Infectious Diseases A to Z: Candidiasis (Moniliasis; Thrush)

Candidiasis

With this new column, Elite will compile an index of various infectious diseases, occasionally highlighting emerging conditions.

Candidiasis (Moniliasis; Thrush)

General definition and information: A fungal infection caused by yeasts that belong to the genus Candida, which normally reside in the intestinal tract and can be found on mucous membranes and skin. Candida auris (C. auris), one of the more than 20 species of Candida, is an emerging fungus that presents a serious global health threat, according to the Centers for Disease Control and Prevention (CDC).1 Healthcare facilities in several countries have reported that C. auris has caused severe illness in hospitalized patients and is often resistant to multiple antifungal drugs, the CDC reports. Commonly called “thrush” when it infects the mouth, candidiasis can be characterized by three types: infections of the mouth, throat, and esophagus; vaginal candidiasis; and invasive candidiasis, which occurs when a Candida species enters the bloodstream and spreads throughout the body. Oral thrush, a condition more likely to occur in babies and older adults, causes creamy, white lesions, usually on the tongue or inner cheeks.  Candidiasis in the vagina is commonly referred to as a “yeast infection” and occurs when naturally occurring microorganisms in the vaginal area become overgrown due to an imbalance of Lactobacillus bacteria, otherwise known as “friendly” bacteria that normally live in digestive, urinary, and genital systems without causing disease.

Causes & Modes of Transmission: When the protective mechanisms of Lactobacillus bacteria fail, the number of candida fungus increases and infection can take hold. Invasive candidiasis is a serious infection that can affect the blood, heart, brain, eyes, bones, and other body parts. Infants who develop the condition can pass the infection to their mothers during breastfeeding. The infection may then pass back and forth between the mother’s breasts and the baby’s mouth, according to the Mayo Clinic.2

Treatment Strategies: Thrush may be treated with topical antifungal medications such as nystatin (Mycostatin and others) and clotrimazole. According to the CDC, the specific type and dose of antifungal medication used to treat invasive candidiasis usually depends on the patient’s age, immune status, and location and severity of the infection. For most adults, the initial recommended antifungal treatment is an echinocandin (caspofungin, micafungin, or anidulafungin) given through IV injection. Fluconazole, amphotericin B, and other antifungal medications may also be appropriate in certain situations, according to the CDC, which also reports that treatment should continue for two weeks after signs and symptoms have resolved and Candida yeasts are no longer in the bloodstream. Other forms of invasive candidiasis, such as infections in the bones, joints, heart, or central nervous system, usually need to be treated for a longer period of time, the CDC reports. There are also reportedly natural ways to care for the condition,3 including adequate sleep; healthy diet that avoids refined sugars, carbohydrates, alcohol, and white flour while adding healthy fats such as fish oil, organic raw butter, leafy vegetables; and extra virgin coconut oil; exercise, especially aerobic exercise, running, dancing, swimming, and biking; taking probiotics; and adding natural antifungals, such as pau d’arco, oil of oregano, capric acid (found in coconut oil), and enteric-coated garlic.

Prevention Parameters: According to the Mayo Clinic, there are a number of prevention strategies that healthcare providers can communicate, including adequately rinsing one’s mouth, especially when a corticosteroid inhaler is used; brushing teeth at least twice per day and flossing daily, unless otherwise directed by a dentist; clean dentures daily, remove them at night, and ensure they fit properly without causing irritation; see a dentist regularly, especially if there is a diabetes diagnosis; limiting the amount of sugar-containing foods consumed; and maintaining blood sugar control.

References

  1. Candidiasis. CDC. W2015. Accessed online: ww.cdc.gov/fungal/diseases/candidiasis/index.html
  2. Oral thrush. Mayo Clinic. 2019. Accessed online: www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533
  3. Treatment for invasive candidiasis. Mayo Clinic. 2018. Accessed online www.cdc.gov/fungal/diseases/candidiasis/invasive/treatment.html

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