Candidiasis or Candida Infections

Last Updated on October 29, 2023

Candidiasis or candida infection can occur in many forms.

Thrush or Oral Candidiasis

oral-candidiasis-tongue — Credit: Wikipedia/James Heilman

Infection of the oral cavity with Candida albicans produces a curdy white deposit associated with redness and burning sensation in localized areas of the oral mucosa. It is common in infants, extremely debilitated individuals or those being treated with immunosuppressive drugs.

Candidal infection can also get super-imposed on the ulcers of the oral cavity produced by other diseases such as pemphigus, lichen planus etc.

Vulvovaginitis

Candidal infection of the vaginal cavity commonly occurs in adult females and produces a clinical picture resembling thrush. It is usually associated with a curdy vaginal discharge and may be accompanied by severe pruritus (itching) in the vulva.

Balanoposthitis

Balanoposthitis is an infection of the glans penis and preputial skin. Candidiasis of the glans penis may manifest as a large localized area of superficial ulceration, while candidiasis of the prepuce produces erythema and maceration of the preputial skin.

The preputial opening may become narrowed and develop fissures when an attempt is made to withdraw the skin.

This is generally acquired from an infected female during sexual intercourse and the female partner may be completely asymptomatic. Thus, treatment of the female partner in addition to that of the patient is very essential.

Diabetic individuals are also more prone to this disease.

Treatment

Gentian violet as a one percent aqueous solution or medicine containing nystatin or hamycin alone or in combination with corticosteroids is a very effective anti-candida drug. The recently introduced anti-fungal agents, miconazole, econazole and clotrimazole, and others are also very good anti-candida agents and are particularly useful in cases having a mixed infection.

Local applications of any of these agents, twice a day as rule, bring about quick relief.

The treatment in all cases should be continued for at least one week after clinical cure, to prevent recurrences. Any of the predisposing factors should be eradicated.

The oral anti-fungal drugs are effective against candida as well in cases having severe, generalized or intractable infections.

In vulvovaginitis, the patient should be advised to insert pessaries containing nystatin, miconazole or clotrimazole into the vagina once or twice a day for a week or so, in addition to the local applications of anti-candida drugs.

Treatment of the sexual partner at the same time is also essential to prevent relapses.

Cutaneous Candidiasis

Cutaneous candidiasis is mostly caused by Candida albicans. Commonly referred to as a yeast infection, it is also technically known as candidosis, moniliasis, and oidiomycosis

Found as a commensal on the skin, the vagina, the mouth and the gastrointestinal tract of many healthy individuals, under certain favorable conditions, candida albicans can become pathogenic and produce disease.

Certain factors increase the predisposition to develop candidiasis

Heat and humidity
Immune deficiency
Diabetes mellitus
Pregnancy
Prolonged oral treatment with tetracyclines
oral contraceptives
Corticosteroids or immunosuppressive drugs

Intertrigo

This occurs mainly in the adults and manifests as localized areas of erythema and maceration associated with itching and burning sensation. It occurs chiefly in a fold of skin such as groins, interdigital spaces of the toes or fingers, under the breasts and less commonly other skin folds.

The margins of the lesions are generally not well demarcated and often have satellite lesions beyond the periphery of the main lesion.

Interdigital intertrigo caused by candida cannot be clinically differentiated from tinea interdigitale.

Chronic Paronychia

This occurs in the adults only and manifests as an asymptomatic, erythematous swelling of the posterior nail fold of one or more fingers. The nail fold gets separated from the nail plate which develops irregularities in its thickness caused by inflammation of the nail matrix. Nail matrix is not invaded as such.

It may also be possible to express out a bead of pus from underneath the nail fold and the area may be tender.

This is commonly seen in professions involving excessive exposure of the fingers to trauma, alkalis and maceration and also in patients having diabetes mellitus.

Angular stomatitis

Some patients develop proliferative and fissured lesions at the angles of the mouth resembling those seen in vitamin B complex deficiency.

Treatment of Cutaneous Candidiasis

Local applications of any of these agents, twice a day as rule, bring about quick relief.

In paronychia, it is necessary to insert the medicine under the nail fold and protect the hands from trauma, maceration and excessive use of alkalis. It is necessary to continue the treatment until the swelling of the nail fold has disappeared and the cuticle of the nail fold has rejoined the nail plate, and this may take several months.

The treatment in all cases should be continued for at least one week after clinical cure, to prevent recurrences. Any of the predisposing factors should be eradicated.

The oral anti-fungal drugs are effective against candida as well in cases having severe, generalized or intractable infections.

Generalized Cutaneous Candidiasis

Occasionally, the lesions of candidiasis may spread on to the entire body producing multiple ill-defined erythematous and scaly macules, but even in these cases, there is always a tendency for greater involvement of the skin folds.

This type of candidiasis usually occurs in very severely ill patients, particularly those having uncontrolled diabetes or those who are on treatment with immunosuppressive drugs.

The diagnosis in each case can be confirmed by demonstrating the candida from the scrapings or the discharge. The scrapings should be taken in the same manner as for dermatophytosis, and mounted in 10 percent KOH solution.

The organism can be identified as clusters of spherical spores and elongated tube-like structures called pseudo-hyphae which somewhat resemble the hyphae of dermatophytes. The actual causative agent can be identified by culture on Sabouraud’s medium, but the growth can be obtained within 24 hours.