CANDIDIASIS – Predisposing Factors, Clinical Manifestations, Management and Prevention 

CANDIDIASIS – Predisposing Factors, Clinical Manifestations, Management and Prevention

Candidiasis is an infection caused by a yeast-like fungus called Candida albicans. It can affect the mouth, vagina, skin, stomach, and urinary tract. Oral infections, called oral thrush, are most commonly in infants, elderly people and those with a weakened immune system. Candidiasis normally found on mucous membranes, on skin, in vagina and in gastro intestinal tract.

PREDISPOSING FACTORS RESPONSIBLE FOR CANDIDIASIS

• Warm, moist area of skin
  
• Broad-spectrum antibiotics
  
• Central venous catheters or parenteral nutrition
  
• Pregnancy
  
• Use of birth control pills
  
• Poor nutrition
  
• Corticosteroid treatment or cushing’s disease
  
• Diabetes mellitus
  
• Immunosuppression
  
• Some malignancies of the blood
  
• Renal replacement therapy
  
• Implanted prostheses
  
• Radiotherapy
  
• Intensive care or prolonged ventilation
  
• Gastrointestinal (GI) tract surgery
  

 

CLINICAL MANIFESTATIONS

 A. Oral Candidiasis (Thrush): a yeast infection of the mouth or throat area is called thrush. Healthy adults do not usually get thrush. It is most often seen in:

• Creamy white (curd – like) patches in the mouth or on the throat
  
• Redness or discomfort in the mouth area
  
• Sore throat and difficulty swallowing
  
• Cracking at corners of the mouth where lips meet
  
• Painful cracks at the corners of the mouth
  

 

B. Yeast Infection of the Genitals: Vaginal yeast infections are common in women. Common symptoms include:

• Extreme itching in the vaginal area
  
• Soreness and redness in the vaginal area
  
• White, clumpy vaginal discharge that look like cottage cheese
  
• Painful intercourse. But men can get a yeast infection, too. This is more likely in men who are not circumcised.
  
• Red rash on penis
  
• Itching or burning on the tip of the penis
  

 

C. Skin Infection: skin rashes, patches, and blisters found most commonly in the groin, between fingers and toes, and under the breasts. Diffuse papulae erythematous rash with pin point satellite lesion around edges of affected area.

 

MANAGEMENT

Many antifungal medications can treat candidiasis. Doctor will prescribe a drug depending on condition.

Antifungal medications – these include oral rinses and tablets, vaginal tablets and suppositories and creams. For vaginal yeast infections, medications that are available over the counter include creams and suppositories such as miconazole (monistat), ticonazole (vagistat) and clotrimazole (gyne-lotrimin). Doctor may prescribe a pill, fluconazole (diflucan). Side effects vary.

Creams combined with low-strength corticosteroids – reduce inflammation and itching.

Most treatments last from 2-3 days to 2 weeks. Be sure to take all medicine exactly as prescribed. If you do not, the same infection could come back, or you could become infected with a new strain of candida.

For severe candidiasis that could be life threatening to someone with a weak immune system, doctor may prescribe an intravenous (IV) medication, amphotericin B.

PREVENTION

Here are some hygiene tips to help prevent vaginal candidiasis:

• Wipe from front to back after going to the toilet – the rectal area is full of yeast
  
• Take baths not showers – sitting in the bath can clear yeast from the vaginal area
  
• Dry thoroughly afterwards, especially the pubic hair  - use a hair dryer on low setting
  
• Don’t use soap around the vagina – soap kills bacteria want to keep and has no effect on yeast
  
• Avoid chemicals like deodorant tampons and especially vaginal douches, which serve no purpose and may cause infection.
  
• 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.
  

 

These sensible precautions may also help prevent candidiasis:

• Wear loose cotton underwear
  
• Avoid pantyhose and tight pants
  
• 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.
  
• Cut down on sugar and alcohol (yeast’s favorite foods)
  
• Consider changing “the pill” – if you have had recurring infections, talk to your doctor about changing your birth control pill and see if it helps.
  
• Make sure your partner is not affected – there’s no point curing candidiasis if you are going to be re-infected.
  
• Don’t ask for antibiotics if you have got a cold or the flu – the flu is caused by viruses, so taking antibiotics won’t help and they might provoke candidiasis.
  

 

NURSING MANAGEMENT FOR FUNGAL INFECTION

1. Wash hands and teach other caregivers to wash hands before contact with patient, and between procedures with patient
   
2. Encourage intake of protein and calorie-rich foods to maintain optimal nutritional status.
   
3. Encourage fluid intake of 2000 ml to 3000 ml of water per day to promote diluted urine and frequent emptying of bladder
   
4. Advice the person not to sharing the linen and personal items like towel, comb etc.
   
5. Use a clean towel each day
   
6. Carefully dry all skin folds including under breast, under arms and between toes.
   
7. Wear clean under clothes and it should not be very tight fitted
   
8. Do not wear same shoes everyday
   
9. Do not wear rubber or plastic soled shoes
   
10. Use talcum powder or OTC (over the counter) antifungal agents (clotrimazole) twice a day.
    

 

FOR CANDIDIASIS

• Teach the patient to avoid tight clothes such as jeans
  
• Wear cotton underwear
  
• Bath frequently and dry genital area well
  
• Advice the patient that sexual partners should also be treated with antifungal medicines
  
• Use condom or abstinence