View source for Medicine:Candidiasis

{{short description|Fungal infection due to any type of Candida}}
{{Infobox medical condition (new)
| name            = Candidiasis
| synonyms        = Candidosis, moniliasis, oidiomycosis <ref name="Andrews"/>
| image           = Human tongue infected with oral candidiasis.jpg
| image_size      = 250px
| alt = Photo of a light-skinned human sticking tongue out where the tongue is mostly colored light yellow due to an oral candidiasis infection
| caption         = Oral candidiasis (thrush)
| field           = [[Medicine:Infectious disease (medical specialty)|Infectious disease]]
| symptoms        = White patches or vaginal discharge, itching <ref name=CDCVaginal2019/><ref name=CDCThrush2019/>
| complications   =
| onset           =
| duration        =
| types           =
| causes          = ''Candida'' (a type of [[Biology:Yeast|yeast]])<ref name=CDCCan2019/>
| risks           = Immunosuppression (HIV/AIDS), [[Medicine:Diabetes|diabetes]], [[Biology:Corticosteroid|corticosteroid]]s, [[Chemistry:Antibiotic|antibiotic]] therapy <ref name=CDC2014RiskO/>
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      = [[Chemistry:Clotrimazole|Clotrimazole]], [[Biology:Nystatin|nystatin]], [[Chemistry:Fluconazole|fluconazole]]<ref name=CDC2014Otx/>
| prognosis       =
| frequency       = 6% of babies (mouth)<ref name=Oral2014Stat/> 75% of women at some time (vaginal)<ref name=CDC2014Epi/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Candidiasis''' is a fungal infection due to any species of the genus ''Candida'' (a type of [[Biology:Yeast|yeast]]).<ref name=CDCCan2019>{{Cite web|url=https://www.cdc.gov/fungal/diseases/candidiasis/|title=Candidiasis|date=13 November 2019|website=Fungal Diseases|publisher=Centers for Disease Control and Prevention|access-date=24 Dec 2019|location=United States}}</ref> When it [[Medicine:Oral candidiasis|affects the mouth]], in some countries it is commonly called '''thrush'''.<ref name=CDCThrush2019/> Signs and symptoms include white patches on the tongue or other areas of the mouth and throat.<ref name=CDCThrush2019>{{Cite web|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html|title=Candida infections of the mouth, throat, and esophagus|date=13 November 2019|website=Fungal Diseases|publisher=Centers for Disease Control and Prevention|access-date=24 Dec 2019|location=United States}}</ref> Other symptoms may include soreness and problems swallowing.<ref name=CDC2014OralS>{{cite web|title=Symptoms of Oral Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/symptoms.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229221255/http://www.cdc.gov/fungal/diseases/candidiasis/thrush/symptoms.html|archive-date=29 December 2014}}</ref> When it [[Medicine:Vaginal yeast infection|affects the vagina]], it may be referred to as a '''yeast infection''' or '''thrush'''.<ref name=CDCVaginal2019>{{Cite web|url=https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html|title=Vaginal Candidiasis|date=13 November 2019|website=Fungal Diseases|publisher=Centers for Disease Control and Prevention|location=United States|access-date=24 Dec 2019}}</ref><ref>{{cite web |title=Thrush in men and women |url=https://www.nhs.uk/conditions/thrush-in-men-and-women/ |website=nhs.uk |access-date=16 March 2020 |language=en |date=9 January 2018}}</ref> Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina.<ref name=CDC2014VagS /> Yeast infections of the penis are less common and typically present with an itchy rash.<ref name=CDC2014VagS>{{cite web|title=Symptoms of Genital / Vulvovaginal Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/genital/symptoms.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229221253/http://www.cdc.gov/fungal/diseases/candidiasis/genital/symptoms.html|archive-date=29 December 2014}}</ref> Very rarely, yeast infections may become invasive, spreading to other parts of the body.<ref name=CDC2014Inv/> This may result in [[Medicine:Fever|fever]]s along with other symptoms depending on the parts involved.<ref name=CDC2014Inv>{{cite web|title=Symptoms of Invasive Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/invasive/symptoms.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229230002/http://www.cdc.gov/fungal/diseases/candidiasis/invasive/symptoms.html|archive-date=29 December 2014}}</ref>

<!-- Cause -->
More than 20 types of ''Candida'' may cause infection with ''[[Biology:Candida albicans|Candida albicans]]'' being the most common.<ref name=CDC2014Can>{{cite web|title=Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229221331/http://www.cdc.gov/fungal/diseases/candidiasis/|archive-date=29 December 2014}}</ref> Infections of the mouth are most common among children less than one month old, the elderly, and those with weak immune systems.<ref name=CDC2014RiskO/> Conditions that result in a weak immune system include HIV/AIDS, the medications used after [[Medicine:Organ transplantation|organ transplantation]], [[Medicine:Diabetes|diabetes]], and the use of [[Biology:Corticosteroid|corticosteroid]]s.<ref name=CDC2014RiskO/> Other risk factors include during breastfeeding, following [[Chemistry:Antibiotic|antibiotic]] therapy, and the wearing of dentures.<ref name=CDC2014RiskO>{{cite web|title=Risk & Prevention|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/risk-prevention.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014}}</ref><ref name=Walker_2008>{{cite journal | vauthors = Walker M | title = Conquering common breast-feeding problems | journal = The Journal of Perinatal & Neonatal Nursing | volume = 22 | issue = 4 | pages = 267–74 | date = 2008 | pmid = 19011490 | doi = 10.1097/01.JPN.0000341356.45446.23 | s2cid = 27801867 }}</ref> Vaginal infections occur more commonly during [[Medicine:Pregnancy|pregnancy]], in those with weak immune systems, and following antibiotic therapy.<ref name=CDC2014VP>{{cite web|title=People at Risk for Genital / Vulvovaginal Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/genital/risk-prevention.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229230132/http://www.cdc.gov/fungal/diseases/candidiasis/genital/risk-prevention.html|archive-date=29 December 2014}}</ref> Individuals at risk for invasive candidiasis include low birth weight babies, people recovering from surgery, people admitted to [[Medicine:Intensive care unit|intensive care unit]]s, and those with an otherwise compromised immune system.<ref name=CDC2014IP>{{cite web|title=People at Risk for Invasive Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/invasive/risk-prevention.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229230136/http://www.cdc.gov/fungal/diseases/candidiasis/invasive/risk-prevention.html|archive-date=29 December 2014}}</ref>

