Candida
Candida is the name for a group of yeasts (a type of fungus) that commonly infect the skin. The name “candida” refers to the white colour of the organisms in culture. Candidal infection is known as “candidiasis”, “candidosis” or “moniliasis”.
Candida depends on a living host for survival. It is a normal inhabitant of the human digestive tract from early infancy, where it lives without causing any disease most of the time. However, if the host’s defences are lowered, the organism can cause infection of the mucosa (the lining of the mouth, anus and genitals), the skin, and rarely, deep-seated infection.
The most common Candida (C) species to result in candidiasis is C. albicans
Oral candidiasis:
Oral candidiasis is often known as “thrush” because its white spots resemble the breast of the bird with the same name. Although candida is present in 50% of healthy mouths, it causes infection (candidiasis) when increased numbers of yeast cells invade the mucosa (the name for the moist skin inside body openings.
Clinical features :
Candida may arise suddenly as an acute infection or persist for long periods as a chronic infection.
Acute pseudomembranous candidiasis. There are white patches on gums, tongue & inside the mouth that can be peeled off leaving a raw area.
Acute atrophic candidiasis. There are smooth red shiny patches on the tongue. The mouth is very sore.
Chronic atrophic candidiasis. This is common in those with dentures. The underlying mucosa is red and swollen.
Angular cheilitis. There are sore red splits at each side of the mouth, more likely if there is overhang of the upper lip over the lower lip causing a moist deep furrow. Angular cheilitis due to candida and/or Staphylococcus aureus arises frequently in those taking the medication isotretinoin for acne; this medication dries the lips.
Chronic hyperplastic candidiasis. This is a type of oral leukoplakia (white patch) inside the cheeks or on the tongue with persistent nodules or lumps. It usually affects smokers and is pre-malignant. Red patches (erythroplakia) as well as white patches may indicate malignant change.
Chronic mucocutaneous candidiasis presents as a chronic pseudomembranous infection. The skin and nails are also affected.
Median rhomboid glossitis – there is diamond-shaped inflammation at the back of the tongue.
Candida can cause secondary infection of other skin conditions such as lichen planus or geographic tongue.
Severe infections may extend down the throat (oesophageal infection).
| Patient information | Fungal infections | Vulvovaginal candidiasis
Vulvovaginal candidiasis:
Vulvovaginal candidiasis is a yeast infection of the vulva and vagina. It is commonly called thrush.
Most women notice from time to time that they have a discharge from the vagina. This is a normal process which keeps the mucous lining of the vagina moist. The discharge is usually clear but may dry on underclothes leaving a faint yellowish mark. This type of discharge does not require any medication.
Other causes of vaginal discharge include infection with:
Candida (a yeast)
Trichomonas (a small parasite)
Gardnerella (the chance association of two kinds of bacteria which live in the vagina).
About 10% of non-pregnant women aged 15 to 55 harbour the yeast Candida albicans in the vagina but most have no symptoms and it is harmless to them. In a few women vaginal candidiasis causes a heavy white curd-like vaginal discharge, a burning sensation in the vagina and vulva and/or an itchy rash. This is also known as thrush or monilia.
Thrush occurs most commonly with:
Pregnancy
A course of broad spectrum antibiotics such as tetracycline
Diabetes
Iron deficiency anaemia
Immunological deficiency
On top of another skin condition, often psoriasis,lichen planus or lichen sclerosus.
Other illness
It may sometimes be transmitted or aggravated by sexual intercourse.
The doctor diagnoses the condition by inspecting the affected area and taking a swab. In recurrent cases the swab should be repeated after treatment to see whether Candida albicans is still present, or if a non-albicans candida is present. These are more resistant to treatment.
Swab results can be misleading however, because the yeast can be present without causing symptoms and it can only be cultured if a certain amount is present.
Some women appear to be hypersensitive to the organism, so although its presence cannot be proven by the laboratory, the yeast is still responsible for the subject’s symptoms, especially if they recur each month (cyclic vulvovaginitis).
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