Candidiasis

- is an infection caused by yeast-like fungi. Although infection of the mucous

membrane (such as vagina, mouth) predominates, more widespread and
deeply seated infection involving internal organs can occur.
- Etiologic agent: Candida Albicans
- The incubation period is variable.
- Candida is a non-pathogenic (normal flora of the mucous membranes of
upper respiratory tract and female genital tracts and also of gastrointestinal
tract), sometimes it become pathogenic yeast, invade the mucous membrane
and causes candidiasis (opportunistic infection) in immunocompromised
individuals.
- In 2016, a total 1,481,899 women are affected by Candidiasis in the
Philippines.
• There are 3 major type of infections caused by Candida albicans: oropharyngeal
candidiasis, vulvovaginal (genital) candidiasis, and invasive candidiasis
(candidemia).

1. Oropharyngeal Candidiasis
is an infection in the mouth and throat area. Usually, it is characterized by the
formation of white patches on top of the tongue and throughout the mouth,
which is also known as “thrush”. Thrush can be removed with a blade or a
cotton-tipped swab, but the underlying tissue will be irritable and show a
distinct redness. This infected area will cause soreness and difficultly during
eating
2. Vulvovaginal (genital) candidiasis
is the infection of the genital region, typically the vaginal walls, in women.
The vaginal yeast infection causes itchiness and a burning-sensation in the
vagina and surrounding tissues. Also, a white discharge – described with an
appearance similar to white cottage cheese – is typically present.
Genital candidiasis is much more prevalent in women, but men can also
contract it. Although it is not considered an STD, men are usually infected
after sex with a woman having a vaginal yeast infection. Symptoms involved
rash, irritation on the head and surrounding skin of the penis
3. Invasive candidiasis (or candidemia)
is the infection of C. albicans into the bloodstream. This
leads to its invasion of organs throughout the body, such as the kidney,
liver, brain and many more. Patients began to suffer from fevers, chills,
fatigue, muscles aches, and abdominal pains. Typically, patients with
compromised immune systems are only at risk, while healthy people are
susceptible to oral/genital candidiasis. Compromised immune systems can
be caused by chemotherapy, transplantation, broad-spectrum antibiotics,
and much more
 Etiology
 pregnancy
 use of high estrogen oral contraceptives
 disturbed glucose tolerance e.g. diabetes mellitus
 use of broad-spectrum systemic antibiotics and corticosteroid
 tight-fitting synthetic underwear
 immunosuppression
Pathogenesis
 Mode of Transmission
by contact with excretions of mouth, skin, and feces from patients
or carriers; from mother to infant during childbirth; disseminated
candidiasis may originate from mucosal lesions, unsterile narcotic
injections, catheters

 Communicability
Although rare, person to person transmission can occur between
family members or between patients.
 Manifestations
SKIN
Scaly, erythematous, papular rash (+ exudates ; breast area)
Between fingers
Axilla
Groin area
Umbilicus
NAILS
Red and swollen
Darkened nail beds
Occasionally with purulent discharges
Separation of pruritic nail from the nail beds

OROPHARYNGEAL MUCOSA
Cream colored or bluish white patches of exudates in the tongue
Mouth
Pharynx
Swelling
Respiratory distress in neonates
VAGINAL MUCOSA
 White yellowish discharge
 Puritus
 Excoriation
 White or gray raised patches
 Local inflammation
RENAL SYSTEM
 fever, flank pain, dysuria, hematuria, pyuria
PULMONARY
 Hymoptysis, fever, cough
BRAIN
 Headache, nuchal rigidity, seizures
ENDOCARDIUM
 Systolic or diastolic murmur, fever, chest pain
EYES
 Blurred vision, orbital or periorbital pain
 Diagnostic Tests
 Direct microscopy
In all suspected cases, mycological examination should be
carried out. A wet mount or saline preparation has a sensitivity of 40-
60%. Microscopic examination usually reveals the characteristic
budding cells and pseudohyphae of Candida in Gram-stained smear
prepared from vaginal discharge.

 Culture
Vaginal culture is the most sensitive test for final diagnosis.
However, a positive culture does not mean that the C. albicans is
pathogenic, as it may be the normal commensal.

 pH
A normal vaginal pH (4.0-4.5) is found in patients who have
VVC. A pH greater than 5.0 suggests the possibility of bacterial
vaginosis, trichomoniasis, or a mixed infection.
 Treatment

 Uncomplicated yeast infection

For mild to moderate symptoms and infrequent episodes of yeast infections, your
doctor might recommend:

1. Short-course vaginal therapy.

Antifungal medications are available as creams, ointments, tablets and
suppositories. An antifungal regimen that lasts one, three or seven days will
usually clear a yeast infection. A number of medications have been shown to be
effective, including butoconazole (Gynazole-1), clotrimazole (Gyne-Lotrimin),
miconazole (Monistat 3), and terconazole (Terazol 3). Some of these are available
by prescription only, while others are available over-the-counter.