<!-- Prevention and treatment -->
Efforts to prevent infections of the mouth include the use of [[Chemistry:Chlorhexidine|chlorhexidine]] mouthwash in those with poor immune function and washing out the mouth following the use of inhaled steroids.<ref name="CDC2014Otx" /> Little evidence supports [[Biology:Probiotic|probiotic]]s for either prevention or treatment, even among those with frequent vaginal infections.<ref name="Jur2012">{{cite journal | vauthors = Jurden L, Buchanan M, Kelsberg G, Safranek S | title = Clinical inquiries. Can probiotics safely prevent recurrent vaginitis? | journal = The Journal of Family Practice | volume = 61 | issue = 6 | pages = 357, 368 | date = June 2012 | pmid = 22670239 }}</ref><ref name="Ab2009">{{cite journal | vauthors = Abad CL, Safdar N | title = The role of lactobacillus probiotics in the treatment or prevention of urogenital infections--a systematic review | journal = Journal of Chemotherapy | volume = 21 | issue = 3 | pages = 243–52 | date = June 2009 | pmid = 19567343 | doi = 10.1179/joc.2009.21.3.243 | s2cid = 32398416 }}</ref> For infections of the mouth, treatment with topical [[Chemistry:Clotrimazole|clotrimazole]] or [[Biology:Nystatin|nystatin]] is usually effective.<ref name="CDC2014Otx" /> Oral or intravenous [[Chemistry:Fluconazole|fluconazole]], [[Chemistry:Itraconazole|itraconazole]], or [[Chemistry:Amphotericin B|amphotericin B]] may be used if these do not work.<ref name="CDC2014Otx">{{cite web|title=Treatment & Outcomes of Oral Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/treatment.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014}}</ref> A number of topical antifungal medications may be used for vaginal infections, including clotrimazole.<ref>{{cite web|title=Treatment & Outcomes of Genital / Vulvovaginal Candidiasis|url=https://www.cdc.gov/fungal/diseases/candidiasis/genital/treatment.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229230134/http://www.cdc.gov/fungal/diseases/candidiasis/genital/treatment.html|archive-date=29 December 2014}}</ref> In those with widespread disease, an [[Chemistry:Echinocandin|echinocandin]] such as [[Chemistry:Caspofungin|caspofungin]] or [[Chemistry:Micafungin|micafungin]] is used.<ref name="IDSA2016" /> A number of weeks of intravenous amphotericin B may be used as an alternative.<ref name="IDSA2016" /> In certain groups at very high risk, antifungal medications may be used preventatively,<ref name="CDC2014IP" /><ref name="IDSA2016">{{cite journal | vauthors = Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD | display-authors = 6 | title = Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America | journal = Clinical Infectious Diseases | volume = 62 | issue = 4 | pages = 409–17 | date = February 2016 | pmid = 26810419 | doi = 10.1093/cid/civ1194 | doi-access = free }}</ref> and concomitantly with medications known to precipitate infections.

<!-- Epidemiology -->
Infections of the mouth occur in about 6% of babies less than a month old.<ref name=Oral2014Stat/> About 20% of those receiving [[Medicine:Chemotherapy|chemotherapy]] for cancer and 20% of those with AIDS also develop the disease.<ref name=Oral2014Stat>{{cite web|title=Oral Candidiasis Statistics|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/statistics.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229221333/http://www.cdc.gov/fungal/diseases/candidiasis/thrush/statistics.html|archive-date=29 December 2014}}</ref> About three-quarters of women have at least one yeast infection at some time during their lives.<ref name=CDC2014Epi>{{cite web|title=Genital / vulvovaginal candidiasis (VVC)|url=https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229221412/http://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html|archive-date=29 December 2014}}</ref> Widespread disease is rare except in those who have risk factors.<ref>{{cite web|title=Invasive Candidiasis Statistics|url=https://www.cdc.gov/fungal/diseases/candidiasis/invasive/statistics.html|website=cdc.gov|access-date=28 December 2014|date=February 13, 2014|url-status=live|archive-url=https://web.archive.org/web/20141229221416/http://www.cdc.gov/fungal/diseases/candidiasis/invasive/statistics.html|archive-date=29 December 2014}}</ref>

== Signs and symptoms ==
[[File:Derm-57.jpg|thumb|Skin candidiasis]]
[[File:Yeast Infection.png|thumb|[[Medicine:Vaginal yeast infection|Vaginal yeast infection]]]]
[[File:Toefungus.jpg|thumb|Nail candidiasis (onychomycosis)]]
Signs and symptoms of candidiasis vary depending on the area affected.<ref name="ID10" /> Most candidal infections result in minimal complications such as redness, itching, and discomfort, though complications may be severe or even fatal if left untreated in certain populations. In healthy ([[Biology:Immunocompetence|immunocompetent]]) persons, candidiasis is usually a localized infection of the skin, fingernails or toenails (onychomycosis), or mucosal membranes, including the [[Biology:Human mouth|oral cavity]] and [[Biology:Pharynx|pharynx]] (thrush), [[Biology:Esophagus|esophagus]], and the sex organs ([[Biology:Vagina|vagina]], [[Medicine:Human penis|penis]], etc.);<ref name="Medscape clinical" /><ref name="Baron">{{cite book |vauthors=Walsh TJ, Dixon DM |chapter=Deep Mycoses |title=Baron's Medical Microbiology |editor=Baron S |edition=4th |publisher=Univ of Texas Medical Branch |year=1996 |pmid=21413276 |isbn=978-0-9631172-1-2 |chapter-url=https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 |display-editors=etal |url-status=live |archive-url=https://web.archive.org/web/20081201115047/http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 |archive-date=2008-12-01 }}</ref><ref name="Thrush - 2015 review">{{cite journal | vauthors = Patil S, Rao RS, Majumdar B, Anil S | title = Clinical Appearance of Oral Candida Infection and Therapeutic Strategies | journal = Frontiers in Microbiology | volume = 6 | pages = 1391 | date = December 2015 | pmid = 26733948 | pmc = 4681845 | doi = 10.3389/fmicb.2015.01391 | doi-access = free }}</ref> less commonly in healthy individuals, the gastrointestinal tract,<ref name="pmid24789109">{{cite journal | vauthors = Martins N, Ferreira IC, Barros L, Silva S, Henriques M | title = Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment | journal = Mycopathologia | volume = 177 | issue = 5–6 | pages = 223–40 | date = June 2014 | pmid = 24789109 | doi = 10.1007/s11046-014-9749-1 | quote = Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients but also related to nosocomial infections and even in healthy individuals. There is a wide variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. | hdl = 10198/10147 | s2cid = 795450 | url = http://repositorium.sdum.uminho.pt/bitstream/1822/31482/1/document_17753_1.pdf | hdl-access = free }}</ref><ref name="pmid24612332">{{cite journal | vauthors = Wang ZK, Yang YS, Stefka AT, Sun G, Peng LH | title = Review article: fungal microbiota and digestive diseases | journal = Alimentary Pharmacology & Therapeutics | volume = 39 | issue = 8 | pages = 751–66 | date = April 2014 | pmid = 24612332 | doi = 10.1111/apt.12665 | s2cid = 22101484 | quote = In addition, GI fungal infection is reported even among those patients with normal immune status. Digestive system-related fungal infections may be induced by both commensal opportunistic fungi and exogenous pathogenic fungi. The IFI in different GI sites have their special clinical features, which are often accompanied by various severe diseases. Although IFI associated with digestive diseases are less common, they can induce fatal outcomes due to less specificity of related symptoms, signs, endoscopic and imaging manifestations, and the poor treatment options.&nbsp;... Candida sp. is also the most frequently identified species among patients with gastric IFI.&nbsp;...  Gastric IFI is often characterised by the abdominal pain and vomiting and with the endoscopic characteristics including gastric giant and multiple ulcers, stenosis, perforation, and fistula. For example, gastric ulcers combined with entogastric fungal infection, characterised by deep, large and intractable ulcers,[118] were reported as early as the 1930s.&nbsp;... The overgrowth and colonisation of fungi in intestine can lead to diarrhoea. | doi-access = free }}</ref><ref name="SIFO">{{cite journal | vauthors = Erdogan A, Rao SS | title = Small intestinal fungal overgrowth | journal = Current Gastroenterology Reports | volume = 17 | issue = 4 | pages = 16 | date = April 2015 | pmid = 25786900 | doi = 10.1007/s11894-015-0436-2 | s2cid = 3098136 | quote = Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms.&nbsp;... For routine SIFO in an immunocompetent host, a 2–3 week oral course of fluconazole 100–200 mg will suffice. }}</ref> urinary tract,<ref name="pmid24789109" /> and [[Medicine:Respiratory tract|respiratory tract]]<ref name="pmid24789109" /> are sites of candida infection.

