may live harmlessly along with the abundant “native” species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina. In these situations, the overgrowth of Candida is prevented by the presence of the native bacteria and by the body’s immune defenses. If the population of native bacteria is decreased by antibiotics, or if the patient’s immune defenses are weakened by illness (especially AIDS or diabetes), malnutrition or certain medications (corticosteroids or anticancer drugs), Candida fungi can multiply enough to cause symptoms. Candida infections can create occasional symptoms in healthy people as well. Candidiasis can affect many different parts of the body, causing either localized infections or overwhelming illness, depending on the patient and his or her underlying health.

• Thrush — Thrush is the common name for a mouth infection caused by the Candida albicans fungus. It affects moist surfaces around the lips, inside the cheeks and on the tongue and palate. Thrush is common in people with diseases such as cancer and AIDS, which suppress the immune system. It also can develop in people with normal immune systems, particularly people who have diabetes or who have long-lasting irritation from dentures.



• Esophagitis — Candida infections of the mouth can spread to the esophagus, causing esophagitis. This infection is most common in people with AIDS and people receiving chemotherapy for cancer.



• Cutaneous (skin) candidiasis — Candida can cause skin infections, including diaper rash, in areas of skin that receive little ventilation and are unusually moist. Some common sites include the diaper area; the hands of those who routinely wear rubber gloves; the rim of skin at the base of the fingernail, especially for hands that are exposed to moisture; areas around the groin and in the crease of the buttocks; and the skin folds under large breasts in women. Involvement of the skin is a Candida infection that can affect people who are in good health.



• Vaginal yeast infections — Vaginal yeast infections are not usually transmitted sexually. During a lifetime, 75 percent of all women are likely to have at least one vaginal Candida infection, and up to 45 percent have two or more. Women may be more susceptible to vaginal yeast infections if they are pregnant or have diabetes. The use of antibiotics, use of birth-control pills, or frequent douching also can promote yeast infections.



• Deep candidiasis (for example, candida sepsis) — In deep candidiasis, Candida fungi contaminate the bloodstream and spread throughout the body, causing severe infection. This type of candidiasis is especially common in newborns with very low birth weights and in patients with severely depleted immune systems or severe medical problems. In these people, Candida fungi may access the bloodstream through skin catheters, tracheostomy sites, ventilation tubing or surgical wounds. Deep candidiasis also may occur in healthy people if Candida fungi enter the blood through intravenous drug abuse, severe burns or wounds caused by trauma.

Candidiasis produces different symptoms, depending on the site of infection.

• Thrush — Thrush causes curdlike white patches inside the mouth, especially on the tongue and palate and around the lips. If you try to scrape off the whitish surface of a patch, you will usually find a red, inflamed area, which may bleed slightly. There may also be cracked, red, moist areas of skin at the corners of the mouth. Sometimes thrush patches are painful, but often they are not.



• Esophagitis — Candida esophagitis may make swallowing difficult or painful, and it may sometimes cause a type of chest pain that centers behind the sternum (breastbone).



• Cutaneous candidiasis — Cutaneous candidiasis causes patches of red, moist, weepy skin, sometimes with small pustules nearby.



• Vaginal yeast infections — Vaginal yeast infections may cause the following symptoms: vaginal itch and/or soreness; a thick cheeselike vaginal discharge; a burning discomfort around the vaginal opening, especially if urine contacts the area; and pain or discomfort during sexual intercourse.



• Deep candidiasis — When Candida spreads to the bloodstream, it may cause a wide range of symptoms, from unexplained fever to shock and multiple organ failure.

Your doctor will ask you about your medical history, including diabetes, cancer, HIV and other chronic illnesses. He or she also will ask you about your diet and about your recent use of antibiotics or medications that can suppress the immune system. If your doctor suspects cutaneous candidiasis, he or she may ask about how you care for your skin and about conditions that expose your skin to excessive moisture, such as occlusive clothing or rubber gloves.

Your doctor often can diagnose thrush, cutaneous candidiasis or vaginal yeast infection by a simple physical examination. However, if the diagnosis is in question, your doctor may scrape the surface to obtain cells to examine under the microscope, or might culture a skin sample to identify fungus or yeast in the sample. If your doctor suspects that you may be suffering from an undiagnosed medical illness that increases your risk for candidiasis — such as diabetes, cancer or HIV infection — blood tests or other types of diagnostic procedures may be necessary.

To diagnose Candida esophagitis, your doctor will examine your esophagus with an endoscope, a flexible instrument that is passed into your esophagus to allow direct viewing of the area. During this examination, called endoscopy, your doctor will take a sample of tissue (either a biopsy, or a “brushing”) from your esophagus to be examined in the laboratory.

To diagnose deep candidiasis, your doctor will draw a sample of blood for blood culture — blood samples are checked in the laboratory for growth of Candida fungi or other infectious agents.

In otherwise healthy people who have thrush, cutaneous candidiasis or vaginal yeast infections, Candida infections usually can be eliminated with a short treatment (sometimes a single dose) of antifungal medication. However, in people with AIDS or other diseases that weaken the immune system, Candida infections can be difficult to treat and can recur after treatment is complete. In people with weakened immune systems, candidiasis can be life-threatening if it passes into the blood and spreads to vital organs.

In general, you can prevent most Candida infections by keeping your skin clean and dry, by using antibiotics only as your doctor directs and by following a healthy lifestyle with proper nutrition. People with diabetes should try to keep their blood sugar under tight control.

If you have HIV or another cause of recurrent episodes of thrush, antifungal drugs, such as clotrimazole (Lotrimin, Mycelex) can help to minimize flares.

Treatment of candidiasis varies, depending on the area affected:

• Thrush — Doctors treat thrush with topical, antifungal medications such as nystatin and clotrimazole. For mild cases of thrush, a suspension of nystatin can be swished in the mouth and swallowed, or a clotrimazole lozenge can be dissolved in the mouth. For more severe cases, ketoconazole (Nizoral) or fluconazole (Diflucan) can be taken once a day by mouth.



• Esophagitis — Candida esophagitis is treated with ketoconazole, itraconazole (Sporanox) or fluconazole (most effective medication in patients with HIV/AIDS).



• Cutaneous candidiasis — This skin infection can be effectively treated with a variety of antifungal powders and creams. The affected area must also be kept clean and dry and protected from chafing.



• Vaginal yeast infections — Vaginal yeast infections can be treated with antifungal medications that are administered directly into the vagina as tablets, creams, ointments or suppositories. These medications include butoconazole (Femstat), clotrimazole (Gyne-Lotrimin), miconazole (Monistat 3 and others), nystatin (Mycostatin and others), tioconazole (Trosyd) and terconazole (Vagistat-1). A single dose of oral fluconazole also can be used, although this treatment is not recommended during pregnancy. Treatment of sex partners is not usually necessary.



• Deep candidiasis — This infection is usually treated with intravenous amphotericin B (Abelcet) or fluconazole.

Call your doctor whenever you have symptoms of candidiasis, especially if you have a chronic illness or have weakened immune defenses caused by cancer, HIV or medications that suppress the immune system.

Typically, in otherwise healthy people with superficial candidiasis, a properly treated infection resolves without leaving permanent damage, and it is unlikely to return as long as the patient remains healthy and well nourished. In patients with chronic illnesses or weakened immune systems, episodes of candidiasis may be more resistant to treatment and may eventually recur when treatment ends. In patients with deep candidiasis, those who are diagnosed quickly and treated effectively have the best prognosis, especially if their infection can be stopped before it spreads to major organs.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.