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 are:

• Oral candidiasis (thrush)
• Perlèche (candidal angular chelitis)
• Cutaneous disease
• Vulvovaginitis
• 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 patients)

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 candidiasis.

• Dermatitis (e.g., contact or primary irritant, seborrheic, atopic)
• Prolonged neutropenia
• Psoriasis
• Bacterial infection
• Cushing's disease
• Obesity
• Histiocytosis
• Pregnancy
• Diabetes
• HIV infection
• Intravenous drug abuse
• Surgery
• Intravascular catheter
• Long-term antibiotic use

• Fever, malaise
• Hypotension
• Creamy white patches overlying erythematous buccal mucosa (thrush)
• Painful, macerated fissures at the corners of the mouth (perlèche)
• Erythematous skin lesion found most commonly in the groin, between fingers and toes, under the female breast, and in the axilla (cutaneous disease)
• Vulvar erythema, edema, and pruritus; usually includes a curdlike discharge (vulvovaginitis)
• Large abscesses and diffuse microabscesses (disseminated candidiasis)
• Erosive lesions of the distal esophagus and stomach (gastrointestinal candidiasis)
• Urinary tract infection (urinary tract candidiasis)

• Herpes simplex virus
• Acquired immunodeficiency syndrome (AIDS)
• Contact or primary irritant (e.g., diaper rash), seborrheic, or atopic dermatitis
• Psoriasis
• Bacterial infection
• Acrodermatitis enteropathica
• Histiocytosis

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 tissue.

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 use
• Lysis/centrifuge of blood cultures to isolate causative organism

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 candidiasis
• 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 action.

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 free
• 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 intake
• 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 noted.

• 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 candidiasis

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 diarrhea
• 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 with irritability
• Arsenicum album for burning, itching rashes, especially with anxiety
• Graphites for thick, cracked skin (corners of mouth or heels) that oozes
• Kreosotum for leukorrhea that causes itching, swelling, and extreme excoriation

May be helpful to stimulate immune system, digestion, and relieve stress.

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 women.

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