In immunocompromised individuals, ''Candida'' infections in the esophagus occur more frequently than in healthy individuals and have a higher potential of becoming [[Medicine:Systemic disease|systemic]], causing a much more serious condition, a fungemia called candidemia.<ref name="Medscape clinical" /><ref name="Fidel">{{cite journal | vauthors = Fidel PL | title = Immunity to Candida | journal = Oral Diseases | volume = 8 | pages = 69–75 | year = 2002 | issue = Suppl 2 | pmid = 12164664 | doi = 10.1034/j.1601-0825.2002.00015.x }}</ref><ref name="Pappas">{{cite journal | vauthors = Pappas PG | title = Invasive candidiasis | journal = Infectious Disease Clinics of North America | volume = 20 | issue = 3 | pages = 485–506 | date = September 2006 | pmid = 16984866 | doi = 10.1016/j.idc.2006.07.004 }}</ref> Symptoms of esophageal candidiasis include difficulty swallowing, painful swallowing, abdominal pain, nausea, and vomiting.<ref name="Medscape clinical" /><ref name="Yamada 2009" />

=== Mouth ===
Infection in the mouth is characterized by white discolorations in the tongue, around the mouth, and in the throat. Irritation may also occur, causing discomfort when swallowing.<ref>{{Cite web|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html|title=Candida infections of the mouth, throat, and esophagus {{!}} Fungal Diseases {{!}} CDC|date=2019-04-17|website=www.cdc.gov|access-date=2019-08-01}}</ref>

Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a few weeks.<ref>{{cite web|title = Thrush|url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001650/|year = 2011|access-date = 2011-04-08|url-status = live|archive-url = https://web.archive.org/web/20110210121452/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001650|archive-date = 2011-02-10}}</ref>

=== Genitals ===
Infection of the vagina or [[Medicine:Vulva|vulva]] may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray cottage cheese-like discharge.  Symptoms of infection of the male genitalia (balanitis thrush) include red skin around the head of the penis, swelling, irritation, itchiness and soreness of the head of the penis, thick, lumpy discharge under the foreskin, unpleasant odour, difficulty retracting the foreskin ([[Medicine:Phimosis|phimosis]]), and pain when passing urine or during sex.<ref>[http://www.nhs.uk/Conditions/Thrush-men/Pages/Symptoms.aspx NHS: Symptoms of thrush in men (balanitis thrush)] {{webarchive|url=https://web.archive.org/web/20131101202229/http://www.nhs.uk/Conditions/Thrush-men/Pages/Symptoms.aspx |date=2013-11-01 }}</ref>

=== Skin ===
Signs and symptoms of candidiasis in the skin include itching, irritation, and chafing or broken skin.<ref name="medlineplus.gov">{{Cite web|url=https://medlineplus.gov/ency/article/000880.htm|title=Candida infection of the skin: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2019-08-06}}</ref>

