Candidiasis is a yeast, or fungal, infection caused by several species of
candida, the most predominant being Candida albicans. Although
approximately 80% of healthy individuals will have normal colonization in the
mouth, gastrointestinal tract, vagina, and rectum, most produce bacterial flora
to protect against infections. Clinical manifestations vary according to subtype
and range from superficial to severe infections. Candidiasis is the fourth
leading cause of nosocomial infectious disease. Approximately 75% of women will
contract candidiasis of the vagina during their lifetime, and 90% of people
diagnosed with HIV/AIDS will develop a candida infection. The primary subtypes
- Oral candidiasis (thrush)
- Perlèche (candidal angular chelitis)
- Cutaneous disease
- Disseminated candidiasis (can affect lungs, liver, spleen, kidneys,
heart, brain, and eyes)
- Gastrointestinal candidiasis
- Urinary tract candidiasis
- Candidal endocarditis (often due to damaged or prosthetic cardiac
valves or long-term intravenous catheter use)
- Central nervous system candidiasis (extremely rare)
- Chronic candidiasis (occurs predominantly in immunosuppressed
Biological factors (e.g., immunologic defects); physical influences (e.g.,
excessive moisture in groin and inframammary folds); pharmaceutical therapies
(e.g., broad-spectrum antibacterials); and genetic predisposition (e.g., chronic
mucocutaneous candidiasis) are factors in the etiology of
- Dermatitis (e.g., contact or primary irritant, seborrheic,
- Prolonged neutropenia
- Bacterial infection
- Cushing's disease
- HIV infection
- Intravenous drug abuse
- Intravascular catheter
- Long-term antibiotic use
|Signs and Symptoms|
- Fever, malaise
- Creamy white patches overlying erythematous buccal mucosa
- Painful, macerated fissures at the corners of the mouth
- Erythematous skin lesion found most commonly in the groin, between
fingers and toes, under the female breast, and in the axilla (cutaneous
- Vulvar erythema, edema, and pruritus; usually includes a curdlike
- Large abscesses and diffuse microabscesses (disseminated
- Erosive lesions of the distal esophagus and stomach (gastrointestinal
- Urinary tract infection (urinary tract
- Herpes simplex virus
- Acquired immunodeficiency syndrome (AIDS)
- Contact or primary irritant (e.g., diaper rash), seborrheic, or
- Bacterial infection
- Acrodermatitis enteropathica
The physical presentations of candidiasis vary according to subtype. They may
include white patches in the mouth or throat; peeling skin on hands; swollen
nail folds; itchy, shiny rash that is pink with scaly or blistered edges;
vaginal redness and swelling of the vulva accompanied by thick white discharge;
and red patches and blisters on penis.
Because candida is commonly found in healthy individuals, caution is
recommended in diagnosis based on laboratory findings alone. Laboratory tests
include culture analysis for yeast and pseudohyphae, antibiotic susceptibility
testing, blood culture, candida antibody and candida antigen tests, and analysis
of the cerebrospinal fluid.
Histologic response is often purulent and may resemble infectious bacterial
lesions; abscesses or microabscesses may be present; occasional response is
granulomatous; budding yeast, pseudohyphae, and true hyphae may be found in
CT scans of the abdomen may show hepatosplenomegaly with low-density liver
defects in disseminated disease; esophagoscopy may be used in candidiasis
patients with swallowing difficulties and the absence of thrush or who do not
respond to antifungal therapy.
- Physical examination—assess appearance and
clinical symptoms; tissue biopsy or evidence of retinal disease required for
diagnosis of invasive systemic disease
- Clinician interview—evaluate for intravenous
drug use, recent surgery or hospitalization, and chronic antibiotic
- Lysis/centrifuge of blood cultures to isolate causative
A number of topical and systemic antifungal agents are available for treating
the subtypes of candidiasis. Topical agents include oral rinses, oral tablets
(troches), vaginal tablets or suppositories, and creams. Fluid and electrolyte
therapy may be required for more serious cases.
- Imidazole antibiotics, such as fluconazole (Difulcan), ketoconazole
(Nizoral—topical), and itraconazol (Sporanox), are
effective in treating several subtypes of candidiasis; dosages vary depending on
subtype; some isolates of candida species are developing resistance to
imidazoles; recommended dosages include the following examples:
- fluconazole or itraconazol (100 mg/day) for oral
- fluconazole (150 mg once) for vulvovaginal candidiasis
- flucytosine (150 mg/kg/day) or fluconazole (200 to 400 mg/day
intravenously) for disseminated candidiasis
- Other antifungals, such as amphotericin B (topical, infusion, or
liquid form), are also available to treat more severe or recalcitrant cases or
where esophagitis is present; side effects include irreversible kidney damage,
allergic reaction (preventable with steroids), and lowering of blood potassium
and magnesium levels; may be contraindicated if patient is taking other
medications such as antineoplastics, interferon, or AZT.
