A report on

CANDIDIASIS

Candidiasis

•is a fungal infection (mycosis) of any of the Candida species, of which Candida albicans is the most common.

•Candidiasis encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases

• Candida infections of the latter category are also referred to as candidemia and are usually confined to severely immunocompromised persons, such as cancer, transplant, and AIDS patients.

• Superficial infections of skin and mucosal membranes by Candida, causing local inflammation and discomfort are however common in many human populations

Candidiasis may be divided into the following types: • Oral candidiasis (Thrush) • Perlèche (Angular cheilitis) • Candidal vulvovaginitis • Candidal intertrigo • Diaper candidiasis

Infectious agent: Candida albicans is a fungus (a form of yeast) and a causal agent of opportunistic oral and genital infections in humans. It is commensal and is among the normal flora, the many organisms that live in the human mouth and gastrointestinal tract.

•Candida albicans lives in 80% of the human population with no harmful effects, although overgrowth results in candidiasis.

Source of infection: • External use of detergents or douches or internal disturbances can perturb the normal vaginal flora, result in an overgrowth of Candida cells causing symptoms of infection, such as local inflammation.

Pregnancy and the use of • oral contraceptives have been reported as risk factors

•hormone replacement therapy and infertility treatments may also be predisposing factors.

•Steroids and some cancer medications weaken the immune system and can allow yeast to flourish

•Candida albicans infections of the mouth (known as oral thrush) most often develop in people with diseases such as cancer and AIDS.

• Taking birth control pills increases your chances of getting vaginal candidiasis • Hot weather and tight clothing are also risk factors, as they create the ideal environment for candida

Other conditions that tend to encourage yeast include obesity and pregnancy. Yeast generally infects intertriginous areas, that is, areas where skin contacts skin. Overweight people have more folds in their skin. They also sweat more, and Candida albicans is fond of moist skin

• Pregnancy causes temporary obesity and may weaken the immune system, increasing the risk of yeast infections.

The leading cause of candidiasis actually is the overuse of antibiotics.

Why?

Yeast must compete for the right to live on us with various other species, many of them bacteria. These bacteria, which live on the skin and in the intestine and vagina, among other places, are harmless but good at fighting off yeast

When we take antibiotics to deal with less friendly bacteria, we kill off these harmless ones as well. Yeast, which is unaffected by antibiotics, moves into the vacated spots once occupied by bacteria, and starts to grow and multiply.

Pathophysiology:

For most of the patients, candidiasis is iatrogenic in origin, and the unhealthy lifestyle also leads to the imbalance of friendly bacteria, Candida and host immune system interactions. The compromised immune system or lack of friendly bacteria may lead to Candida overgrowth in the gut or vagina causing local symptoms and functional disorders in other organs.

Candida produces certain molecules which interfere with normal human cellular metabolism, such as alcohol, acetaldehyde, ammonia and uric acid. Candida also externalizes a protein-digesting enzyme (proteinase) which lyses secretory IgA of the mucosa and humoral immunoglobulins, keratin and collagen as well.

Proteinase also destructs the microvilli of intestine and leads to lack of mucosal digestive enzymes causing maldigestion and malabsorption. The damage of the intestinal mucosa results in leaky gut with increased absorption of debris

(large undigested food particles, bacterial and yeast components and various toxic chemicals) from the gut and in overstimulation of the immune system that may lead to several systemic inflammatory disorders, allergy and autoimmune diseases.

Clinical Manifestations: Most candidial infections are treatable and result in minimal complications such as • Redness • itching and • Discomfort though complication may be severe or fatal if left untreated in certain populations

Symptoms of candidiasis may vary depending on the area affected. • Thrush — Thrush causes curdlike white patches inside the mouth, especially on the tongue and palate and around the lips. If you try to scrape off this whitish surface, you will usually find a red, inflamed area, which may bleed slightly. There may be cracked, red, moist areas of skin at the corners of the mouth. Sometimes thrush patches are painful, but often they are not

•Esophagitis — Candida esophagitis may make swallowing difficult or painful,and it may cause chest pain behind the breastbone (sternum).

•Cutaneous candidiasis — causes patches of red, moist,weepy skin, sometimes with small pustules nearby.

