What Is Candidiasis?

Candidiasis is a type of fungal infection caused by the most common species, Candida albicans. This yeast infection can cause serious complications in the body in case not treated or prevented at the right time.

What are the species of candidiasis?

Candidiasis is caused by nine species, mainly Candida albicans, Candida parapsilosis, Candida glabrata, Candida africana, Candida dubliniensis, Candida bracarensis, Candida orthopsilosis,  Candida nivariensis and Candida metapsilosis. Of these nine species, three species are widespread causes, namely Candida albicans, Candida parapsilosis and Candida glabrata globally.¹

What is the classification of candidiasis?

The fungal (yeast) infection lives at different locations of the body. So they are classified as:

Oropharyngeal & oesophagus candidiasis (Oral thrush) 

This type of infection is present in the tongue, mouth, throat, and stomach.²

What are the symptoms of oral thrush candidiasis?

• White patches on the cheeks, tongue, and throat.
• Redness in the mouth
• Unable to taste
• Eating causes pain
• Dry mouth

What risk factors are associated with oral thrush candidiasis?

• Chronic illness (Diabetes, Cancer, HIV/AIDS)
• Smoking
• Continuous wearing of dentures
• Certain medications like asthma inhalers and corticosteroids
• Anaemia

How to diagnose oral thrush candidiasis?

• Throat culture is done by swabbing sterile cotton on the back of the tongue and studying microorganisms.
• Endoscopy can be advised to study any lesions in the lining of the whole abdomen by a small camera-inserted tube.³ 
• Perform an X-ray to see white patches in the lining to check for fungal infection.³ 

What treatment is done for oral thrush candidiasis?

• Mouthwashes like chlorhexidine gluconate⁴ and amphotericin B.⁵
• Probiotics.⁶
• For mild to moderate infections, antifungal medicines such as miconazole, clotrimazole and nystatin can be used for 7 to 14 days.⁷
• Fluconazole is given for severe infections taken by mouth.⁷
• Your healthcare professional will prescribe the dose adjustment of these medicines on the basis of the patient's condition.

Dermal (Cutaneous) candidiasis

This cutaneous infection creates a red patch, itchy cracks, and rash in the buttocks and breasts.²

What are the symptoms of cutaneous candidiasis?

• Skin rash on skin and middle of body
• Erythematous⁸
• Itchy skin
• Red skin rash
• Hair follicles infection

What are the risk factors for cutaneous candidiasis?

• Postpartum corticosteroids⁹
• Type 2 Diabetes
• Childbirth
• Preterm

How is cutaneous candidiasis diagnosed?

• Clinical skin appearance
• Positive fungal culture¹⁰
• Skin biopsy

What is the treatment for cutaneous candidiasis?

• Itraconazole¹¹
• Fluconazole has some limitations regarding safety on long-term use. 
• Other natural remedies include coconut oil¹⁷, tea tree oil¹⁸ and neem extract.¹⁸

Vaginal candidiasis

This type of infection causes burning, itching, and redness in the vagina.² 

Do you know the symptoms of vaginal candidiasis?

• Ache in urination
• Itching and discomfort in the vagina
• Irregular vaginal discharge
• Pain during sex

Which risk factors should be avoided in vaginal candidiasis?

• Recently took any antibiotics 
• Immunocompromised
• Hormonal birth control pills
• Pregnancy
• Diabetes

How to diagnose vaginal candidiasis?

• Yeast culture is the first choice of diagnostic test for this type of Candidiasis.¹²
• Microscope vaginal discharge to confirm the fungal infection in the laboratory.¹³
• Self-diagnosis if there’s any itching or irritation in the vagina. 

What treatment is effective against vaginal candidiasis?

Invasive candidiasis

This infection includes the bloodstream, heart, eyes, cerebral, and urine.²

What are the symptoms of invasive candidiasis?

• Fever
• Chills
• Hypotension
• Confusion

What risk factors can occur in invasive candidiasis?

• Elemental risk factor: 

Type 2 diabetes, sepsis, illness severity, pancreatitis.¹⁵

• Induced: 

Corticosteroids, immunosuppressants, antibiotics (broad spectrum), surgery, intravenous feeding.¹⁵

What diagnostic tests are used for invasive candidiasis?

• A positive culture is the highest standard of test for invasive candidiasis.¹⁶
• Biopsy is performed for histopathology.¹⁶
• Polymerase Chain reaction (PCR) if fungal infection is detected by DNA organising.¹⁶

How to treat invasive candidiasis?

The recent advancement is carried out to identify new drugs that can treat Invasive candidiasis. Many treatments are available, out of which three main classes of drugs are:

• Echinocandins are fungicidal drugs that are more safe and potent. They include caspofungin, anidulafungin, or micafungin.¹⁹
• Azoles are the class of fungal drugs used for systemic infections. They comprise voriconazole, fluconazole, posaconazole, isavuconazole and itraconazole.¹⁹
• Amphotericin-B are drugs that slow the rise of Candida cause fungal infection.¹⁹ 

Out of these three classes, the therapeutic effect of echinocandins is much higher than the other two; that is why echinocandins are the ultimate choice for the treatment of Invasive Candidiasis, with a broad spectrum and safety profile. Those preparations of echinocandins and azoles are used in the treatment of meningoencephalitis and endocarditis. Echinocandins are available in intravenous form, while azoles are formulated in intravenous and oral form.  

Musculoskeletal candidiasis (Osteomyelitis)

This infection is found in the muscles and joints of the body.²

What symptoms are related to musculoskeletal candidiasis? 

• Pain
• Tenderness
• Invasion of soft tissue
• Boil formation
• Inflamed wound
• Weakness

What risk factors are connected to musculoskeletal candidiasis?

