PABUSTAN, NIKKI ANN M.

CANDIDIASIS COMMON NAME: Thrush or Moniliasis ETIOLOGY

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Candida albicans (sometimes referred to as monilia) is a fungus that is normally present on the skin and in mucous membranes such as the vagina, mouth, or rectum. The fungus also can travel through the blood stream and affect the throat, intestines, and heart valves.

EPIDEMIOLOGY NEWBORN. Oral thrush is quite common in young babies because normal microbiota is not yet established. HAVING DIABETES. People who have diabetes and have high blood sugar levels are more likely to get thrush in the mouth (oral thrush), because the extra sugar in your saliva acts like food for Candida. OBESE. More moist skin tends to become infected with fungus. COURSE OF ANTIBIOTICS. Too much use of broad-spectrum antibiotics suppresses normal microbiota which leads to opportunistic fungal infections. Antibiotics will kill harmless bacteria which live in the mouth. They do not kill Candida spp. which may multiply more easily if there are fewer bacteria around. IMMUNOSUPPRESSED INDIVIDUALS. Includes AIDS patients, cancer patients. Wearing dentures, especially if they are not taken out at night, not kept clean, or do not fit well and rub on the gums. Taking steroid tablets or inhalers. Having a dry mouth due to a lack of saliva. This may occur as a side-effect from certain drugs (such as antidepressants, antipsychotics, chemotherapy), following radiotherapy to the head or neck Having severe anemia. Lacking iron, folate or vitamin B12. Having a poor immune system. For example, if you are taking medicines that suppress your immune system, if you have certain cancers, or if you have HIV/AIDS. Being frail or in generally poor health. Smoking. Smokers are more likely to develop oral thrush. Excessive use of antibacterial mouthwash

MODE OF TRANSMISSION Direct Contact Endogenous spread (part of normal human flora); by contact with excretions of mouth, skin, and feces from patients or carriers; from mother to infant during childbirth; disseminated candidiasis may originate from mucosal lesions, unsterile narcotic injections, catheters INCUBATION PERIOD: variable; usually 2 to 5 days

PATHOGENESIS Mycosis of superficial layers of skin or mucous membranes (oral thrush, vulvovaginitis, paronychia, onychomycosis, intertrigo); ulcers or pseudomembranes in esophagus, gastrointestinal tract or bladder; hematogenous dissemination may produce lesions in kidney, spleen, lung, liver, prosthetic cardiac valve, eye, meninges, brain MICROBIAL ANTAGONISM
Normal Microbiota in the Mucous Membranes (Genitourinary or Mouth) Suppress Normal Bacterial Microbiota in GU or Mouth Antibiotic kills harmless bacteria and not fungi like Candida spp.

Intake of Antibiotics

Candida sp. becomes DOMINANT

Balance between the 2 or more normal microbial species is UPSET

Fewer normal BACTERIAL microbiota, overgrowth of Candida sp.

PATHOPHYSIOLOGY
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VULVOVAGI NAL CANDIDIASI S

SYMPTOMS: Itchiness, red, swollen, painful curd-like vaginal discharge

1 Disruption of a colonized surface (skin or mucosa)

4 increased permeability (swelling)

2 allowing the organisms access to the bloodstream

3 vasodilation causing redness

MANIFESTATIONS (SIGNS and SYMPTOMS) Oral candidiasis This disorder, also known as thrush, causes white, curd-like patches in the mouth or throat. Whitish patches can appear on the tongue, inside of the cheeks, or the palate. Oral candidiasis typically occurs in people with abnormal immune systems. These can include people undergoing chemotherapy for cancer, people taking immunosuppressive drugs to protect transplanted organs, or people with HIV infection. Vulvovaginal candidiasis Most women with vaginal candidiasis experience severe vaginal itching. They also have a white thick discharge that often looks like cottage cheese and has a sweet or bread-like odor. The vulva and vagina can be red, swollen, and painful. Sexual intercourse can also be painful. PATHOGNOMIC SIGN >Curd-like patches or white thick discharge TYPE ORAL CANDIDIASIS MEDICAL TREATMENT Topical Applications: Miconazole, Clotrimazole or nystatin Gentian violet or amphotericin B NURSING INTERVENTIONS Provide a nonirritating mouthwash to loosen tenacious secretions Use soft toothbrush to avoid irritation. Demonstrate comprehensive oral hygiene practices, and have the patient perform a return demonstration. Newborn. It is easy to mistake thrush for milk or formula. It looks like cottage cheese or milk curds. Don't try to wipe away these patches, because you can make them red and sore. Some babies with thrush can be cranky and do not want to eat. PREVENTION Mouth care: Brush your teeth, gums, and tongue after you eat and before you go to sleep. If you wear dentures, leave your dentures out overnight, or for at least six hours daily. Constant wearing of dentures, and not taking them out at night, is thought to be one of the most common causes of oral thrush. If you have diabetes - good control of your blood sugar level reduces the risk of thrush and other infections. Maintain normal vaginal flora so that the Candida are not given the opportunity to multiply Wash regularly and dry the skin carefully afterwards. Overweight people should be careful to dry all skin folds. Avoid using other people's towels.

VULVOVAGINAL CANDIDIASIS

Fluconazole

SKIN CANDIDIASIS

Topical Applications: Miconazole, Clotrimazole or nystatin

Wipe from front to back when wiping the vagina Do not use anymore underwear which you wore when you had the infection Wash the hands very carefully after touching an infected area and after applying an antifungal cream. Exposed to air the infected area Do not use lotion on skinfolds, instead just use antifungal creams.

PICTURES BEFORE ORAL CANDIDIASIS AFTER

VULVAGINAL CANDIDIASIS

OTHERS

REFERENCE Tortora, G. (2011). Microbiology: An introduction (10th Ed.). p.339, 401, 589, 601-602, 758-759 http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/msds30e-eng.php http://www.nlm.nih.gov/medlineplus/ency/article/001511.htm http://www.cdc.gov/fungal/candidiasis/ http://www.netdoctor.co.uk/diseases/facts/candidaalbicans.htm