•Vaginal yeast infections —may cause the following symptoms: vaginal itch and/or soreness;
•a thick vaginal discharge with a texture like soft or cottage cheese;

• a burning discomfort around the vaginal opening, especially if urine touches the area; • and pain or discomfort during sexual intercourse.

• Candidal paronychia is candidiasis of the fingernails. It often strikes people whose hands are in water a lot. Sometimes it presents as a painful, red, swollen area around the fingernail. In worse cases, the fingernail may separate, revealing a discoloured white or yellow nail bed.

• Deep candidiasis — When Candida spreads to the bloodstream, it may cause a wide range of symptoms, from unexplained fever to shock and multiple organ failure.

Diagnostic Procedures: Diagnose of a yeast infections is done either via microscopic examination or culturing.

For identification by light microscopy, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% potassium hydroxide (KOH) solution is then added to the specimen. The KOH dissolves the skin cells but leaves the Candida cells intact, permitting visualization and budding yeast cells typical of many Candida species

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then streaked on a culture medium. The culture is incubated at 37 °C for several days, to allow development of yeast or bacterial colonies. The characteristics (such as morphology and colour) of the colonies may allow initial diagnosis of the organism that is causing disease symptoms.

Treatment: In clinical settings, candidiasis is commonly treated with antimycotics—the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole

• Cutaneous candidiasis — This skin infection can be effectively treated with a variety of antifungal powders and creams. The affected area must be kept clean and dry and protected from chafing.

• Vaginal yeast infections —can be treated with antifungal medications that are applied directly into the vagina as tablets, creams, ointments or suppositories.

• Deep candidiasis — This infection is usually treated with intravenous amphotericin B (Abelcet) or fluconazole.

Prevention: 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 favourite foods) • consider changing "the pill" if you've had recurring infections, change your birth control pill and see if it helps

• make sure your partner is uninfected there's no point curing candidiasis if you're going to be re-infected • don't ask for antibiotics if you've got the flu - the flu is caused by viruses, so taking antibiotics won't help and they might provoke candidiasis

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 yourself thoroughly afterwards, especially the pubic hair - use a hair dryer on low setting if you have to.

don't use soap around the vagina - soap kills the bacteria you want to keep, and has no effect on yeast

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

• use tampons, not sanitary towels, which cut off air to the vagina • avoid chemicals like deodorant tampons and especially vaginal douches, which serve no purpose and may cause infection

Nursing Process Patient with Candidiasis Infecion

Assessment
• Patient with Candidiasis should be examinednafter the onset of symptoms. • The area is observed for erythema, edema, excoriation and discharge. • The patient is aked to describe any discharge and other symptoms, such as odor, itching, or swelling.

• The patient is asked about the occurrence of factorsthat may contribute to the infection.
• Physical or chemical factors, such as constant moisture from tight clothing, perfumes and powders, soaps. • Psychogenic factors (eg, stress) • Use of medications such as antibiotics • Medical conditions

•The patient is also asked about factors that could contribute to infection, including hygiene practices and the use of birth control/fertility methods.

Based on the nursing assessment and other data, major nursing diagnosis may include the following: • Discomfort related to odor, itching or swelling from the infectious process • Anxiety related to stressful symptoms • Risk for infection • Deficient knowledge about proper hygiene

Diagnosis

Planning Major goals may include
•Relief of discomfort •Reduction of anxiety related to symptoms •Prevention of re-infection •Acquisition of knowledge regarding proper hygiene

Intervention
Relieving discomfort • Treatment with the appropriate medication usually relieves comfort. • Reducing anxiety • Explaining the cause of symptoms may reduce anxiety related to fear of a more serious illness and discussing ways to help prevent infection may help patient adopt strategies that decrease infection •

• Preventing reinfection
• The patient should be informed about the importance of adequate treatment of self. • When medications such as antibiotics are prescribed, the nurse instructs the patient about usual precautions related to using such agents. If itching occurs several days after use, this may not just be an allergic reaction but a yeast infection

Evaluation • Expected outcomes may include •Experiences reduced discomfort •Reports itching relieved • Experiences relief of anxiety • Remains free from infection •Has no signs of inflammation, pruritus or odor.