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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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Diagnose vaginitis by exam, not by phone: symptoms are often misleading, and relatively few women can accurately self-diagnose candidiasis
From OB/GYN News, 4/15/05 by Jane Salodof MacNeil

HOUSTON -- Telephone consultations for vaginitis often result in misdiagnosis, Dale Brown Jr., M.D., warned at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

"Patients think it is a drag to come in to be evaluated, and many health care professionals think it is a drag to have to treat vaginitis all the time," said Dr. Brown, chairman of clinical affairs in the obstetrics and gynecology department at Baylor.

Nonetheless, thorough office examinations are necessary, even for what appear to be repeated fungal infections, according to Dr. Brown. He maintained that symptoms are often misleading, and studies have found relatively few women can accurately self-diagnose vulvovaginal candidiasis.

"Patients are spending a lot of money over the counter and then they have to come in to be treated again. They don't know what they are treating," Dr. Brown said, contending that availability of over-the-counter antifungal treatments for candidiasis has not lived up to expectations of reduced health care costs. Instead, he said, many women are seeking a physician's help only after trying two or three different medications that did not relieve their symptoms.

Candida albicans was confirmed in only 33% of cases for which over-the-counter medications were purchased in one report cited by Dr. Brown (J. Fam. Pract. 1996;42:595-600).

He noted that women with a history of diagnosed fungal infections were even more likely to misdiagnose a repeat infection.

In another study at a vaginitis referral center, he said only 28% of cases of candidiasis were clinically confirmed (Obstet. Gynecol. 1997;90:50-3).

A third investigation cited by Dr. Brown involved the collection of vaginal swabs every 4 months from 1,248 women. He said the study, presented at a meeting of the Infectious Diseases Society for Obstetrics and Gynecology in 2002, found 24% of women who were never colonized by yeast used antifungal drugs at least once.

At least half the women who are diagnosed with candidiasis actually have another condition, according to Dr. Brown. Although frequently suspected, candidiasis accounts for only 20%-25% of vaginitis; bacteria are responsible for 40%-50% of cases and trichomoniasis for 15%-20%.

Dr. Brown urged consideration of other noninfectious causes and less common infections. He gave a long list of possible diagnoses that included atrophic vaginitis, a foreign body, allergic hypersensitivity and contact dermatitis, trauma, desquamative inflammatory vaginitis, erosive lichen planus, lactobacilli vaginosis, cytolytic vaginosis, streptococcal group A infection, ulcerative vaginitis with Staphylococcus aureus, and idiopathic ulceration associated with human immunodeficiency virus.

When examining women for vaginitis, physicians should have patients use a magnifying glass to identify the exact location of the itch.

He recommended collecting a specimen from the lateral midsection of the vagina and looking for systemic diseases that can present as a vulvovaginal symptom. He singled out erythrasma and tinea cruris as two conditions that can be mistaken for candidiasis.

"Most common vaginitis is not hard to treat, but too often we make a diagnosis that is not the correct diagnosis and we get failure of our treatment," he said.

ARTICLES BY JANE SALODOF MACNEIL

Contributing Writer

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group

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