=== Invasive infection ===
Common symptoms of gastrointestinal candidiasis in healthy individuals are anal itching, belching, bloating, indigestion, nausea, diarrhea, gas, intestinal cramps, vomiting, and gastric ulcers.<ref name="pmid24789109" /><ref name="pmid24612332" /><ref name="SIFO" /> Perianal candidiasis can cause anal itching; the lesion can be red, papular, or ulcerative in appearance, and it is not considered to be a [[Medicine:Sexually transmitted infection|sexually transmitted infection]].<ref>{{cite book|editor-first = Bruce G. | editor-last = Wolff | name-list-style = vanc |display-editors=etal |title=The ASCRS textbook of colon and rectal surgery|year=2007|publisher=Springer|location=New York|isbn=978-0-387-24846-2|pages=241, 242, 245}}</ref> Abnormal proliferation of the candida in the gut may lead to dysbiosis.<ref name="ReferenceA">{{cite journal | vauthors = Mukherjee PK, Sendid B, Hoarau G, Colombel JF, Poulain D, Ghannoum MA | title = Mycobiota in gastrointestinal diseases | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 2 | pages = 77–87 | date = February 2015 | pmid = 25385227 | doi = 10.1038/nrgastro.2014.188 | s2cid = 5370536 }}</ref> While it is not yet clear, this alteration may be the source of symptoms generally described as the [[Medicine:Irritable bowel syndrome|irritable bowel syndrome]],<ref>{{cite journal | vauthors = Santelmann H, Howard JM | title = Yeast metabolic products, yeast antigens and yeasts as possible triggers for irritable bowel syndrome | journal = European Journal of Gastroenterology & Hepatology | volume = 17 | issue = 1 | pages = 21–6 | date = January 2005 | pmid = 15647635 | doi = 10.1097/00042737-200501000-00005 | url = http://www.jptwellnesscircle.com/teleseminars/DrSantelmannCandida.pdf | citeseerx = 10.1.1.567.6030 | s2cid = 35882838 | access-date = 2017-10-24 | archive-date = 2019-12-05 | archive-url = https://web.archive.org/web/20191205034202/http://www.jptwellnesscircle.com/teleseminars/DrSantelmannCandida.pdf | url-status = dead }}</ref><ref>{{cite journal | vauthors = Collins SM | title = A role for the gut microbiota in IBS | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 11 | issue = 8 | pages = 497–505 | date = August 2014 | pmid = 24751910 | doi = 10.1038/nrgastro.2014.40 | s2cid = 10676400 }}</ref> and other gastrointestinal diseases.<ref name="pmid24612332" /><ref>{{cite journal | vauthors = Gouba N, Drancourt M | title = Digestive tract mycobiota: a source of infection | journal = Médecine et Maladies Infectieuses | volume = 45 | issue = 1–2 | pages = 9–16 | date = 2015 | pmid = 25684583 | doi = 10.1016/j.medmal.2015.01.007 | doi-access = free }}</ref>

=== Neurological symptoms ===
Systemic candidiasis can affect the central nervous system causing a variety of neurological symptoms, with a presentation similar to meningitis.

== Causes ==
{{Main|Biology:Candida (fungus)}}
''Candida'' yeasts are generally present in healthy humans, frequently part of the human body's normal oral and intestinal flora, and particularly on the skin; however, their growth is normally limited by the human [[Biology:Immune system|immune system]] and by competition of other [[Biology:Microorganism|microorganism]]s, such as bacteria occupying the same locations in the human body.<ref name=Goroll>{{cite book | vauthors = Mulley AG, Goroll AH |title=Primary Care Medicine: office evaluation and management of the adult patient |publisher=Wolters Kluwer Health |location=Philadelphia |year=2006 |pages=802–3 |isbn=978-0-7817-7456-7 |url=https://books.google.com/books?id=aWQhTbwoM9EC&pg=RA1-PA802 |access-date=2008-11-23}}</ref>
''Candida'' requires moisture for growth, notably on the skin.<ref name=Mims>{{cite book|last=Goehring|first=Richard V. | name-list-style = vanc |title=Mims' medical microbiology.|year=2008|publisher=Mosby Elsevier|location=Philadelphia, PA|isbn=978-0-323-04475-2|page=656|edition=4th}}</ref> For example, wearing wet swimwear for long periods of time is believed to be a risk factor.<ref name=MedlinePlus>{{MedlinePlusEncyclopedia |001511|Vaginal yeast infection}}</ref> Candida can also cause diaper rashes in babies.<ref name="medlineplus.gov"/> In extreme cases, superficial infections of the skin or mucous membranes may enter the bloodstream and cause systemic ''Candida'' infections.{{cn|date=June 2022}}

Factors that increase the risk of candidiasis include [[Biology:HIV|HIV]]/AIDS, mononucleosis, [[Medicine:Cancer|cancer]] treatments, steroids, stress, antibiotic therapy, diabetes, and nutrient deficiency. Hormone replacement therapy and infertility treatments may also be predisposing factors.<ref>{{cite journal | vauthors = Nwokolo NC, Boag FC | title = Chronic vaginal candidiasis. Management in the postmenopausal patient | journal = Drugs & Aging | volume = 16 | issue = 5 | pages = 335–9 | date = May 2000 | pmid = 10917071 | doi = 10.2165/00002512-200016050-00003 | s2cid = 24662417 }}</ref> Use of inhaled corticosteroids increases risk of candidiasis of the mouth.<ref name=":1">{{Cite web|url=https://www.uptodate.com/contents/major-side-effects-of-inhaled-glucocorticoids#H4|title=Major side effects of inhaled glucocorticoids|last1=Saag|first1=Kenneth G|last2=Furst|first2=MScDaniel E | name-list-style = vanc |website=UpToDate|access-date=2019-08-02|last3=Barnes|first3=Peter J}}</ref> Inhaled corticosteroids with other risk factors such as antibiotics, oral glucocorticoids, not rinsing mouth after use of inhaled corticosteroids or high dose of inhaled corticosteroids put people at even higher risk.<ref name=":1" /> Treatment with antibiotics can lead to eliminating the yeast's natural competitors for resources in the oral and intestinal flora, thereby increasing the severity of the condition.<ref>{{cite journal | vauthors = Bassetti M, Mikulska M, Viscoli C | title = Bench-to-bedside review: therapeutic management of invasive candidiasis in the intensive care unit | journal = Critical Care | volume = 14 | issue = 6 | pages = 244 | date = December 2010 | pmid = 21144007 | pmc = 3220045 | doi = 10.1186/cc9239 | doi-access = free }}</ref> A weakened or undeveloped immune system or metabolic illnesses are significant predisposing factors of candidiasis.<ref name="Odds">{{cite journal | vauthors = Odds FC | title = Candida infections: an overview | journal = Critical Reviews in Microbiology | volume = 15 | issue = 1 | pages = 1–5 | year = 1987 | pmid = 3319417 | doi = 10.3109/10408418709104444 }}</ref> Almost 15% of people with weakened immune systems develop a systemic illness caused by ''Candida'' species.<ref>{{cite journal | vauthors = Choo ZW, Chakravarthi S, Wong SF, Nagaraja HS, Thanikachalam PM, Mak JW, Radhakrishnan A, Tay A | display-authors = 6 | title = A comparative histopathological study of systemic candidiasis in association with experimentally induced breast cancer | journal = Oncology Letters | volume = 1 | issue = 1 | pages = 215–222 | date = January 2010 | pmid = 22966285 | pmc = 3436220 | doi = 10.3892/ol_00000039 | url = http://www.spandidos-publications.com/ol/1/1/215 | archive-url = https://web.archive.org/web/20110716113502/http://www.spandidos-publications.com/ol/1/1/215 | url-status = live | archive-date = 2011-07-16 }}</ref> Diets high in simple carbohydrates have been found to affect rates of oral candidiases.<ref name=Review2002>{{cite journal | vauthors = Akpan A, Morgan R | title = Oral candidiasis | journal = Postgraduate Medical Journal | volume = 78 | issue = 922 | pages = 455–9 | date = August 2002 | pmid = 12185216 | pmc = 1742467 | doi = 10.1136/pmj.78.922.455 }}</ref>

