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1. CDC Information on Candida albicans and Candidiasis

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1. CDC Information on Candida albicans and Candidiasis

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Candida albicans is a type of fungus that naturally resides in the human body. It can cause infections when it overgrows, leading to a condition known as candidiasis.

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Candidiasis is a fungal infection caused by an overgrowth of the yeast Candida.

Many types of Candida live naturally in parts of the body and only cause symptoms if too much grows (i.e., vaginal yeast infections).

Invasive candidiasis can occur in hospitalized patients if Candida infects the bloodstream (candidemia), organs, or bones.

Overview

Candidiasis is a fungal infection caused by Candida, a yeast. Everyone has Candida on their skin and in parts of their body (like the mouth, throat, gut, and vagina). Candida only causes symptoms and infections if it grows out of control.

Vaginal candidiasis (yeast infections) are one of the most common fungal infections. Candida can also overgrow in the mouth or throat (thrush) or in the esophagus (the tube leading from the throat into the gut).

Invasive candidiasis occurs among hospitalized patients when Candida infects the internal organs like the kidney or brain or the bloodstream (also called candidemia). The symptoms and severity of infection are very different compared to the more common candidiasis of the vagina, mouth, throat, and esophagus. Generally, healthy people are not at risk for invasive candidiasis.

Types and strains

Many types (species) of Candida live on the skin and in parts of the body and normally do not cause any health effects. The most common species that can overgrow and cause candidiasis are: Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei.

Candida auris‎

Symptoms

Symptoms of candidiasis depend on the part of the body that is infected.

Some examples of types of infection and symptoms include:

V aginal candidiasis (yeast infection) -vaginal itching, soreness, and discharge.

Candidiasis in the mouth and throat (thrush)- white patches, redness or soreness.

Candidiasis in the esophagus - pain and difficulty swallowing.

Invasive candidiasis- fever and chills are common.

Symptoms depend on where the infection spreads such as organs or bloodstream (candidemia).

People who get invasive candidiasis are already sick making it hard to determine symptoms.

Risk factors

A weakened immune system and certain types of medications increases the risk of candidiasis.

Other risk factors can depend on the type of infection. For example, pregnancy and hormonal changes increase the risk of yeast infections. People with HIV/AIDS have a higher risk of getting esophageal candidiasis.

Invasive candidiasis occurs among sick and hospitalized patients and is not a risk for healthy people. Some medical interventions increase the risk for invasive candidiasis and candidemia, include having a central venous catheter, surgery, and chemotherapy.

Treatment and recovery

Candidiasis can be treated with different types of antifungal medications. Antifungal medications come in different forms: topical (creams, lozenges, oral rinses), pills, or intravenous solutions (taken through the vein). The type, dose, and length of antifungal treatment depend on the type and severity of infection and underlying health conditions.

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Candidiasis occurs when Candida , a yeast that lives in parts of the body, grows out of control.

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Candidiasis is an infection caused by the fungus Candida albicans. It can affect various parts of the body, including the mouth, throat, genitals, and bloodstream.

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Candida albicans is a type of yeast that is part of the normal flora of the human body but can cause infection when overgrown.

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The creams and suppositories in these regimens are oil based and might weaken latex condoms and diaphragms. Patients should refer to condom product labeling for further information. Even women who have previously received a diagnosis of VVC by a clinician are not necessarily more likely to be able to diagnose themselves; therefore, any woman whose symptoms persist after using an over-the-counter preparation or who has a recurrence of symptoms <2 months after treatment for VVC should be evaluated clinically and tested. Unnecessary or unapproved use of over-the-counter preparations is common and can lead to a delay in treatment of other vulvovaginitis etiologies, which can result in adverse outcomes. No substantial evidence exists to support using probiotics or homeopathic medications for treating VVC.

Follow-Up

Follow-up typically is not required. However, women with persistent or recurrent symptoms after treatment should be instructed to return for follow-up visits.

Management of Sex Partners

Uncomplicated VVC is not usually acquired through sexual intercourse, and data do not support treatment of sex partners. A minority of male sex partners have balanitis, characterized by erythematous areas on the glans of the penis in conjunction with pruritus or irritation. These men benefit from treatment with topical antifungal agents to relieve symptoms.

Special Considerations

Drug Allergy, Intolerance, and Adverse Reactions

Topical agents usually cause no systemic side effects, although local burning or irritation might occur. Oral azoles occasionally cause nausea, abdominal pain, and headache. Therapy with the oral azoles has rarely been associated with abnormal elevations of liver enzymes. Clinically important interactions can occur when oral azoles are administered with other drugs ( 1141).

Complicated Vulvovaginal Candidiasis

Diagnostic Considerations

Vaginal culture or PCR should be obtained from women with complicated VVC to confirm clinical diagnosis and identify non- albicans Candida. Candida glabrata does not form pseudohyphae or hyphae and is not easily recognized on microscopy. C. albicans azole resistance is becoming more common in vaginal isolates ( 1144, 1145), and non- albicans Candida is intrinsically resistant to azoles; therefore, culture and susceptibility testing should be considered for patients who remain symptomatic.