- Topical azole preparations, such as vaginal tablet clotrimazole (100
mg once a day for seven days) and the vaginal suppository miconazole (200 mg
once a day for three days); creams are sometimes combined with low-strength
corticosteroid for anti-inflammatory and antipruritic
|Complementary and Alternative
Many patients may present with a self-diagnosis of intestinal candida. Stool
culture or candida antigen (serum) may be the preferred methods for testing in
this population. However, neither test is perfect. Many people without symptoms
will test positive. The "candida diet" allows no alcohol, no simple sugars, and
very limited refined foods. Many people may feel better due to the diet alone.
The thrust of alternative therapies for candida is to "starve" the yeast present
and use natural antifungals.
- Vitamin C (500 to 1,000 mg/day), vitamin E (200 to 400 IU/day), and
selenium (200 mcg/day) anti-inflammatory
- Essential fatty acids: anti-inflammatory, a mix of omega-6 (evening
primrose) and omega-3 (flaxseed) may be most optimum (2 tbsp. oil/day or 1,000
to 1,500 mg bid). Dietary manipulation includes reducing animal fats and
increasing fish and nuts.
- Biotin: (300 mcg) inhibits the pseudohyphae form of candida, which is
the most irritating to membranes
- B-complex: B1 (50 to 100 mg), B2 (50 mg), B3 (25 mg), B5 (100 mg), B6
(50 to 100 mg), B12 (100 to 1,000 mcg), folate (400 mcg/day) should be yeast
- Calcium (1,000 to, 1,500 mg/day) to correct deficiency often found in
yeast infections, and magnesium (750 to 1,000 mg/day) to balance calcium
- Lactobacillus acidophilus (2 to 5 million organisms tid) to help
restore normal balance of bowel and mucous membranes. Many European physicians
routinely prescribe acidophilus when they prescribe antibiotics. Studies showed
saccromyces boulardii effectively treats antibiotic-induced diarrhea.
- Caprylic acid: (1 g with meals) antifungal fatty acid
- Avoid simple carbohydrates including fruit juice, yeast, and
fermented foods, limit fruit to 1 serving/day, increase garlic (fungicidal),
nuts (essential fatty acids), whole grains (B vitamins), oregano, cinnamon,
sage, and cloves (antifungal spices)
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
- Pau d'arco bark (Tabebuia avellanedae): antifungal, best used
as a tea (2 tbsp. boiled in 1 quart of water; 3 to 6 cups/day), or use the
cooled tea as a vaginal douche
- Goldenseal (Hydrastis canadensis), Oregon grape root
(Mahonia nervosa), and barberry (Berberis vulgaris) are bitter,
digestive, and immune stimulants. Chamomile (Matricaria recutita) and
licorice (Glycyrrhiza glabra) are anti-inflammatory and soothing to
mucous membranes. Use a tea or tincture of the five herbs listed above (1 cup
tea tid or 30 to 60 drops tincture tid) for six weeks.
- Topical treatments include tea tree oil (Melaleuca alternifolia)
or lavender essential oil (Lavandula species) bid to tid; apply full
strength to skin infections, discontinue if skin irritation develops;
marigold (Calendula officinalis): apply three to five times/day in a
salve for rashes, soothing to skin and mucous membranes
- Fireweed (Epilobium parviflorum): quite effective as a tea for
oral, vaginal, and intestinal
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Borax for bleeding oral mucosa, especially with
- Belladonna for bright red, inflamed skin that is not raw or
oozing, but is painful, especially with irritability
- Chamomilla for "diaper" rash that is bright red, especially
- Arsenicum album for burning, itching rashes, especially with
- Graphites for thick, cracked skin (corners of mouth or heels)
- Kreosotum for leukorrhea that causes itching, swelling, and
May be helpful to stimulate immune system, digestion, and relieve
Almost all AIDS patients will have some form of mucosal candidiasis;
underlying predisposing factor(s) should be addressed in all forms of invasive
disease. Monitor closely patients who are on daily amphotericin B therapy.
Repeat blood cultures until negative.
When taking antibiotics, supplement with lactobacillus acidophilus; avoid
broad-spectrum antibiotics unless necessary; practice good hygiene, including
oral hygiene and thorough cleansing of genital areas; maintain appropriate
weight; wear cotton or silk underwear; women should avoid douches (unless
medically indicated), vaginal deodorants, and bubble baths; limit sweets and
alcohol intake; diabetics should adhere to treatments; wear rubber gloves if
occupation requires keeping hands in water; keep skin dry.
- Secondary bacterial infections (e.g., in the vagina); drug side
effects and interactions may range from severe irreversible kidney damage
(amphotericin) and liver toxicity (fluconazole) to milder bouts of nausea,
vomiting, headache, abdominal pain, and diarrhea.
- Endocarditis, myocarditis, pericarditis
- CNS infection
Most cases of candidiasis are curable, often responding to treatment within
days; people with immune deficiencies or taking immunosuppressants require
long-term monitoring. Overall mortality associated with hematogenously
disseminated candidiasis is significant.
Animal studies have shown that ketoconazole can cause birth defects, although
this side effect has not been studied in pregnant
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Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
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