''C. albicans'' was isolated from the vaginas of 19% of apparently healthy women, i.e., those who experienced few or no symptoms of infection. External use of detergents or [[Biology:Douche|douche]]s or internal disturbances (hormonal or physiological) can perturb the normal [[Biology:Vaginal flora|vaginal flora]], consisting of [[Biology:Lactic acid bacteria|lactic acid bacteria]], such as lactobacilli, and result in an overgrowth of ''Candida'' cells, causing symptoms of infection, such as local [[Medicine:Inflammation|inflammation]].<ref>{{cite journal | vauthors = Mårdh PA, Novikova N, Stukalova E | title = Colonisation of extragenital sites by Candida in women with recurrent vulvovaginal candidosis | journal = BJOG | volume = 110 | issue = 10 | pages = 934–7 | date = October 2003 | pmid = 14550364 | doi = 10.1111/j.1471-0528.2003.01445.x | s2cid = 25585573 | doi-access = free }}</ref> Pregnancy and the use of oral contraceptives have been reported as risk factors.<ref name="Schiefer">{{cite journal | vauthors = Schiefer HG | title = Mycoses of the urogenital tract | journal = Mycoses | volume = 40 | issue = Suppl 2 | pages = 33–6 | year = 1997 | pmid = 9476502 | doi = 10.1111/j.1439-0507.1997.tb00561.x | s2cid = 27268821 }}</ref> [[Medicine:Diabetes mellitus|Diabetes mellitus]] and the use of antibiotics are also linked to increased rates of yeast infections.<ref name="Schiefer"/>

In penile candidiasis, the causes include sexual intercourse with an infected individual, low immunity, antibiotics, and diabetes. Male genital yeast infections are less common, but a yeast infection on the penis caused from direct contact via sexual intercourse with an infected partner is not uncommon.<ref>{{cite journal | vauthors = David LM, Walzman M, Rajamanoharan S | title = Genital colonisation and infection with candida in heterosexual and homosexual males | journal = Genitourinary Medicine | volume = 73 | issue = 5 | pages = 394–6 | date = October 1997 | pmid = 9534752 | pmc = 1195901 | doi = 10.1136/sti.73.5.394 }}</ref>

Breast-feeding mothers may also develop candidiasis on and around the nipple as a result of moisture created by excessive milk-production.<ref name="Walker_2008" />

[[Biology:Vagina|Vagina]]l candidiasis can cause congenital candidiasis in newborns.<ref name="Skoczylas 2014 179–89">{{cite journal | vauthors = Skoczylas MM, Walat A, Kordek A, Loniewska B, Rudnicki J, Maleszka R, Torbé A | title = Congenital candidiasis as a subject of research in medicine and human ecology | journal = Annals of Parasitology | volume = 60 | issue = 3 | pages = 179–89 | date = 2014 | pmid = 25281815 }}</ref>

== Diagnosis ==
[[File:Vaginal swab wet mount of candida.jpg|thumb|Vaginal swab wet mount of candida (phase contrast) showing the pseudohyphae]]
[[File:Candida albicans PHIL 3192 lores.jpg|thumb|[[Organization:Agar plate|Agar plate]] culture of ''C. albicans'']]
[[File:Vaginal wet mount of candidal vulvovaginitis.jpg|thumb|[[Medicine:KOH test|KOH test]] on a vaginal wet mount, showing slings of pseudohyphae of ''Candida albicans'' surrounded by round vaginal epithelial cells, conferring a diagnosis of candidal vulvovaginitis ]]
[[Image:Esophageal candidiasis (2) PAS stain.jpg|thumb|Micrograph of esophageal candidiasis showing hyphae, [[Medicine:Biopsy|biopsy]] specimen, PAS stain]]
[[File:Candida Gram stain.jpg|thumb|right|[[Physics:Gram stain|Gram stain]] of ''Candida albicans'' from a vaginal swab; the small oval chlamydospores are 2–4&nbsp;[[Micrometre|µm]] in diameter ]]
[[File:CHROMAgar with N glabratus, P kudriavzevii, Candida albicans and Candida tropicalis, annotated.jpg|thumb|Chromogenic agar can help in indicating the involved species of ''Candida'' versus similar fungi. (CHROMAgar shown)]]
In oral candidiasis, simply inspecting the person's mouth for white patches and irritation may make the diagnosis. A sample of the infected area may also be taken to determine what organism is causing the infection.<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/oral-thrush/diagnosis-treatment/drc-20353539|title=Oral thrush - Diagnosis and treatment - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-08-06}}</ref>

Symptoms of vaginal candidiasis are also present in the more common [[Medicine:Bacterial vaginosis|bacterial vaginosis]];<ref>{{cite web |url=http://women.webmd.com/features/is-it-yeast-infection | first = Terri | last = Warren | name-list-style = vanc  |title=Is It a Yeast Infection? |year=2010 |access-date=2011-02-23 |url-status=live |archive-url=https://web.archive.org/web/20110225041728/http://women.webmd.com/features/is-it-yeast-infection |archive-date=2011-02-25 }}</ref> aerobic vaginitis is distinct and should be excluded in the differential diagnosis.<ref>{{cite journal | vauthors = Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B | title = Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis | journal = BJOG | volume = 109 | issue = 1 | pages = 34–43 | date = January 2002 | pmid = 11845812 | doi = 10.1111/j.1471-0528.2002.00432.x | hdl = 10067/1033820151162165141 | s2cid = 8304009 | hdl-access = free }}</ref> In a 2002 study, only 33% of women who were self-treating for a yeast infection were found to have such an infection, while most had either bacterial vaginosis or a mixed-type infection.<ref>{{cite journal | vauthors = Ferris DG, Nyirjesy P, Sobel JD, Soper D, Pavletic A, Litaker MS | title = Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis | journal = Obstetrics and Gynecology | volume = 99 | issue = 3 | pages = 419–25 | date = March 2002 | pmid = 11864668 | doi = 10.1016/S0029-7844(01)01759-8 | s2cid = 25895596 }}</ref>

