Candidiasis or thrush is a fungal infection (mycosis) of any of the Candida species (all yeasts), of which Candida albicans is the

most common.[1][2]Also commonly referred to as a yeast infection, candidiasis is also technically known as candidosis, moniliasis, and oidiomycosis.[3] Candidiasis encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. Candida infections of the latter category are also referred to as candidemia and are usually confined to severely immunocompromisedpersons, such as cancer, transplant, and AIDS patients, as well as nontrauma emergency surgery patients.[4] Superficial infections of skin and mucosal membranes by Candida causing local inflammation and discomfort are common in many human populations.[2][5][6] While clearly attributable to the presence of the opportunistic pathogens of the genus Candida, candidiasis describes a number of different disease syndromes that often differ in their causes and outcomes Syptoms of candidiasis vary depending on the area affected.[7] Most candidial infections result in minimal complications such as redness, itching and discomfort, though complications may be severe or fatal if left untreated in certain populations. In immunocompetent persons, candidiasis is usually a very localized infection of the skin or mucosal membranes, including the oral cavity (thrush), the pharynx or esophagus, the gastrointestinal tract, theurinary bladder, or the genitalia (vagina, penis).[1] Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the male genitals. In immunocompromised patients, Candidainfections can affect the esophagus with the potential of becoming systemic, causing a much more serious condition, a fungemia calledcandidemia.[5][6] Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a few weeks.[8] 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.[9] In a 2002 study published in the Journal of Obstetrics and Gynecology, only 33% of women who were selftreating for a yeast infection actually had a yeast infection, while most had either bacterial vaginosis or a mixed-type infection.[10] 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. Candida 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 in the human body.[11] C. albicans was isolated from the vaginas of 19% of apparently healthy women, i.e., those who 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 Candida cells, causing symptoms of infection, such as local inflammation.[12] Pregnancy and the use of oral contraceptives have been reported as risk factors.[13] Diabetes mellitus and the use of antibacterial antibiotics are also linked to an increased incidence of yeast infections.[13] Diets high in simple carbohydrates have been found to affect rates of oral candidiases,[14] and hormone replacement therapy and infertility treatments may also be predisposing factors.[15] Wearing wet swimwear for long periods of time is also believed to be a risk factor.[2] A weakened or undeveloped immune system or metabolic illnesses such as diabetes are significant predisposing factors of candidiasis.[16] Diseases or conditions linked to candidiasis include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress, and nutrient deficiency. Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida species.[17] In extreme cases, these superficial infections of the skin or mucous membranes may enter into the bloodstream and cause systemic Candida infections. In penile candidiasis, the causes include sexual intercourse with an infected individual, low immunity, antibiotics, and diabetes. Male genital yeast infections are less common, and incidences of infection are only a fraction of those in women; however, yeast infection on the penis from direct contact via sexual intercourse with an infected partner is not uncommon. [18]

Candida species are frequently part of the human body's normal oral and intestinal flora. Treatment with antibiotics can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition.[citation needed] Higher prevalence of colonization of C. albicans was reported in young individuals with tongue piercing, in comparison to unpierced matched individuals.[19] In the Western Hemisphere, about 75% of females are affected at some time in their lives. In clinical settings, candidiasis is commonly treated with antimycotics; the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole. For example, a one-time dose of fluconazole (150-mg tablet taken orally) has been reported as being 90% effective in treating a vaginal yeast infection.[21] This dose is only effective for vaginal yeast infections, and other types of yeast infections may require different dosing. In severe infections,amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for thrush in breastfeeding babies, but when used in large quantities, it can cause mouth and throat ulcerations, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.[22] Chlorhexidine gluconate oral rinse is not recommended to treat candidiasis,[23] but is effective as prophylaxis;[24] chlorine dioxide rinse was found to have similar in vitro effectiveness against Candida.[25] C. albicans can develop resistance to antimycotic drugs.[26] Recurring infections may be treatable with other antifungal drugs, but resistance to these alternative agents may also develop.

History
Descriptions of what sounds like oral thrush go back to the time of Hippocrates circa 460 - 370 BC.[7] The genus Candida and species C. albicans were described by botanist Christine Marie Berkhout in her doctoral thesis at the University of Utrecht in 1923. Over the years, the classification of the genera and species has evolved. Obsolete names for this genus include Mycotorula and Torulopsis. The species has also been known in the past as Monilia albicans and Oidium albicans. The current classification is nomen conservandum, which means the name is authorized for use by the International Botanical Congress (IBC).[27] The genus Candida includes about 150 different species; however, only a few are known to cause human infections. C. albicans is the most significant pathogenic species. Other species pathogenic in humans include C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. dubliniensis, and C. lusitaniae.