• Novel surgery
• Recent transplantation of organ
• Previous use of a broad range of antifungals and antibiotics
• Delivered immunosuppressant

Which diagnostic procedures are used for musculoskeletal candidiasis? 

• Biopsy of tissue
• Yeast culture
• Histopathology
• Radiography to check for any signs of bone destruction, joint swelling, and osteopenia.²⁰
• Computed tomography (CT) scan.²⁰ 
• Magnetic resonance imaging (MRI) to see bone-associated edema, tendon breakage, mass, and sinus condition.²⁰
• Bone scan to identify any points of fungal infection of the musculoskeletal.²⁰ 

What effective treatment is used in musculoskeletal candidiasis?

• Antifungal therapy lasts for 12 months with voriconazole due to its potential effectiveness and likelihood of achieving a complete response.²⁰
• Surgical intervention in case of severe injury and bone destruction.²⁰

Other 

Similar to the above classification, there is a fungal infection of nails known as Candida Onychomycosis²¹, mainly comprising three species:

• Candida paronychia
• Candida granuloma
• Candida onycholysis

What organs do candidiasis involve?

Do you know Candidiasis can increase the possibility of disease of  

• Brain
• Kidney
• Heart

if it invades the body (Candida albicans) or expands out of reach? It shows symptoms such as

• Rashes
• Patches (Purple or Red)
• Skin cracks
• Constipation and diarrhoea
• Flaky skin
• Endocarditis

Furthermore, Candidiasis (Thrush) can be improved by taking care of the gut, vagina, thrush, and mouth.²² A healthy diet and less strain will subsequently enhance the immune system, thus preventing the individual from Candidiasis.²³

What factors yield candidiasis?

Candidiasis could lead to high infection growth by the presence of various species of Candida. This infection could be a result of:

• Long-term or recent usage of antibiotics.
• Pregnancy because of the increased oestrogen in the body, more sugar in vaginal secretions, change in the pH of the vagina can disturb the equilibrium between the yeast and bacteria. 
• Type 2 Diabetes is the increased sugar content in urine, saliva, and sweat will help fungi to grow rapidly and effectively.
• Immunocompromised situations like AIDS/HIV, chemotherapy, and radiotherapy could build up Candidiasis. 
• Hormonal birth control pills can disturb the balance of progesterone and oestrogen in the body thus favourable to Candidiasis. 

How to avoid candidiasis?

Candidiasis can be prevented by:

• Get an oral examination by your doctor or dentist.
• Maintain good oral hygiene and physical condition. 
• The sugar-rich diet should be controlled. 
• Get your care while pregnant.
• Chronic illnesses like type 2 diabetes, HIV/AIDS, cancer, and cardiovascular diseases should have complete follow-up.
• Avoid smoking and stress. 
• Always consult your healthcare provider for any precautions to avoid Candidiasis. 

How to treat candidiasis?

This yeast infection should be treated as soon as fungal infection occurs. The fungal medicines are available in many forms:

• Tablets
• Capsules
• Drops
• Syrups
• Ointments
• Lozenges
• Injections

These formulations should be taken after proper diagnosis and on the recommendation of healthcare professionals in the context to the severity of the disease, how to apply or take and how much time required medicine should be taken. It is best to prevent Candidiasis at a very early stage in order to avoid long-term treatment. 

Moreover, alternative treatment of medicinal plants like Lonicera japonica  is acknowledged due to its strong antimicrobial activity against Candida tropicalis and Candida albicans in healing wounds. Similarly plant extracts like:

• Pyrostegia venusta²⁴
• Piper betle²⁴
• Strychnos spinosa²⁴

showed broad antifungal activity. 

What particular population is linked with candidiasis?

Candidiasis was studied to check the antifungal susceptibility and bitterness of the species Candida suffering from oral lesions, and it was found 

• 45-65 % of healthy babies²⁵ 
• 30-55 % of healthy individuals²⁵ 

were suffering from Candida albicans in the oral cavity. This is because most of these species are present in the mouth, yet studies on other species can also be carried out for any future recommendations. 

It is evident from this study that the population specifications or contributions are relevant and dependent on the species and its virulence and pathogenicity. 

What are the misunderstandings regarding candidiasis?

Every disease is backed up with certain myths and misconceptions. Certainly, Candidiasis is also among those infections that are considered to have some misinterpretations:

• Women are only prone to this fungal infection. 
• In fact, this disease is common in males too.
• Sexual intercourse is the major reason for its spread.
  • There are other causes for its distribution, like weak immune system, chronic illness, stress, etc. However, one should avoid having sexual intercourse during the infection.
• These infections are safe, and they will be cured on their own.
  • The truth is,  as the infection spreads, it causes difficulty, and time elapses in curing, so it should only be treated with antifungal drugs on the advice of a healthcare practitioner. 
• Natural remedies will be more beneficial than properly suggested treatment plans.
• Candida is present only on the skin
  • In this article, its presence is thoroughly understood and discussed.
• Vaginal (Hygiene) wash and soap is sufficient to get rid of Candidiasis.
  • It only controls the pH of the vagina as a temporary solution. 

Summary

• Candidiasis is a yeast infection caused by Candida species.  Predominantly Candida albicans, which affects various parts and organs of the body.
• Candidiasis is classified into oral thrush, musculoskeletal, vaginal, invasive, cutaneous, and nail Candidiasis. 
• Maintaining good hygiene, ignoring myths and misconceptions, and managing chronic illness can help prevent this infection.
• Treatments like unconventional remedies and herbal medicines can be useful in managing the fungal infection.
• Proper health education and awareness should be the prior belief in understanding this infection. 
• Candidiasis can only be treated with proper medical treatment, i.e., antifungal medicines and plans.
• Correct medical consultation can help in exact diagnosis, cure, and precautionary approach.