Diagnosis of a yeast infection is confirmed either via microscopic examination or culturing.  For identification by light microscopy, a scraping or swab of the affected area is placed on a [[Physics:Microscope slide|microscope slide]]. A single drop of 10% [[Chemistry:Potassium hydroxide|potassium hydroxide]] (KOH) solution is then added to the specimen. The KOH dissolves the skin cells, but leaves the ''Candida'' cells intact, permitting visualization of pseudohyphae and budding yeast cells typical of many ''Candida'' species.{{cn|date=June 2022}}

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&nbsp;°C (98.6&nbsp;°F) 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 causing disease symptoms.<ref name="Guarner Brandt 2011 pp. 247–280">{{cite journal | last1=Guarner | first1=J. | last2=Brandt | first2=M. E. | title=Histopathologic Diagnosis of Fungal Infections in the 21st Century | journal=Clinical Microbiology Reviews | publisher=American Society for Microbiology | volume=24 | issue=2 | date=2011-04-01 | issn=0893-8512 | pmid=21482725 | pmc=3122495 | doi=10.1128/cmr.00053-10 | pages=247–280}}</ref>
Respiratory, gastrointestinal, and esophageal candidiasis require an endoscopy to diagnose.<ref name="SIFO" /><ref name="Medscape workup">{{cite web|vauthors=Hidalgo JA, Vazquez JA|title=Candidiasis: Workup|url=http://emedicine.medscape.com/article/213853-workup#showall|website=Medscape|publisher=WebMD|access-date=22 June 2016|date=18 August 2015|url-status=live|archive-url=https://web.archive.org/web/20160611062234/http://emedicine.medscape.com/article/213853-workup#showall|archive-date=11 June 2016}}</ref> For gastrointestinal candidiasis, it is necessary to obtain a 3–5&nbsp;milliliter sample of fluid from the [[Biology:Duodenum|duodenum]] for [[Biology:Microbiological culture|fungal culture]].<ref name="SIFO" /> The diagnosis of gastrointestinal candidiasis is based upon the culture containing in excess of 1,000 colony-forming units per milliliter.<ref name="SIFO" />

=== Classification ===
Candidiasis may be divided into these types:
* Mucosal candidiasis
** [[Medicine:Oral candidiasis|Oral candidiasis]] (thrush, oropharyngeal candidiasis)<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" />
*** Pseudomembranous candidiasis<ref name="Thrush - 2015 review" />
*** Erythematous candidiasis<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" />
*** Hyperplastic candidiasis<ref name="Thrush - 2015 review" />
*** Denture-related stomatitis<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" /> — ''Candida'' organisms are involved in about 90% of cases
*** [[Medicine:Angular cheilitis|Angular cheilitis]]<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" /> — ''Candida'' species are responsible for about 20% of cases, mixed infection of ''C. albicans'' and ''[[Medicine:Staphylococcus aureus|Staphylococcus aureus]]'' for about 60% of cases.
*** [[Medicine:Median rhomboid glossitis|Median rhomboid glossitis]]<ref name="Thrush - 2015 review" />
** Candidal vulvovaginitis (vaginal yeast infection)<ref name="Medscape clinical" /><ref name=Mastro2013>{{cite journal | vauthors = Mastromarino P, Vitali B, Mosca L | title = Bacterial vaginosis: a review on clinical trials with probiotics | journal = The New Microbiologica | volume = 36 | issue = 3 | pages = 229–38 | date = July 2013 | pmid = 23912864 | url = http://www.newmicrobiologica.org/PUB/allegati_pdf/2013/3/229.pdf | archive-url = https://web.archive.org/web/20150518165920/http://www.newmicrobiologica.org/PUB/allegati_pdf/2013/3/229.pdf | url-status = live | archive-date = 2015-05-18 }}</ref>
** Candidal [[Medicine:Balanitis|balanitis]] — infection of the glans penis,<ref name="Medscape clinical" /> almost exclusively occurring in uncircumcised males<ref name="Nyirjesy 2013">{{cite journal | vauthors = Nyirjesy P, Sobel JD | title = Genital mycotic infections in patients with diabetes | journal = Postgraduate Medicine | volume = 125 | issue = 3 | pages = 33–46 | date = May 2013 | pmid = 23748505 | doi = 10.3810/pgm.2013.05.2650 | s2cid = 25586978 }}</ref>
** Esophageal candidiasis (candidal esophagitis)<ref name="Medscape clinical" /><ref name="Yamada 2009" >{{cite book|vauthors=Yamada T, Alpers DH |title=Textbook of gastroenterology|year=2009|publisher=Blackwell Pub.|location=Chichester, West Sussex|isbn=978-1-4051-6911-0|edition=5th|page=814|display-authors=0}}</ref>
** Gastrointestinal candidiasis<ref name="pmid24789109" /><ref name="pmid24612332" /><ref name="SIFO" />
** Respiratory candidiasis<ref name="Medscape clinical">{{cite web | vauthors=Hidalgo JA, Vazquez JA | title=Candidiasis: Clinical Presentation | url=http://emedicine.medscape.com/article/213853-clinical#showall | website=Medscape | publisher=WebMD | access-date=22 June 2016 | date=18 August 2015 | url-status=live | archive-url=https://web.archive.org/web/20160601153633/http://emedicine.medscape.com/article/213853-clinical#showall | archive-date=1 June 2016 }}</ref><ref name="pmid24789109" />
* Cutaneous candidiasis
** Candidal folliculitis<ref name="Medscape clinical" />
** [[Medicine:Candidal intertrigo|Candidal intertrigo]]<ref name="Medscape clinical" />
** Candidal paronychia<ref name="Medscape clinical" />
** Perianal candidiasis, may present as pruritus ani<ref name="Andrews">{{cite book | first1 = William D | last1 = James | first2 = Dirk M | last2 = Elston | first3 = Timothy G | last3 = Berger | first4 = George Clinton | last4 = Andrews | name-list-style = vanc |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier|pages=308–311|year=2006 |isbn=978-0-7216-2921-6|display-authors=0}}</ref>{{rp|309}}
** [[Medicine:Candidid|Candidid]]
** [[Medicine:Chronic mucocutaneous candidiasis|Chronic mucocutaneous candidiasis]]<ref name="Medscape clinical" />
** [[Medicine:Congenital cutaneous candidiasis|Congenital cutaneous candidiasis]]<ref name="Skoczylas 2014 179–89"/>
** Diaper candidiasis: an infection of a child's diaper area<ref name="Andrews" />{{rp|309}}
** [[Medicine:Erosio interdigitalis blastomycetica|Erosio interdigitalis blastomycetica]]
** Candidal [[Medicine:Onychomycosis|onychomycosis]] (nail infection) caused by ''Candida''<ref name="Medscape clinical" /><ref>{{cite journal | vauthors = Nolting S, Brautigam M, Weidinger G | title = Terbinafine in onychomycosis with involvement by non-dermatophytic fungi | journal = The British Journal of Dermatology | volume = 130 | pages = 16–21 | date = April 1994 | issue = Suppl 43 | pmid = 8186136 | doi = 10.1111/j.1365-2133.1994.tb06088.x | s2cid = 37415499 }}</ref>
* Systemic candidiasis<ref name="Medscape clinical" />
** Candidemia, a form of fungemia which may lead to [[Medicine:Sepsis|sepsis]]<ref name="Medscape clinical" />
** Invasive candidiasis (disseminated candidiasis) — organ infection by ''Candida''<ref name="Medscape clinical" />
** Chronic systemic candidiasis (hepatosplenic candidiasis) — sometimes arises during recovery from [[Medicine:Neutropenia|neutropenia]]<ref name="Medscape clinical" /><ref name="Reiss 2011">{{cite book| first1 = Errol | last1 = Reiss | first2 = H. Jean | last2 = Shadomy | first3 = G. Marshall | last3 = Lyon | name-list-style = vanc |title=Fundamental medical mycology|year=2011|publisher=John Wiley & Sons|location=Hoboken, N.J.|isbn=978-1-118-10176-6|chapter-url=https://books.google.com/books?id=eTkxR7lxr4YC&q=candidiasis&pg=PT360|chapter=Chapter 11|url-status=live|archive-url=https://web.archive.org/web/20160430223033/https://books.google.com/books?id=eTkxR7lxr4YC&pg=PT360&dq=candidiasis&hl=en&sa=X&ei=jEgpUv35FIWA0AWe_ICYBg&redir_esc=y#v=onepage&q=candidiasis&f=false|archive-date=2016-04-30}}</ref>
* Antibiotic candidiasis (iatrogenic candidiasis)