Society and culture

Some alternative medicine proponents postulate a widespread occurrence of systemic candidiasis (or candida hypersensitivity syndrome, yeast allergy, or gastrointestinal candida overgrowth), a medically unrecognised condition.[28] The view was most widely promoted in a book published by Dr. William Crook[29] that hypothesized a variety of common symptoms such as fatigue, PMS,sexual dysfunction, asthma, psoriasis, digestive and urinary problems, multiple sclerosis, and muscle pain could be caused by subclinical infections of C. albicans.[29] Crook suggested a variety of remedies to treat these symptoms, including dietary modification, prescription antifungals, and colonic irrigation. With the exception of the few dietary studies in the urinary tract infectionsection, conventional medicine has not used most of these alternatives, since limited scientific evidence proves either their effectiveness or subclinical systemic candidiasis is a viable diagnosis.[30][31][32][33] In 1990, alternative health vendor Nature's Way signed an FTC consent agreement not to misrepresent in advertising any self-diagnostic test concerning yeast conditions or to make any unsubstantiated representation concerning any food or supplement's ability to control yeast conditions, with a fine of $30,000 payable to the National Institutes of Health for research in genuine candidiasis

Candidiosis pp. 458-460 Candida albicans and related species of Candida are deuteromycetes. They predominantly form yeastlike cells, but there is some formation of a mycelium. Candida is a normal inhabitant of the mouth, intestinal tract and vagina, and in a healthy host, lives harmlessly as a saprotroph. It is an opportunistic pathogen, however, and becomes pathogenic in a compromised or debilitated host. Factors predisposing the host to infection include malnutrition [lots of junk foods can do this], unsanitary conditions, the presence of other diseases, or prolonged antibiotic therapy. Administration of antibiotics reduces and alters the resident bacterial population, which normally keeps the Candida population in check. Although we refer to an infection by Candida as candidiosis, there actually are a great variety and severity of syndromes produced. C. albicans is the causative agent in about 85-95% of the cases of candidiosis. In humans, Candida can infect the skin, fingernails, mouth and other parts of the digestive tract, vagina, internal viscera [organs - especially those in the abdominal cavity], bones, and the brain. Both the skin and fingernail may be the site of a Candida infection. Contributing factors include excessive moisture from activities that involve frequent wetting of the hands (the infection is likely to be particularly severe if carbohydrates such as fruit juice, sugar, or beer are in the water). Candidosis commonly occurs as diaper rash in babies who wear plastic pants, which retain moisture. Additional contributing factors include diabetes, obesity, and excessive perspiration. The source of infection is either the saliva or feces, which contains cells of Candida. Infected areas become intensely reddened and weeping, and typically have a scalloped border surrounded by pustules or scales. These lesions produce an itch and burning sensation. Fingernails and the deep-lying parts of the nail fold are commonly infected. The tissue surrounding the nail becomes swollen and painful, while the fingernail becomes hardened, thickened, and discolored with striations or grooves. Candidiosis is primarily a disease of the mucous membranes, on which soft gray-white lesions will form. These lesions begin as small focal points of colonization that enlarge to become a patch. They contain mycelium [roots] of the fungus, which lies over a red, oozing mucosa. In humans, candidiosis may occur as a vaginal infection, often appearing during pregnancy, when the glycogen content of the mucous membranes in the vagina increases, favoring the growth of the fungus. During birth, the infant is infected by fungal cells from the vagina and often develops candidiosis in the mouth, where lesions occur on gums, tonsils, tongue, or mucus membranes (a condition commonly known as thrush). In some cases, gasteroenteritis will develop in humans and may occur when infants swallow some of the C. albicans cells from their mouth. Adults also may have candidiosis of the mouth. Predisposing factors are cases of influenza, prolonged antibiotic therapy, and disorders of the immune system, including lymphoma, leukemia, and other malignancies. In general, the severity of the candidiosis and its persistence are directly proportional to the severity of the underlying disease. In some cases, candidiosis becomes apparent before the primary disease is diagnosed. If the case of candidiosis is severe, the infection can spread to the pharynx, larynx, and esophagus. In a small percentage of cases, the infection becomes systemic. After the Candida cells reach the gastrointestinal tract, they can pass through its surrounding mucosa into the blood stream, which disseminates the fungus to the kidneys, liver, spleen, bone, brain and lungs. Such a systemic infection may be lethal. Death from systemic candidiosis is particularly likely to occur in severely ill patients who have cancer, organ transplants, or a severe debilitating disease. Intravenous drugs users who repeatedly introduce Candida cells into the body are at great risk from death due to systemic candidiosis. Candidiosis also occurs in other mammals and birds. It is common in caged pet birds [like chickens] such as canaries and parakeets when cages are not maintained in a sanitary condition and debilitating factors, such as vitamin-B deficiencies, are present. The disease is most commonly localized in the crop of the bird. Baby pigs may develop candidiosis if they are reared on an artificial diet. The piglets vomit frequently, become emaciated by 2 weeks of age, and have a more or less continuous white lining that covers the back of the tongue and esophagus. Candidiosis has also been observed in cattle in a feedlot; diarrhea and symptoms similar to pneumonia resulted in the death of some of the cattle.

