balance. They are vital for numerous body func-
tions such as digestion. Candidiasis develops when
there is a disturbance of the balance that allows
Candidato flourish, such as a change in the acid
balance (pH) of the tissues, suppression of normal
flora bacteria with antibiotic therapy, compro-
mised immune function, and excessive moisture.
Candidiasis is the most common cause of
ESOPHAGITIS, VAGINITISin women, and diaper rash in
infants.
Chronic candidiasis may indicate an
underlying health condition such as
DIABETES and is often the first sign of
HIV INFECTION. A doctor should conduct
a comprehensive health examination in
people who have four or more episodes
of candidiasis in a year.Symptoms and Diagnostic Path
Symptoms of candidiasis vary with the site of
infection. In the mouth there are white patches on
the tongue and inner cheeks (oral mucosa). Can-
didal vaginitis produces a characteristic “cheesy”
discharge and intense itching. Candidal diaper
rash appears as red, fragile blotches or sores with
white pustules. In candidal esophagitis the doctor
can see characteristic ulcerations on endoscopic
examination. Invasive candidiasis may present
with FEVERalong with indications of LIVERdisease
such as JAUNDICE, neurologic impairment when
infection involves the CENTRAL NERVOUS SYSTEM, car-
diovascular compromise with candidal ENDOCARDI-
TIS(infection of the lining of the HEART), or RENAL
FAILUREwhen infection involves the KIDNEYS.
The diagnostic path for superficial (oral,
esophageal, perineal, or genital) candidiasis
includes taking samples of the white patches or
discharge for examination under the microscope,
which reveals the presence of abundant Candida
colonies. BLOODcultures show Candidagrowth in
invasive candidiasis.
Treatment Options and Outlook
Superficial candidiasis is common and easily treat-
able with ANTIFUNGAL MEDICATIONS. HEALINGoccurs
without residual consequences, though infection
may recur when conditions are favorable. Invasive
or systemic candidiasis, which occurs when the
Candidaenter the blood circulation, is a very seri-
ous infection that requires treatment with intra-
venous antifungal medications. Invasive
candidiasis can be life-threatening in IMMUNOCOM-
PROMISEDpeople.ANTIFUNGAL MEDICATIONS TO TREAT CANDIDIASIS
amphotericin-B clotrimazole
econazole fluconazole
flucytosine ketoconazole
micafungin miconazole
nystatinRisk Factors and Preventive Measures
DIABETES, long-term use of CORTICOSTEROID MEDICA-
TIONS, antibiotic therapy, and HIV/AIDSare among
the key risk factors for candidiasis. A normal
course of ANTIBIOTIC MEDICATIONSprescribed to treat
bacterial infection may cause candidal vaginitis;
women who are susceptible to vaginal candidiasis
should discuss prophylactic antifungal therapy
with their doctors. Preventive measures for candi-
dal diaper rash, a consequence of both pH change
(from URINEcontact with the SKIN) and excessive
moisture, include frequent diaper changes and
application of protective cream or ointment to
keep the perineal area clean and dry.
See also ENDOSCOPY; FUNGUS; OPPORTUNISTIC INFEC-
TION; TINEA INFECTIONS.carrier A person who has a bacterial or viral
INFECTIONbut does not show symptoms or become
ill because of the infection and yet can pass the
infection on to other people. A third of people
who have infectious HEPATITIS are carriers, for
example. In some circumstances treating the
infection eliminates it so the person cannot pass
the infection to others. In other circumstances,
such as hepatitis B VIRUS(HBV) infection, there is
no effective treatment and the person is capable
for life of transmitting the infection.
See also BACTERIA; GENETIC CARRIER; MODES OF
TRANSMISSION; PARASITE.chickenpox A common childhood illness that
results from INFECTION with the varicella-zoster
VIRUS, a member of the herpesvirus family. Chick-
enpox, also called varicella disease, is highly con-
tagious, spreading through direct contact andchickenpox 315