OVERVIEW

I love candy, but my mummy insists I will get Candidiasis if I eat too much of candy. How is that possible?

When you hear the word Candidiasis, does your mind immediately pull up a mental image of candy?

This is a common misconception many people have about this infection. Though a misconception, there is an iota of truth to it.  In this article, our aim is to shed more light on this infection and as such, help clarify this misconception. It isn’t unnatural for one to believe this analogy; after all, the name candidiasis might have originated from candy (it didn’t).

Candidiasis (a.k.a. thrush or a yeast infection) is a fungal infection caused by Candida species.

There are over 20 species of this unique fungi that causes infection in humans including; Candida glabrata, Candida tropicals, Candida auris and Candida albicans to name a few, of which Candida albicans is the most common causative organism.

They are mainly found in moist, warm environments, living on skin and other mucous membranes (in the mouth and vagina in women and clippers of babies).

Interestingly, yeasts are naturally present in people as normal flora, but an increase in their population might result in an infection.

We must know that, Candida is an opportunistic microbe. Meaning, it is often harmless unless there is an overgrowth. Dampness, heat, and weakened local or systemic defenses, provide a fertile environment for yeast to grow.

Candidiasis is usually not severe in healthy persons (immunocompetent). It usually manifests as a localized infection of the skin, fingernails or toenails, or mucosal membranes, including the oral cavity and pharynx (thrush), esophagus, and the genitalia.

On the other hand, Candida infection can be more severe in immunocompromised (impaired immune system) individuals. It presents with a higher risk of spread through the blood to other organs such as the heart, brain and kidneys.

 

TYPES 

Based on the site of infection, candidiasis can be grouped into many types. The most common ones are as follows:

  • Oropharyngeal Candidiasis (also known as thrush): Candida infections of the mouth and throat.
  • Vaginal Candidiasis: Candidia infections of the vagina
  • Candida balanitis: Candidiasis of the glans penis, almost exclusively occurring in uncircumcised men
  • Invasive Candidiasis: Candidiasis that infect the blood and spread throughout the body.

 

SYMPTOMS

Symptoms of candidiasis vary, depending on the region of the body that is infected.

Infection of the mouth is usually common in infants. It may present with symptoms like:

  • Creamy white lesions on the tongue, inner cheeks, or on the roof of your mouth, gums and tonsils.
  • slightly raised lesions with a cheese-like appearance
  • Redness, or soreness in the esophagus and mouth that results in difficulty eating or swallowing.
  • Cracking and redness at the corners of the mouth
  • Loss of taste

Vaginal candidiasis infection affects up to 3 out of 4 women at some point in their lives. Symptoms may include:

  • Vaginal itching or soreness
  • Dyspareunia: Pain during sexual intercourse
  • Dysuria: Pain or discomfort on urination
  • Abnormal vaginal discharge (Thick, white, odor-free discharge)
  • Vaginal rash

Note that, though most infections are mild some women might develop severe infections leading to redness, swelling and cracks in the vagina walls.

Candidiasis of the penis may present with;

  • itching or soreness on the penis (especially on the head of the penis)
  • discharge under the foreskin (thick, unpleasant odor)
  • difficulty retracting the foreskin (phimosis)
  • Dyspareunia: Pain during sexual intercourse
  • Dysuria: Pain or discomfort on urination

In invasive candidiasis, the infection spreads through the blood to other parts of the body, such as the heart valves, brain, spleen, kidneys, and eyes. This may present with systemic symptoms like:

  • fever and chills
  • malaise

RISK FACTORS 

  • Pregnant women
  • Diabetics
  • Immunocompromised persons, such as HIV patients or patients on steroids or chemotherapy
  • Patients on long term antibiotics
  • Hot weather
  • Restrictive clothing
  • Poor personal hygiene
  • Infrequent diaper or underwear changes in children and elderly patients
  • Inflammatory diseases that occur in skinfolds such as psoriasis.

 

PREVENTION 

  • Wearing cotton underwear can prevent genital candidiasis
  • Proper oral hygiene can help prevent oral candidiasis
  • Avoid the use of scented feminine products, including bubble bath, pads and tampons
  • Avoid the unnecessary use of antibiotics
  • Rinse your mouth with water or brush your teeth after taking medication such as a corticosteroid inhaler.
  • Brush your teeth at least twice a day.
  • Keep your dentures clean.

 

DIAGNOSIS 

  • Swab from infected area for fungal culture
  • Endoscopy is often employed in cases of infection of the gastrointestinal tract (especially the esophagus)
  • If needed, a physical exam and certain blood tests may be done to identify any possible underlying medical conditions that could cause candidiasis
  • Urinalysis is done for genitourinary candidiasis.

 

TREATMENT

The mainstay treatment is by the use of antifungal drugs like:

  • Fluconazole (per os – by mouth)
  • Nystatin, Flucytosine, Boric acid (for topical use)
  • Anidulafungin, Caspofungin, or Amphotericin B (intra venous administration) in severe cases such as invasive candidiasis.

Note that Candidiasis is more serious and less responsive to treatment in people with certain underlying conditions, such as diabetes. In diabetic patients, controlling blood sugar levels is an important step in curing the infection.

 

DOES SUGAR CONTRIBUTE TO CANDIDIASIS?

Even though sugar does not cause candidiasis, it does contribute to the growth and adaptation of candida. Remember we said earlier that there is an iota of truth to the misconception of sugar causing candidiasis. How then does sugar contribute to this infection?

Firstly, sugar causes dysbiosis (microbial imbalance) in the normal flora; especially in the gut which results in candida overgrowth. We all know what happens when there is an overgrowth of candida right? Candidiasis.

Secondly, candida has the ability to develop resistance and create a layer of slime known as biofilm, that protects it from a wide variety of pH changes and antifungal drugs. This accounts for an increase in resistance to antifungals worldwide over the past 30 to 40 years. No wonder it is very difficult to treat. Biofilms are ways in which Candida albicans shields itself from our immune system and antifungals. The biofilm can be thought of as a protective matrix in which the microbe can live and multiply safely. A research conducted by PubMed (2006 research study) found that candida biofilms are comprised of about 32% glucose. It was also found that 80% of its cell wall is made up of carbohydrates (sugar). They get this from the excess sugars that is consumed.

Lastly, a research team in New Zealand found that carbohydrates were needed by Candida to switch to its hyphal form. In its hyphal form, Candida is able to spread more quickly throughout the gastrointestinal tract.

This is the reason why following a low-sugar diet is one of the key elements in any good treatment of Candida.

 

EPIDEMIOLOGY

Oral thrush is the most common fungal infection of the mouth.

The exact number of cases of candidiasis in the mouth, throat, and esophagus is difficult to determine because of inadequate surveillance system for these infections. In one study by the Centers for Disease Control (CDC), approximately one-third of patients with advanced HIV infection had candidiasis in the mouth and throat. 

Esophageal candidiasis is the most common esophageal infection in people with AIDS and accounts for about 50% of all esophageal infections. 

Vaginal candidiasis is common. In the US, it is the second most common type of vaginal infection (second to bacterial vaginal infections). In the Western Hemisphere, about 75% of females are infected with a vaginal candidiasis at some time in their lifetime.  

Invasive candidiasis is a common healthcare-associated infection in the US.

Studies by CDC has it that, approximately 46,000 cases of healthcare-associated invasive candidiasis occur yearly in the US.