Yeast Infection symptoms and signs

Signs and symptoms of a candidal infection can vary depending on the location of the infection.

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In women, signs and symptoms of a vaginal yeast infection are a white cheesy discharge that typically itches and irritates the vagina and surrounding outer tissues. On occasion there may be pain with sexual intercourse or burning with urination. In infants and adults, a candidal infection can appear many different ways. Oral candidiasis is called thrush. Thick, white lacy patches on top of a red base can form on the tongue, palate, or elsewhere inside the mouth. These patches sometimes look like milk curds but cannot be wiped away as easily as milk can. If the white plaques are wiped away with a blade or cotton-tipped applicator, the underlying tissue may bleed. This infection also may make the tongue look red without the white coating. Thrush can be painful and make it difficult to eat. Care should be given to make sure a person with thrush does not become dehydrated. Candidal organisms naturally live on the skin, but breakdown of the outer layers of skin promote the yeast's overgrowth. This typically occurs when the environment is warm and moist such as in diaper areas and skin folds. Superficial candidal skin infections appear as a red flat rash with sharp scalloped edges. There are usually smaller patches of similar appearing rash nearby, known as "satellite lesions." These rashes may cause itching or pain.

Candidiasis Yeast Infection Overview

A yeast infection results from an overgrowth of yeast (a type of fungus) anywhere in the body. Candidiasis is by far the most common type of yeast infection. There are more than 20 species of Candida, the most common beingCandida albicans. These fungi live on all surfaces of our bodies. Under certain conditions, they can become so numerous they cause infections, particularly in warm and moist areas. Examples of such infections are vaginal yeast infections,thrush (infection of tissues of the oral cavity), skin and diaper rash, and nailbed infections.

Candidal infections commonly occur in warm moist body areas, such as underarms. Usually your skin effectively blocks yeast, but any breakdown or cuts in the skin may allow this organism to penetrate. Typical affected areas in babies include the mouth and diaper areas. Vaginal yeast infection, which is the most common form of vaginitis is often referred to as vaginal Candidiasis.

In adults, oral yeast infections become more common with increased age. Adults also can have yeast infections around dentures, in skin folds under the breast and lower abdomen, nailbeds, and beneath other skin folds. Most of these candidal infections are superficial and clear up easily with treatment. Infections of the nailbeds often require prolonged therapy.

Rarely, the yeast infection may spread throughout the body. In systemic candidal disease (in which the fungus enters the bloodstream and spreads throughout the body), up to 45% of people may die. Even common mouth and vaginal yeast infections can cause critical illness and can be more resistant to normal treatment.

Yeast infections that return may be a sign of more serious diseases such asdiabetes, leukemia, or AIDS.

Candidiasis Yeast Infection Causes

In women, yeast infections are the second most common reason for vaginal burning, itching, and discharge. Yeasts are found in the vagina of 20% to 50% of healthy women and can overgrow if the environment in the vagina changes. Antibiotic and steroid use is the most common reason for yeast overgrowth. But pregnancy, menstruation, sperm, diabetes, and birth control pills also can contribute to getting a yeast infection. Yeast infections are more common after menopause

In people who have a weakened immune system because of cancer treatments, steroids, or diseases such as AIDS, candidal infections can occur throughout the entire body and can be life-threatening. The blood, brain, eye, kidney, and heart are most frequently affected, but Candida also can grow in the lungs, liver, and spleen. Candida is a leading cause of esophagitis(inflammation in the swallowing tube) in people with AIDS.

Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida. These infections enter into the bloodstream through breakdowns or cuts in the skin or mucous membranes. Candidal organisms may build up in an area because of frequent use of antibiotics, which kill the bacteria that normally keep them under control.

Use of devices implanted in the skin such as urinary catheters and IV ports also provide access for the yeast to enter the body. IV drug users utilizing dirty needles may inject the yeast directly into their bloodstream or deep tissues.

