July 18, 2016

What is Candida?

What is Candida?

Candida belongs to a group of fungi that has adapted to colonizing the human body as its host. The Candida species are in fact responsible for many of the commonly seen infections. There are two clinical presentations of candida species infections. The first type is the muco-cutaneous infections that is easily seen and diagnosed. The changes to the skin and the mucosa of the mouth have characteristic features. The other type is not easily diagnosed without the help of laboratory diagnostics. This second type is the invasive infection that can involve the internal organs.

40% of the patients who died as a result of healthcare associated blood infections have been found to have been colonized with Candida species. Also those who survive have to endure much longer hospital stays up to 30 days. Healthcare professional are growing increasingly concerned about the treatment-resistant, non-albicans species. Dr. David R. Snydman MD has written about the alarming increase in health facility nosocomial blood infections. This is being experienced especially in critical care units.

The favorable parts of the body that allows this type of fungus to grow and proliferate include:

  • The mouth
  • Pulmonary and laryngeal
  • Skin folds
  • The external genitalia
  • The urinary tract
  • The genital tract
  • The liver
  • Hair and nail

 What causes Candida Infection?

The skin fungus has a preference for areas that are warm and moist. There are underlying illnesses/ conditions which affect or overwhelm the body’s own natural defense to respond to eliminate the fungus. The risk of candida species overgrowth is increased with the following:

Conditions

  • Poor nutrition
  • Excessive sweet foods in the diet
  • Poor hygiene

Illnesses

  • Diabetes
  • Auto-immune diseases
  • Prematurity
  • Gastro intestinal diseases
  • Organ transplant especially liver transplant
  • Drugs which include steroids and antibiotic abuse
  • Sexually transmitted illness
  • Blood diseases such as leukemia and leukopenia
  • Kidney patients on dialysis
  • Invasive medical procedures

Candida Symptoms

The wide range of symptoms suggestive of candida infection varies depending on the organ or structure which is affected.

Constitutional symptoms are somewhat non-specific and include:

  • Chronic fatigue
  • Dizziness
  • Loss of the ability to focus and concentrate
  • Irritability
  • Depression
  • Poor memory
  • Low libido
  • Mood swings
  • Sugar cravings

Skin

  • Fungal nail infection
  • Fungal scalp infection
  • Itching
  • Athlete’s foot
  • Distinct body smell
  • Eczema
  • Dermatitis

Mouth

  • White coating of the tongue
  • Bad breath (halitosis)
  • Canker sores
  • Cracked tongue

Gastro-intestinal symptoms

  • Bloating
  • Flatulence
  • Abdominal cramps
  • Diarrhea
  • Constipation
  • Mucus in stool

Upper and Lower Respiratory Tract

  • Sinus congestion
  • Tonsillitis
  • Asthma
  • Chronic cough
  • Chronic post-nasal drip
  • Flu-like illness
  • Allergic rhinitis

Ears, nose and throat

  • Outer ear fungal infection
  • Middle ear otitis
  • Tinnitus (ringing in the ears)

Eyes

  • Itchy eyes
  • Redness
  • Watery
  • Bags under the eyes
  • Blurred vision

Genitourinary system

  • Recurrent urinary infections
  • Vaginal yeast infections (recurrent)
  • Cystitis (bladder) infections
  • Fungal rash on pubic area and between the thighs

Suppressed immune system

  • Frequent colds
  • Frequent flu-like illnesses
  • Allergies

Other symptoms

  • Overweight and obesity
  • Body resistant to weight loss
  • Headaches
  • Joint and muscle pains

Candida Treatment

Anti-fungal treatment comes in different types of preparation. Therapy for skin and mucosal infections typically respond to the azole antifungal agents. Other commonly used anti-fungal drugs are amphotericin B–based preparations, and the echinocandin antifungal agents. There are more potent, newer anti-fungal preparations which are reserved for resistant, non-albicans species.

