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×c J
×c 112
001511
D0021
OY 1 Classification
OY 2 Signs and symptoms
OY Causes
OY 4 Diagnosis
OY 5 Treatment
OY 6 History
OY Society and culture
OY 8 References
OY 9 External links
Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the
male genitals In immunocompromised patients, c
infections can affect the esophagus
with the potential of becoming systemic, causing a much more serious condition, a fungemia
called candidemia ]4]
Children, mostly between the ages of three and nine years of age, can be affected by chronic
mouth yeast infections, normally seen around the mouth as white patches However, this is not a
common condition
]
Symptoms of candidiasis may vary depending on the area affected Infection of the vagina or
vulva may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray
cottage cheese-like discharge, often with a curd-like appearance These symptoms are also
present in the more common bacterial vaginosis
] In a 2002 study published in the
,
] only percent of women who were self-treating
for a yeast infection actually had a yeast infection, while most had either bacterial vaginosis or a
mixed-type infection Symptoms of infection of the male genitalia include red patchy sores near
the head of the penis or on the foreskin, severe itching, or a burning sensation Candidiasis of the
penis can also have a white discharge, although uncommon
] However, having no
symptoms at all is common, and a more severe form of the symptoms may emerge later
]
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c
See also: Candida albicans
c
yeasts are commonly present in humans, and their growth is normally limited by the
human immune system and by other microorganisms, such as bacteria occupying the same
locations (niches) in the human body6]
In a study of 1009 women in New Zealand, c was isolated from the vaginas of 19% of
apparently healthy women, ie, those that experienced few or no symptoms of infection External
use of detergents or douches or internal disturbances (hormonal or physiological) can perturb the
normal vaginal flora, consisting of lactic acid bacteria, such as lactobacilli, and result in an
overgrowth of c
cells causing symptoms of infection, such as local inflammation]
ëregnancy and the use of oral contraceptives have been reported as risk factors,8] while the roles
of engaging in vaginal sex immediately and without cleansing after anal sex and using lubricants
containing glycerin remain controversial
] Diabetes mellitus and the use of anti-
bacterial antibiotics are also linked to an increased incidence of yeast infections8] Diet has been
found to affect rates of symptomatic Candidiases in some animal infection models,9] and
hormone replacement therapy and infertility treatments may also be predisposing factors10]
Wearing wet swimwear for long periods of time is also believed to be a risk factor11]
In penile candidiasis, the causes include sexual intercourse with an infected individual, low
immunity, antibiotics, and diabetes Male genital yeast infection is less common, and incidence
of infection is only a fraction of that in women; however, yeast infection on the penis from direct
contact via sexual intercourse with an infected partner is not uncommon1 ]
For identification by light microscopy, a scraping or swab of the affected area is placed on a
microscope slide A single drop of 10% potassium hydroxide (KH) solution is then added to
the specimen The KH dissolves the skin cells but leaves the c
cells intact, permitting
visualization of pseudohyphae and budding yeast cells typical of many c
species
For the culturing method, a sterile swab is rubbed on the infected skin surface The swab is then
streaked on a culture medium The culture is incubated at °C for several days, to allow
development of yeast or bacterial colonies The characteristics (such as morphology and colour)
of the colonies may allow initial diagnosis of the organism that is causing disease symptoms
For example, a one-time dose of fluconazole (as Diflucan 150-mg tablet taken orally) has been
reported as being 90% effective in treating a vaginal yeast infection14] (Care should be taken by
people who have allergic reactions to azole group of medicines; this medicine has different levels
of contradictory reactions with other medicines as well ) This dose is only effective for vaginal
yeast infections, and other types of yeast infections may require different treatments In severe
infections (generally in hospitalized patients), amphotericin J, caspofungin, or voriconazole may
be used Local treatment may include vaginal suppositories or medicated douches Gentian violet
can be used for breastfeeding thrush, but when used in large quantities it can cause mouth and
throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to
cancer in the digestive tract of other animals15]
c can develop resistance to antimycotic drugs,16] such as fluconazole, one of the drugs
that is often used to treat candidiasis Recurring infections may be treatable with other anti-
fungal drugs, but resistance to these alternative agents may also develop
Ñ
The genus c
and species c was described by botanist Christine Marie Jerkhout
in her doctoral thesis at the University of Utrecht in 192 ver the years, the classification of
the genera and species has evolved bsolete names for this genus include
and
The species has also been known in the past as and
The current classification is
, which means the name is authorized
for use by the International Jotanical Congress (IJC)1]
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Attending ëhysician, Department of Internal Medicine, Division of Infectious Diseases,
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species are yeastlike fungi that can form true hyphae and pseudohyphae For the most
part, c
species are confined to human and animal reservoirs; however, they are frequently
recovered from the hospital environment, including on foods, countertops, air-conditioning
vents, floors, respirators, and medical personnel They are also normal commensals of diseased
skin and mucosal membranes of the gastrointestinal, genitourinary, and respiratory tracts
c
species also contain their own set of well-recognized but not well-characterized
virulence factors that may contribute to their ability to cause infection2 The main virulence
factors include the following:
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As with most fungal infections, host defects also play a significant role in the development of
candidal infections Host defense mechanisms against c
infection and their associated
defects that allow infection are as follows:
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The first step in the development of a candidal infection is colonization of the mucocutaneous
surfaces All of the factors outlined above are associated with increased colonization rates The
routes of candidal invasion include (1) disruption of a colonized surface (skin or mucosa),
allowing the organisms access to the bloodstream, and (2) persorption via the gastrointestinal
wall, which may occur following massive colonization with large numbers of organisms that
pass directly into the bloodstream
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c
species are the most common cause of fungal infection in immunocompromised
persons ropharyngeal colonization is found in 0-55% of healthy young adults, and c
species may be detected in 40-65% of normal fecal florae
Three of every 4 women experience at least one bout of vulvovaginal candidiasis (VVC) during
their lifetime
More than 90% of persons infected with HIV who are not receiving highly active antiretroviral
therapy (HAART) eventually develop oropharyngeal candidiasis (ëC), and 10% eventually
develop at least one episode of esophageal candidiasis4
Clinical and autopsy studies have confirmed the marked increase in the incidence of
disseminated candidiasis, reflecting a parallel increase in the frequency of candidemia This
increase is multifactorial in origin and reflects increased recognition of the fungus, a growing
population of patients at risk (eg, patients undergoing complex surgical procedures, patients with
indwelling vascular devices), and the improved survival rates among patients with underlying
neoplasms or collagen-vascular disease and patients who are immunosuppressed
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Neither sex is predisposed to candidal colonization; however, VVC is the second most common
cause of vaginitis in women
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ëersons at the extremes of age (neonates and adults >65 y) are most susceptible to candidal
colonization Mucocutaneous candidiasis is also more prevalent in neonates and older adults
Very-low-birth-weight and extremely-low-birth-weight infants are at high risk for blood culture±
proven late-onset candidiasis (defined as sepsis that develops after age 2 h)8
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Candidiasis can cause a wide spectrum of clinical syndromes, as described below The clinical
presentation can vary depending on the type of infection and the degree of immunosuppression
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ëhysical examination findings include right upper quadrant tenderness and hepatosplenomegaly
(<40%)
Systemic can
didiasis can be divided into 2 primary syndromes: candidemia and disseminated candidiasis
(organ infection by c
species) Deep organ infections due to c
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generally observed as part of the disseminated candidiasis syndromes and may involve one or
more organs
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