Recurrent Vulvovaginal Candidiasis

Recurrent VVC, usually defined as three or more episodes of symptomatic VVC in <1 year, affects <5% of women but carries a substantial economic burden ( 1146). Recurrent VVC can be either idiopathic or secondary (related to frequent antibiotic use, diabetes, or other underlying host factors). The pathogenesis of recurrent VVC is poorly understood, and the majority of women with recurrent VVC have no apparent predisposing or underlying conditions. C. glabrata and other non- albicans Candida species are observed in 10%-20% of women with recurrent VVC. Conventional antimycotic therapies are not as effective against these non- albicans yeasts as against C. albicans.

Treatment

Most episodes of recurrent VVC caused by C. albicans respond well to short-duration oral or topical azole therapy. However, to maintain clinical and mycologic control, a longer duration of initial therapy (e.g., 7-14 days of topical therapy or a 100-mg, 150-mg, or 200-mg oral dose of fluconazole every third day for a total of 3 doses [days 1, 4, and 7]) is recommended, to attempt mycologic remission, before initiating a maintenance antifungal regimen.

Oral fluconazole (i.e., a 100-mg, 150-mg, or 200-mg dose) weekly for 6 months is the indicated maintenance regimen. If this regimen is not feasible, topical treatments used intermittently can also be considered. Suppressive maintenance therapies are effective at controlling recurrent VVC but are rarely curative long-term ( 1147). Because C. albicans azole resistance is becoming more common, susceptibility tests, if available, should be obtained among symptomatic patients who remain culture positive despite maintenance therapy. These women should be managed in consultation with a specialist.

Severe Vulvovaginal Candidiasis

Severe VVC (i.e., extensive vulvar erythema, edema, excoriation, and fissure formation) is associated with lower clinical response rates among patients treated with short courses of topical or oral therapy. Either 7-14 days of topical azole or 150 mg of fluconazole in two sequential oral doses (second dose 72 hours after initial dose) is recommended.

Non-albicans Vulvovaginal Candidiasis

Because approximately 50% of women with a positive culture for non- albicans Candida might be minimally symptomatic or have no symptoms, and because successful treatment is often difficult, clinicians should make every effort to exclude other causes of vaginal symptoms for women with non- albicans yeast ( 1148). The optimal treatment of non- albicans VVC remains unknown; however, a longer duration of therapy (7-14 days) with a nonfluconazole azole regimen (oral or topical) is recommended. If recurrence occurs, 600 mg of boric acid in a gelatin capsule administered vaginally once daily for 3 weeks is indicated. This regimen has clinical and mycologic eradication rates of approximately 70% ( 1149). If symptoms recur, referral to a specialist is advised.

Management of Sex Partners

No data exist to support treating sex partners of patients with complicated VVC. Therefore, no recommendation can be made.

Special Considerations

Compromised Host

Women with underlying immunodeficiency, those with poorly controlled diabetes or other immunocompromising conditions (e.g., HIV), and those receiving immunosuppression therapy (e.g., corticosteroid treatment) might not respond as well to short-term therapies. Efforts to correct modifiable conditions should be made, and more prolonged (i.e., 7-14 days) conventional treatment is necessary.

Pregnancy

VVC occurs frequently during pregnancy. Only topical azole therapies, applied for 7 days, are recommended for use among pregnant women. Epidemiologic studies indicate a single 150-mg dose of fluconazole might be associated with spontaneous abortion ( 1150) and congenital anomalies; therefore, it should not be used ( 1151).

HIV Infection

Vaginal Candida colonization rates among women with HIV infection are higher than among women without HIV with similar demographic and risk behavior characteristics, and the colonization rates correlate with increasing severity of immunosuppression ( 1152). Symptomatic VVC is also more frequent among women with HIV infection and similarly correlates with severity of immunodeficiency ( 1153). In addition, among women with HIV, systemic azole exposure is associated with isolation of non- albicans Candida species from the vagina.

Treatment for uncomplicated and complicated VVC among women with HIV infection should not differ from that for women who do not have HIV. Although long-term prophylactic therapy with fluconazole 200 mg weekly has been effective in reducing C. albicans colonization and symptomatic VVC ( 1154), this regimen is not recommended for women with HIV infection in the absence of complicated VVC ( 98). Although VVC is associated with increased HIV seroconversion among HIV-negative women and increased HIV cervicovaginal levels among women with HIV infection, the effect of treatment for VVC on HIV acquisition and transmission remains unknown.

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Vulvovaginal Candidiasis - STI Treatment Guidelines

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The creams and suppositories in these regimens are oil based and might weaken latex condoms and diaphragms. Patients should refer to condom product labeling for further information.

