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Candidiasis

Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is probably the most common. more...

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Locations

In immunocompetent people, candidiasis can usually only be found in exposed and moist parts of the body, such as:

  • the oral cavity (oral thrush)
  • the vagina (vaginal candidiasis or thrush)
  • folds of skin in the diaper area (diaper rash)
  • the most common cause of vaginal irritation or vaginitis
  • can also occur on the male genitals, particularly in uncircumcised men.

In immunocompromised patients, the Candida infection can become systemic, causing a much more serious condition, fungemia.

Causes

Yeast organisms are always present in all people, but are usually prevented from "overgrowth" (uncontrolled multiplication resulting in symptoms) by naturally occurring microorganisms.

At least three quarters of all women will experience candidiasis at some point in their lives. The Candida albicans organism is found in the vaginas of almost all women and normally causes no problems. However, when it gets out of balance with the other "normal flora," such as lactobacilli (which can also be harmed by using douches), an overgrowth and symptoms can result. Pregnancy, the use of oral contraceptives and some antibiotics, and diabetes mellitus increase the risk of infection.

Symptoms

The most common symptoms are itching and irritation of the vagina and/or vulva. A whitish or whitish-gray discharge may be present, sometimes resembling cottage cheese, and may have a "yeasty" smell like beer or baking bread.

Diagnosis

KOH (potassium hydroxide) preparation can be diagnostic. A scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% solution of KOH is then placed on the slide. The KOH dissolves the skin cells but leaves the Candida untouched. When viewed under a microscope the hyphae and pseudo spores of Candida are visible. Their presence in large numbers strongly suggest a yeast infection.

Swab and culture is performed by rubbing a sterile swab on the infected skin surface. The swab is then rubbed across a culture medium. The medium is incubated for several days, during which time colonies of yeast and or bacteria develop. The characteristics of the colonies provide a presumptive diagnosis of the organism.

Treatment

Candidiasis is alleged to be successfully treated either with home remedies or, in the case of a more severe infection, with either over the counter or prescription antifungal medications. Home remedies for candidiasis include the consumption or direct application of yogurt, which contains lactobacillus ("friendly" bacteria that kill yeast), acidophilus tablets or salves, and even lightly crushed cloves of garlic, which yield allicin, an antifungal. Boric acid has also been used to treat yeast infections when gelcaps are filled with boric acid powder and two are inserted at bedtime for three to four nights.

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Increased systemic candidiasis in ICU patients with prolonged antifungal treatment of candiduria
From CHEST, 10/1/05 by Matthew P. Chambers

PURPOSE: The incidence of candiduria in ICU patients and risk factors associated with its development have been described; However, links with developing systemic candidiasis following candiduria are lacking. This study identifies incidence and predictive factors for systemic candidiasis in ICU patients with candiduria.

METHODS: Patients admitted to a University-affiliated teaching hospital ICU from Jan-Dec 2004 were evaluated. All patients with their first candiduria isolate in the ICU were included, Patients with candiduria < 48h from admission were excluded. Twelve variables (Table 1) were evaluated by univariate analysis. Variables with p<0.1 were entered into a logistic regression model for identification of independent predictors of systemic candiasis. Mortality and fungal species isolated (both urine and systemic) were also examined.

RESULTS: Of 89 patients screened, 82 met criteria. 21 (25.6%) patients developed systemic candidiasis subsequent to candiduria. Patients were similar with respect to age, prior antibiotic and antifungal exposure, prior positive bacterial and fungal cultures, blood and steroid exposure, and glucose and serum creatinine (Table 1). Mortality was higher in the systemic candidiasis group (42.9% versus 27.9%, p=0.2), but not statistically different. Patients with systemic candidiasis were more likely to be male (63% versus 37%; p=0.08), have a longer duration of initial candiduria treatment (7.4 versus 4.5 days; p=0.004), and a higher incidence of recurrent candiduria (61.9% versus 32.3%; p=0.02) compared to those with candiduria only. Logistic regression analysis identified duration of treatment as an independent predictor of systemic candidiasis (Table 2). Although 80% of urine isolates were not speciated, 49% of systemic infections were C. albicans with 28% being C. glabrata.

CONCLUSION: Systemic candidiasis occurs frequently in ICU patients following candiduria. Patients receiving a longer duration of antifungal therapy for candiduria were at highest risk with males and those with recurrent candiduria having a trend for increased risk. Over one fourth of systemic infections were C. glabrata.

CLINICAL IMPLICATIONS: Strategies should be investigated to identify or prevent systemic infection following candiduria including shortening candiduria antifungal treatment duration.

DISCLOSURE: Matthew Chambers, None.

Matthew P. Chambers PharmD * David A. Kuhl PharmD G. C. Wood PharmD Bradley A. Boucher PharmD Amado X. Freire MD The Regional Medical Center at Memphis, Memphis, TN

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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