Candidiasis Yeast Infection Symptoms and Signs

Signs and symptoms of a candidal infection can vary depending on the location of the infection.

In women, signs and symptoms of avaginal yeast infection are a white discharge that is thick and often described as having a cottage cheese appearance. The infection typically causes itching and irritates the vagina and surrounding outer tissues. On occasion there may be pain with sexual intercourse or burning with urination.

In infants and adults, a candidal infection can appear many different ways. Oral candidiasis is called thrush. Thick, white lacy patches on top of a red base can form on the

tongue, palate, or elsewhere inside the mouth. These patches sometimes look like milk curds but cannot be wiped away as easily as milk can. If the white plaques are wiped away with a blade or cotton-tipped applicator, the underlying tissue may bleed. This infection also may make the tongue look red without the white coating. Thrush can be painful and make it difficult to eat. Care should be given to make sure a person with thrush does not become dehydrated. Thrush was formerly referred to as moniliasis, based upon an older name for Candid albicans (Monilia).

Candidal organisms naturally live on the skin, but breakdown of the outer layers of skin promote the

yeast's overgrowth. This typically occurs when the environment is warm and moist such as in diaper areas and skin folds. Superficial candidal skin infections appear as a red flat rash with sharp scalloped edges. There are usually smaller patches of similar appearing rash nearby, known as "satellite lesions." These rashes may cause itching or pain.

In people with weakened immune systems, candidal infections can affect various internal organs and cause pain or dysfunction of the organ. People with suppressed immune systems due to AIDS, chemotherapy, or other conditions may contract a yeast infection called esophagitis in their upper gastrointestinal (GI) systems. This infection is similar to thrush but extends down the mouth and esophagus to the stomach. Candida esophagitis can cause painful ulcers throughout the GI system, making it too painful to swallow even liquids. If the infection spreads into the intestines, food may be poorly absorbed. People with this condition are in danger of becomingdehydrated. There may be associated pain in the area of the sternum (breast bone), pain in the upper abdomen, and/or nausea and vomiting.

If Candida gets into the bloodstream, the person may become sick with or without fever. If the infection spreads to the brain, they may have acute changes in mental function or behavior. When to call the doctor For healthy children and adults, if a medication is tried and fails, or symptoms become worse, consult your health care practitioner. All people with weakened immune systems should contact their health care practitioners with any new symptoms or infections.

Various conditions can cause nonmenstrual vaginal discharge in women, such as gonorrhea, chlamydia,trichomoniasis, and bacterial vaginosis.

If you are having abnormal vaginal discharge and are not sure whether you have a yeast infection,

consult your health care practitioner.

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If yeast infections recur, see your doctor for a more thorough work-up. Candidiasis that recurs may be a

symptom of a hidden disease such as diabetes, leukemia, or AIDS. Other symptoms such as bloody discharge, abdominal pain, fever, and increased urination also can

indicate more serious problems, and you should seek medical help.

Oral thrush needs a prescription medication and a prompt visit to the doctor. If children take no fluids for longer than 12 hours, contact your doctor. Any feveror prolonged problems with feeding also warrant a visit to a doctor. Diaper rash or other candidal infections on the skin can be treated with over-the-counter nystatin powders (Mycostatin, Nilstat, Nystat-Rx, Nystex, O-V Staticin) or antifungal creams and lotions.

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If the rash worsens at any time, or if the lesions do not clear in 1-2 weeks, call your doctor. Fever, chills, nausea, vomiting, or the rash spreading to other parts of your body may be a sign of a

more serious illness.

People with weakened immune systems must take all forms of candidiasis seriously and treat them aggressively. The infection may indicate that your immune system is functioning poorly. Your doctor should evaluate any symptoms of candidal infections.

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If you already are being treated for a candidal infection and the symptoms worsen or do not improve,

notify your doctor. Fevers, chills, vomiting, general illness, or worsening rash needs to be investigated promptly.

When to go to the hospital Most cases of candidiasis do not have to be treated in the hospital. People with weakened immune systems may have more serious infections, however, and may need to be hospitalized.

Women should go to the hospital when fever, chills, nausea and vomiting, or abdominal pain accompanies vaginal discharge. These symptoms can indicate a more serious problem such as kidney infections, appendicitis, orpelvic inflammatory disease. These potential conditions need to be investigated promptly.

If thrush interferes with drinking liquids or eating for long periods of time, people may need to be hospitalized for more aggressive medications and reestablishing body fluids. Candidal skin infections rarely require hospital treatment.