Types of preparations are:

  1. Oral gel application
  2. Oral tablets
  • Liquids
  1. Intravenous
  2. Vaginal pessary
  3. Topical skin creams

Non-Drug Treatment for Candida

Food and nutrition can interfere with the pH balance of the body and exacerbate conditions such as candidiasis. In this instance the recurrent cycle of candida infection can be improved with a Candida (prevention) Diet.

Tips to adopt for a Candida Diet

Individuals who have recurrent candida infections should consider changing their diet.

  • Minimize processed food in your diet. Select organically grown fruits , non- starchy vegetables, legumes and animal protein
  • Include probiotics with live yogurt cultures for breakfast
  • Almonds, pecan, hazel nuts and flax seeds generally have low mold content. Select these over other nuts and seeds.
  • Non-glutinous whole grain breads, pastas, rice and other similar foods made from buckwheat, millet, oat bran and quinoa are the preferred choices to eat.
  • Avoid eating overnight meals which tend to have mold and bacterial growth.
  • For more alkaline foods and drink use more of the green leafy vegetables
  • Ensure good fats are a part of every meal. Foods high in omega fatty acids include olive oil, flax seeds, coconut and canola oils. These have anti-fungal properties
  • Minimize or eliminate the use of sugar and honey for cooking and baking. A good substitute is cane or beet juice and dried fruits
  • Herbs and spices have anti-fungal properties. Use these generously in cooking and preparing salads

 Good Personal Hygiene helps to decrease the risk of candida overgrowth

It is important for you to get treatment for the underlying illnesses. Diabetes is a chronic disease which is controlled by diet and medication. Monitoring of the blood sugar (glucose) level is important for self-monitoring and also as part of the doctor’s check to achieve control.

Tips

  • Mouth

Clean tongue and brush teeth after meals

  • Genitalia

Pay special attention to properly wash the penis and vagina

  • Daily bath

Having a daily bath or shower removes dead skin and potential skin infections

  • Foot care

Washing the feet daily especially between the toes reduces the risk of fungal infections. Care must be taken to dry the feet after washing them.

 

Prevention of candida cross-infections in healthcare and domiciliary facilities

Care-givers must practice infection control especially when caring for hospitalized patients, babies and young children. Hand washing is the most basic and effective practice.  Each person must have his own comb, hairbrush, nail clipper, toothbrush, rags and towels. Appropriate antiseptics must be used to clean common surfaces. Attention must be paid to carefully sterilize instrument used for therapy. Where procedures required single use disposable sundries and equipment, this must be adhered to.

Utensils and plates must be carefully washed and dried. Personal eating utensils is also safer where this can be encouraged andaccommodated.

A Special Word on Recurrent Candidiasis

There is a strong case for persons who are prone to recurrent candida species infections to explore life-style changes which are mainly dietary and personal body care.

References:

  1. Guidelines for Treatment of Candidiasis, Peter G. Pappas, John H. RexJack D. Sobel, Scott G. Filler4William E. Dismukes1,Thomas J. Walsh, and John E. Edwards
  2. Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination, Jorge Garbino, Daniel P. Lew, Jacques-A. Romand, Stéphane Hugonnet, Raymond Auckenthaler, Didier Pittet
  3. Hierarchical pattern of mucosal candida infections in HIV-seropositive women, Naiyer Imam, M.D., Charles C.J. Carpenter, M.D. , Kenneth H. Mayer, M.D., Alvan Fisher, M.D., Michael Stein, M.D., Stephanie B. Danforth, R.N., M.B.A.
  4. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: A multicenter, prospective, observational study in France (2005–2006), Leroy, Olivier MD; Gangneux, Jean-Pierre MD, PhD; Montravers, Philippe MD, PhD; Mira, Jean-Paul MD, PhD; Gouin, François MD; Sollet, Jean-Pierre MD; Carlet, Jean MD; Reynes, Jacques MD, PhD; Rosenheim, Michel MD; Regnier, Bernard MD, PhD; Lortholary, Olivier MD, PhD; for the AmarCand Study Group
  5. Shifting Patterns in the Epidemiology of Nosocomial Candida Infections, David R. Snydman, MD

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