What is Candidiasis?

The infections caused by the Candida fungus are opportunistic. That is, it is necessary that there be alterations in the defenses of the organism so that they occur.

Candidiasis are mycoses, that is, infections produced by fungi belonging to theCandida species.

• They may be acute, subacute or chronic infections.
• They affect the skin, mucous membranes and deep tissues.
• The symptomatology is very variable.
• The prognosis is also very variable. From muco-cutaneous light infections to the life of the patient compromised in cases of severe immunosuppression.
• These are opportunistic mycoses .

Candida spp *

It is a genus formed by fungi with the appearance of yeast, mostly unicellular. Within the genus, the species of clinical interest are:

• Candida albicans : it is the most virulent species and responsible for more than half of the cases.
• Candida glabrata
• C. parapsilosis : associated with the use of catheters, probes and needles.
• C. krusei : associated with taking Flukonazole (it is an antifungal)

* Acronyms are used to indicate reference to all species in the genus.

What are the opportunistic pathogens?

Opportunistic pathogens are those that, under normal conditions, do not infect a healthy person. There must be an alteration in one of the biological barriers of the immune system for this to happen.

The genus Candida , like the majority of fungi and some bacteria, belong to this group of pathogenic elements. In fact, Candida is part of the normal flora of the skin and mucous membranes in a large percentage of the population.

How does candidiasis occur?

By altering the mechanical barriers: damage to the skin and mucous membranes (primary barriers)

This is what happens in patients with catheters, probes, prostheses or dialysis. This also explains the infection of drug users by parenteral (injectable) drugs.

If the fungus passes through the bloodstream, this can affect any organ. It appears in patients with severe immunosuppression (poorly controlled and terminally ill HIV).

Damage to the skin or mucous membranes prevents this zone from acting as a barrier and allows colonization by the fungus. This is why syringe bites or erosion of the mucosa caused by a catheter predispose to infection.

Due to alterations in the bacterial flora

Damage to the bacterial flora often occurs because of the use of broad-spectrum antibiotics . This is due to their very broad scope. Antibiotics "attack" both the bacteria responsible for infection and those that are part of the flora. At the moment when this barrier disappears, mycosis is made possible.

For example, it is relatively common to find cases of vaginal candidiasis in young women after taking antibiotics.

Immunodepression states

They may be caused by a disease, as is the case with HIV patients, or may be of pharmacological origin, as is the case in patients transplanted and treated with anti-rejection drugs.

Clinical: superficial candidiasis

Muguet (oropharyngeal candidiasis)

It is characterized by the appearance of white pseudomembranes that cover the tongue, the soft palate and the oral mucosa. If they are removed, they reveal a red and worn surface. They can become very painful and compromise swallowing and breathing.

It occurs mainly in HIV-infected patients (up to 90%), as it is one of the first manifestations of the disease. Although this is one of the most frequent opportunistic infections that affect these patients, the incidence has recently reduced.

It also affects patients suffering from cancer due to impaired immune system and newborns for their immaturity.

Vaginitis and vulvovaginitis by Candidiasis

It is relatively common. It is characterized clinically by:

• Very intense vulvar and vaginal burns, especially when urinating
• Congested and very red aspect of the genital mucosa
• Appearance of whitish patches on red mucous membrane
• Vaginal secretions whitish and dense, with lumps. Described as " with a cheese-like appearance "

Balanitis by Candida

It is less common than vaginitis. It is normally associated with diabetes, in uncircumcised individuals or whose partner has already suffered from Candidiasis.

On the glans or foreskin of the reddish lesions appear to the eroded appearance as well as superficial pustules, normally painful. They can be accompanied by burning sensations that increase when urinating.

Cutaneous Candidiasis

It appears basically in the skin folds and in areas where the tightly fitting clothes occlude the skin . This is due to the fact that in both cases, hot and relatively humid zones are created.

It presents with a reddish eruption which causes intense itching and discomfort. It is located mainly on the buttocks, under the breasts, in the genitals and other areas of the skin. In addition, hair follicles can sometimes become infected and small pimples appear.

Diaper dermatitis is relatively common in infants; this one is superinfect by Candida, sharpening the symptoms of the first.

APECED: Polyendocrinopathy autoimmune type 1

It is a very rare genetic disease due to a mutation in the AIRE gene. The disease starts from childhood with repeated, oral and nail-like candidiasis, without any apparent reason.

Later a dysfunction of autoimmune origin appears in several glands. Then there are frames of hypoparatyroidism, adrenal insufficiency and Addison's disease.

Clinic: Deep Candidiasis

Oesophagitis by Candida

It is typical in immunosuppressive patients. It occurs very frequently in patients with HIV or lymphoma , and less frequently during corticosteroid therapy.The symptomatology is very particular:

• Retrosternal burning
• Difficulty digesting (dysphagia)
• heartburn

In addition, whitish pseudomembranes appear throughout the esophagic mucosa.

Clinic: invasive candidiasis

In these cases the fungus passes into the bloodstream and can affect almost any organ. It appears in patients with very severe immunosuppression (poorly controlled and terminally ill HIV).

This is a very bad case, poorly predicted in the majority of cases .

Diagnostic

The diagnosis is made by obtaining and analyzing cultures . They are taken by a smear on the affected area and are cultured in a suitable medium. Then, the cultures will be analyzed under a microscope.

Prevention and treatment

It is important to maintain good personal hygiene . After the shower, dry the skin folds well and take care of the genital area. In the case of pregnant women it is also advisable to consume bioactive yoghurt which promotes the maintenance of vaginal acidity.

Treatment is different depending on the type of fungus. The most common is the typical treatment with Clotrimazole (see treatment for candidiasis).

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