Side effects : slight burning or irritation during application. You may need to use
an alternative form of birth control. Because the suppositories and creams are oil-
based, they could potentially weaken latex condoms and diaphragms.
2. Single-dose oral medication.
Your doctor might prescribe a one-time, single oral dose of the
antifungal medication fluconazole (Diflucan). Or, you may take two single
doses three days apart to manage severe symptoms.
3. Over-the-counter treatment.
Over-the-counter antifungal vaginal suppositories and creams are
effective for many women, and these are a safe choice during pregnancy.
Treatment usually lasts from three to seven days.
Make a follow-up appointment with your doctor if symptoms don't resolve
after treatment, or if they return within two months of treatment.

 Complicated yeast infection

Treatment for a complicated yeast infection might include:

1. Long-course vaginal therapy.

A treatment regimen of azole medications for seven to 14 days can
successfully clear a yeast infection. Medication is usually vaginal cream,
ointment, tablet or suppository.

2. Multidose oral medication.

Your doctor might prescribe two or three doses of fluconazole to be
taken by mouth instead of vaginal therapy. However, this therapy isn't
recommended for pregnant women.
3. Maintenance plan.
For recurrent yeast infections, your doctor might recommend a
medication routine to prevent yeast overgrowth and future infections.
Maintenance therapy starts after a yeast infection is cleared
with treatment.
You may need a longer treatment of up to 14 days to clear the
yeast infection before beginning maintenance therapy.
Therapies may include a regimen of oral fluconazole tablets
once a week for six months.
Some doctors prescribe clotrimazole as a vaginal suppository
used once a week instead of an oral medication.
 Nursing Management

1. Observe standard precautions.

2. Provide a nonirritating mouthwash to loosen tenacious secretions and a soft
toothbrush to avoid irritation.
3. Relieve mouth discomfort with a topical anesthetic, such as lidocaine at
least 1 hour before meals.
4. Apply cornstarch, nystatin powder, or dry padding in intertriginous areas of
obese patients to prevent irritation and candidal growth.
5. Record dates of I.V. catheter insertion and replace the catheter according to
hospital policy to prevent phlebitis.
6. Provide appropriate supportive care for patient’s with systemic infections.
7. Prepare to give blood transfusions if ordered and if the patient has low
platelet count.

8. Frequently check the vital signs of a patient with systemic infection.

9. If you note a vaginal discharge, document the color and amount.

10. Carefully monitor intake and output and potassium levels while the patient
is receiving medications.

11. If the patient has renal involvement, carefully monitor blood urea nitrogen,
serum creatinine, and urine
12. Assess the patient with candidiasis for underlying systemic causes, such as
diabetes mellitus, infection, or immune dysfunction.

13. Demonstrate comprehensive oral hygiene practices, and have the patient
perform a return demonstration.

14. Recommend that the patient use alkaline mouth care products because
increased acidity promotes candidal growth.

15. Tell the patient who’s using nystatin solution to swish it around in his
mouth for several minutes before swallowing.

16. Suggest a soft diet for the patient with severe dysphagia.
 Prevention and Control
1. wipe from front to back after going to the toilet - the rectal area is full of yeast
2. take baths not showers - sitting in the bath can clear yeast from the vaginal area
3. dry yourself thoroughly afterwards, especially the pubic hair - use a hair dryer on
low setting if you have to
4. don't use soap around the vagina - soap kills the bacteria you want to keep, and
has no effect on yeast
5. sterilize or throw away underwear that you wore during your last infection - the
washing machine isn't hot enough, you must boil them if you want to keep them.
You must also replace any diaphragms or caps.
6. avoid chemicals like deodorant tampons and especially vaginal douches, which
serve no purpose and may cause infection
7. wear loose cotton underwear
8. avoid pantyhose and tight pants
9. eat live yogurt, especially if you have been prescribed antibiotics or have
other factors which increase your risk for yeast infections – pasteurized
yogurt isn't effective. Some health food stores carry lactobacillus
acidophilus pills which may help to keep yeast in check
10. cut down on sugar and alcohol (yeast's favourite foods)
11. consider changing "the pill" - if you've had recurring infections, talk to your
doctor about changing your birth control pill and see if it helps
12. make sure your partner is not infected - there's no point curing candidiasis if
you're going to be re-infected
13. don't ask for antibiotics if you've got a cold or the flu - the flu is caused by
viruses, so taking antibiotics won't help and they might provoke candidiasis
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