== Prevention ==
A diet that supports the immune system and is not high in simple carbohydrates contributes to a healthy balance of the oral and intestinal flora.<ref name=Goroll/><ref name=Review2002/> While yeast infections are associated with diabetes, the level of blood sugar control may not affect the risk.<ref>{{cite book|last1=Mobley|first1=David P. | last2 = Cappelli | first2 = Connie C. | name-list-style = vanc |title=Prevention in clinical oral health care|date=2008|publisher=Mosby Elsevier|location=St. Louis, Mo.|isbn=9780323036955|page=254|url=https://books.google.com/books?id=k9fbhs2PMTIC&pg=PA254|url-status=live|archive-url=https://web.archive.org/web/20170906210924/https://books.google.com/books?id=k9fbhs2PMTIC&pg=PA254|archive-date=2017-09-06}}</ref> Wearing cotton underwear may help to reduce the risk of developing skin and vaginal yeast infections, along with not wearing wet clothes for long periods of time.<ref name=CDC2014VP/><ref name=MedlinePlus/> For women who experience recurrent yeast infections, there is limited evidence that oral or intravaginal probiotics help to prevent future infections.<ref name="Jur2012" /><ref name="Fal2006">{{cite journal | vauthors = Falagas ME, Betsi GI, Athanasiou S | title = Probiotics for prevention of recurrent vulvovaginal candidiasis: a review | journal = The Journal of Antimicrobial Chemotherapy | volume = 58 | issue = 2 | pages = 266–72 | date = August 2006 | pmid = 16790461 | doi = 10.1093/jac/dkl246 | quote = Thus, the available evidence for the use of probiotics for prevention of recurrent VVC is limited | doi-access = free }}</ref> This includes either as pills or as yogurt.<ref name="Jur2012" />

Oral hygiene can help prevent oral candidiasis when people have a weakened immune system.<ref name=CDC2014RiskO/> For people undergoing cancer treatment, chlorhexidine mouthwash can prevent or reduce thrush.<ref name=CDC2014RiskO/> People who use inhaled corticosteroids can reduce the risk of developing oral candidiasis by rinsing the mouth with water or mouthwash after using the inhaler.<ref name=CDC2014RiskO/> People with dentures should also disinfect their dentures regularly to prevent oral candidiasis.<ref name="mayoclinic.org"/>

== Treatment ==

Candidiasis is treated with antifungal medications; these include [[Chemistry:Clotrimazole|clotrimazole]], [[Biology:Nystatin|nystatin]], [[Chemistry:Fluconazole|fluconazole]], [[Chemistry:Voriconazole|voriconazole]], [[Chemistry:Amphotericin B|amphotericin B]], and [[Chemistry:Echinocandin|echinocandin]]s.<ref name=IDSA2016 />  Intravenous fluconazole or an intravenous echinocandin such as [[Chemistry:Caspofungin|caspofungin]] are commonly used to treat immunocompromised or critically ill individuals.<ref name=IDSA2016/>

The 2016 revision of the clinical practice guideline for the management of candidiasis lists a large number of specific treatment regimens for ''Candida'' infections that involve different ''Candida'' species, forms of [[Biology:Antimicrobial resistance|antifungal drug resistance]], immune statuses, and infection localization and severity.<ref name=IDSA2016 /> Gastrointestinal candidiasis in immunocompetent individuals is treated with 100–200&nbsp;mg<!--dosage is included here because the cited ref is the only secondary source (as of June 2016) that gives a treatment protocol for immunocompetent GI candidiasis--> fluconazole per day for 2–3&nbsp;weeks.<ref name="SIFO" />

=== Localized infection ===
Mouth and throat candidiasis are treated with antifungal medication. Oral candidiasis usually responds to topical treatments; otherwise, systemic antifungal medication may be needed for oral infections. Candidal skin infections [[Medicine:Candidal intertrigo|in the skin folds (candidal intertrigo)]] typically respond well to topical antifungal treatments (e.g., [[Biology:Nystatin|nystatin]] or [[Chemistry:Miconazole|miconazole]]). For breastfeeding mothers topical miconazole is the most effective treatment for treating candidiasis on the breasts.<ref>{{Cite journal|last=Walker|first=Marsha|date=2008|title=Conquering Common Breast-feeding Problems|journal=The Journal of Perinatal & Neonatal Nursing|language=en|volume=22|issue=4|pages=267–274|doi=10.1097/01.JPN.0000341356.45446.23|pmid=19011490|s2cid=27801867|issn=0893-2190}}</ref> Gentian violet can be used for thrush in [[Social:Breastfeeding|breastfeeding]] babies.<ref name="Walker_2008" /> Systemic treatment with antifungals by mouth is reserved for severe cases or if treatment with topical therapy is unsuccessful. Candida esophagitis may be treated orally or intravenously; for severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.<ref name=CDC2014Otx/>