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4. Symptoms and Complications of Candidiasis

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4. Symptoms and Complications of Candidiasis

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Oral Candidiasis (Thrush): White patches in the mouth, soreness, and difficulty swallowing.

Genital Candidiasis: Itching, redness, and a thick white discharge in women; irritation and redness in men.

Invasive Candidiasis: Fever, chills, and can affect organs like the heart, brain, eyes, bones, and others.

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Symptoms of candidiasis depend on the type of infection: vaginal, oral, esophagus, or invasive.

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5. Diagnosis and Treatment of Candidiasis

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5. Diagnosis and Treatment of Candidiasis

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Diagnosis typically involves clinical examination and laboratory tests such as culture or PCR. Treatment depends on the infection site and severity, ranging from topical antifungals to systemic medications.

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Vaginal candidiasis is diagnosed by testing a sample of vaginal discharge.

Candidiasis of the mouth or throat is diagnosed by exam or testing a sample from the infected area.

Candidiasis of the esophagus is diagnosed by an endoscopy (a camera is extended down the throat to the digestive tract).

Invasive candidiasis is diagnosed with blood tests.

Diagnosis and testing

Different types of exams and tests are used to test for different types of candidiasis. Test results are usually returned within a few days.

Vaginal candidiasis (Yeast infections)

Healthcare providers usually diagnose vaginal candidiasis by taking a small sample of vaginal discharge. They examine the sample under a microscope in the medical office or send it to a laboratory for a fungal culture. However, a positive fungal culture does not always mean that Candida is causing symptoms. Some women can have Candida in the vagina without having any symptoms.

Candidiasis of the mouth or throat (Thrush)

Healthcare providers can usually diagnose candidiasis in the mouth or throat simply by looking inside. Sometimes a healthcare provider will take a small sample from the mouth or throat. The sample is sent to a laboratory for testing, usually to be examined under a microscope.

Candidiasis of the esophagus

Healthcare providers usually diagnose candidiasis in the esophagus by doing an endoscopy. An endoscopy is a procedure to examine the digestive tract using a tube with a light and a camera. A healthcare provider might prescribe antifungal medicine without doing an endoscopy to see if the patient's symptoms get better.

Invasive candidiasis

People tend to already be in the hospital when they get invasive candidiasis such as infections of internal organs and bloodstream infections (candidemia). Healthcare providers rely on the patient's medical history, symptoms, physical examinations, and laboratory tests to diagnose invasive candidiasis. The most common way that healthcare providers test for invasive candidiasis is by taking a blood sample or sample from the infected body site and sending it to a laboratory to see if it will grow Candida in a culture.

When to get tested

If you have symptoms of candidiasis, talk to your healthcare provider about testing.

Symptoms of vaginal candidiasis are similar to other types of vaginal infections so testing helps determine appropriate treatment.

Candidiasis of the mouth, throat, and esophagus mostly affect people with weakened immune systems. Testing and treatment as soon as symptoms start can prevent severe infections.

Invasive candidiasis usually occurs in healthcare settings. Healthcare providers may test patients who develop fever and chills or other symptoms for many types of infections. Invasive candidiasis is diagnosed by laboratory testing of a patient's blood sample.

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Healthcare providers diagnose candidiasis with different tests depending on the type of infection.

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6. Prevention and Management of Candidiasis

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6. Prevention and Management of Candidiasis

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Good hygiene practices, avoiding unnecessary antibiotics, and managing underlying health conditions can help prevent candidiasis. Treatments include antifungal medications like clotrimazole, nystatin, and fluconazole.

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Recent studies have explored the use of probiotics as a novel approach to preventing and treating Candida albicans infections.

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8. Lifecycle and Pathogenicity of Candida albicans

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8. Lifecycle and Pathogenicity of Candida albicans

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This infographic provides a visual representation of how Candida albicans transitions from a harmless commensal organism to a pathogenic state, highlighting key stages in its lifecycle and the factors that contribute to its virulence.

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9. Dr. Jane Smith: Expert in Fungal Infections

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9. Dr. Jane Smith: Expert in Fungal Infections

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Dr. Jane Smith is a leading researcher at XYZ University focusing on fungal infections and antifungal resistance.

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This video provides a comprehensive overview of Candida albicans and the infections it can cause. It covers the basics of how Candida albicans functions as both a commensal organism and a pathogen, the symptoms of candidiasis, and the current treatment options available.

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What causes yeast infections, and how do you get rid of them? - Liesbeth Demuyser

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Fun Fact: Candida albicans can form biofilms on medical devices such as catheters, which makes it particularly difficult to treat because biofilms protect the fungal cells from antifungal treatments and the host's immune response.

Unanswered Question: Despite advances in understanding Candida albicans, scientists are still exploring the precise mechanisms that trigger its transition from a harmless commensal organism to a pathogenic state. What environmental and genetic factors contribute to this shift?