People with weak immune systems run the risk of the candidal organisms spreading to their blood or internal organs, which can cause life-threatening illness. IV medication may be necessary to combat this systemic illness. Your doctor should promptly investigate symptoms of illness or general malaise.

Candidiasis Yeast Infection Diagnosis

For healthy people, most physicians can diagnose a candidal infection without laboratory tests. Occasionally, if the infection won't go away or involves the entire body, more extensive tests may need to be performed.

The only definitive way to diagnose a vaginal yeast infection is to complete a full gynecologic exam.

This exam includes a speculum exam, using a specialized instrument to hold open your vagina. The

exam can be uncomfortable because of pressure against the tissues. The health care practitioner will take a swab of the discharge and may obtain other cultures to rule out other diseases. The swab for yeast will be mixed with a drop of potassium hydroxide and will be placed on a slide. If yeast are present, a specific branching pattern will be seen through the microscope.

The doctor then may insert two fingers into your vagina and gently press on your uterus, ovaries, and

surrounding areas to check for any tenderness or other problems. The health care practitioner also may take blood and urine specimens after this exam. You should not douche or have sexual intercourse 1-2 days before the exam, because doing so may make the diagnosis more difficult.

In healthy children and adults, a quick exam in the mouth or of the skin usually confirms the diagnosis of candidiasis. If there is any confusion about the diagnosis, the health care practitioner may obtain a small scraping of the area, which will be placed on a slide with potassium hydroxide and examined for a branching pattern consistent with yeast.

In people with weakened immune systems, oral, vaginal, and skin candidal infections usually can be diagnosed by sight. When a person becomes sick, the health care practitioner may perform more invasive tests to confirm the diagnosis. Specimen collection may be necessary to check for Candida in the blood and urinary tracts. People with catheters may have their catheters changed and the catheter tips sent for culture. If a CT scan or MRI indicates candidiasis of the brain, health care practitioners may take a biopsy to distinguish between Candida and other diseases. Usually health care practitioner give IV medications for serious systemic infections.

Candidiasis Yeast Infection Treatment Self-Care at Home

Most candidal infections can be treated at home with over-the-counter (OTC) remedies or prescription medications and can clear within a week. But if some other disease has weakened your immune system, consult a doctor for any new symptoms before attempting self-treatment. You may risk getting an infection. Yeast infections

Most women can treat yeast infections at home with over-the-counter medications. A number of OTC remedies are available:

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miconazole (Micon 7, Monistat 3, Monistat 5, Monistat 7, M-Zole Dual Pack) tioconazole (Monistat-1, Vagistat-1) butoconazole (Gynazole 1) clotrimazole (Femcare, Gyne-Lotrimin, Mycelex-G)

Massage these remedies into your vagina and surrounding tissues for 1-7 days depending on the formulation. If increased irritation occurs to the area, discontinue the medication immediately. If you are pregnant, consult your doctor before using these treatments. If a single dose of fluconazole (Diflucan) - (see medical treatments) is as effective as topical antifungal creams. If symptoms are recurrent or continue for more than 1 week, consult your health care practitioner.

Thrush

In thrush, swish the antifungal agent nystatin (Bio-Statin, Mycostatin, Mycostatin Pastilles, Nilstat) around in the mouth. Take care to maintain excellent oral hygiene. All objects put into a child's mouth should be sterilized after each use. Women who are breastfeeding should be evaluated for Candida of the breast. If a person wear dentures, clean them thoroughly after each use and practice good oral hygiene.

Adults have several treatment options not available to babies, such as troches (antifungal lozenges) or pills such as fluconazole (Diflucan), to help clear the infection in addition to nystatin. Skin and diaper rash

Clotrimazole (Mycelex Troche) creams and lotions can be applied to superficial skin infections. Other medications need a prescription and a visit to a health care practitioner. The affected area should be kept clean and dry. For diaper rashes, frequent diaper changes and the use of barrier creams will speed recovery.

If the individual's immune system is weak, the doctor may handle minimal local infections with home care. More serious infections may need IV medications administered at the hospital.

Medical Treatment
A wide array of treatment options is available to treat candidiasis. Options include creams, lotions, pills, troches (lozenges), and vaginal suppositories. Talk to your doctor to find the option that is right for you.

Azole medications are a family of antifungal drugs that end in the suffix "-azole." They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast die. Fortunately, ergosterol is not a component of human membranes, and azoles do not harm human cells. Examples include miconazole, tioconazole, clotrimazole, fluconazole, and butoconazole.

Polyene antifungals include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast-wall that causes the yeast to leak and die.