Vaginal yeast infections are typically treated with topical antifungal agents.<ref name=IDSA2016 /> Penile yeast infections are also treated with antifungal agents, but while an internal treatment may be used (such as a pessary) for vaginal yeast infections, only external treatments&nbsp;– such as a cream&nbsp;– can be recommended for penile treatment.<ref>{{Cite web|title=Male thrush: everything you need to know|url=https://www.medino.com/article/what-is-male-thrush-symptoms-treatment|access-date=2021-05-19|website=medino|language=en}}</ref> A one-time dose of fluconazole by mouth is 90% effective in treating a vaginal yeast infection.<ref name=Moosa>{{cite journal | vauthors = Moosa MY, Sobel JD, Elhalis H, Du W, Akins RA | title = Fungicidal activity of fluconazole against Candida albicans in a synthetic vagina-simulative medium | journal = Antimicrobial Agents and Chemotherapy | volume = 48 | issue = 1 | pages = 161–7 | date = January 2004 | pmid = 14693534 | pmc = 310176 | doi = 10.1128/AAC.48.1.161-167.2004 }}</ref> For severe nonrecurring cases, several doses of fluconazole is recommended.<ref name=IDSA2016 /> Local treatment may include vaginal [[Chemistry:Suppository|suppositories]] or medicated [[Biology:Douche|douche]]s. Other types of yeast infections require different dosing.  ''C. albicans'' can develop resistance to fluconazole, this being more of an issue in those with HIV/AIDS who are often treated with multiple courses of fluconazole for recurrent oral infections.<ref>{{cite journal | vauthors = Morschhäuser J | title = The genetic basis of fluconazole resistance development in Candida albicans | journal = Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease | volume = 1587 | issue = 2–3 | pages = 240–8 | date = July 2002 | pmid = 12084466 | doi = 10.1016/s0925-4439(02)00087-x | doi-access = free }}</ref>

For vaginal yeast infection in [[Medicine:Pregnancy|pregnancy]], topical [[Chemistry:Imidazole|imidazole]] or [[Chemistry:Triazole|triazole]] antifungals are considered the therapy of choice owing to available safety data.<ref name="soong2009"/> Systemic absorption of these topical formulations is minimal, posing little risk of transplacental transfer.<ref name="soong2009"/> In vaginal yeast infection in pregnancy, treatment with topical azole antifungals is recommended for seven days instead of a shorter duration.<ref name="soong2009">{{cite journal | vauthors = Soong D, Einarson A | title = Vaginal yeast infections during pregnancy | journal = Canadian Family Physician | volume = 55 | issue = 3 | pages = 255–6 | date = March 2009 | pmid = 19282531 | pmc = 2654841 }}</ref>

For vaginal yeast infections, many complementary treatments are proposed, however a number have side effects.<ref name=":0">{{cite journal | vauthors = Felix TC, de Brito Röder DV, Dos Santos Pedroso R | title = Alternative and complementary therapies for vulvovaginal candidiasis | journal = Folia Microbiologica | volume = 64 | issue = 2 | pages = 133–141 | date = March 2019 | pmid = 30269301 | doi = 10.1007/s12223-018-0652-x | s2cid = 52889140 }}</ref> No benefit from probiotics has been found for active infections.<ref name=Ab2009/>

=== Blood-borne infection ===
Candidemia occurs when any Candida species infects the blood. Its treatment typically consists of oral or intravenous antifungal medications.<ref name=NIHSystemic>{{cite web |title=Systemic candidiasis |url=http://rarediseases.info.nih.gov/gard/1076/systemic-candidiasis/resources/1 |website=NIH.gov |publisher=U.S. DHHS, National Institute of Health |date=Oct 2014 |access-date=April 19, 2015 |url-status=live |archive-url=https://web.archive.org/web/20150427111120/http://rarediseases.info.nih.gov/gard/1076/systemic-candidiasis/resources/1 |archive-date=April 27, 2015 }}</ref> Examples include intravenous [[Chemistry:Fluconazole|fluconazole]] or an [[Chemistry:Echinocandin|echinocandin]] such as [[Chemistry:Caspofungin|caspofungin]] may be used.<ref name=IDSA2016 /> [[Chemistry:Amphotericin B|Amphotericin B]] is another option.<ref name=IDSA2016 />

== Prognosis ==
In hospitalized patients who develop candidemia, age is an important prognostic factor. Mortality following candidemia is 50% in patients aged ≥75 years and 24% in patients aged <75 years.<ref>{{Cite journal | vauthors = Zatta M, Di Bella S, Giacobbe DR, Del Puente F, Mearelli M, Azzini AM, Brugnaro P, Vedovelli C, Cattelan AM, Busetti M, Gatti G, Bassetti M, Luzzati R |date=2020 |title=Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study |url=https://www.karger.com/Article/FullText/510638 |journal=Gerontology |language=en |volume=66 |issue=6 |pages=532–541 |doi=10.1159/000510638 |issn=0304-324X}}</ref>
Among individuals being treated in [[Medicine:Intensive care unit|intensive care unit]]s, the [[Mortality rate|mortality rate]] is about 30–50% when systemic candidiasis develops.<ref name="Williams 2011">{{cite journal | vauthors = Williams D, Lewis M | title = Pathogenesis and treatment of oral candidosis | journal = Journal of Oral Microbiology | volume = 3 | pages = 5771 | date = January 2011 | pmid = 21547018 | pmc = 3087208 | doi = 10.3402/jom.v3i0.5771 }}</ref>

== Epidemiology ==
Oral candidiasis is the most common fungal infection of the mouth,<ref name="OMF path textbook">{{cite book|last1=Bouquot|first1=Brad W. | last2 = Neville | first2 = Douglas D. | last3 = Damm | first3 = Carl M. | last4 = Allen | first4 = Jerry E. | name-list-style = vanc |title=Oral & maxillofacial pathology|year=2002|publisher=W.B. Saunders|location=Philadelphia|isbn=978-0-7216-9003-2|pages=189–197|edition=2.}}</ref> and it also represents the most common opportunistic oral infection in humans.<ref name="Lalla 2013">{{cite journal | vauthors = Lalla RV, Patton LL, Dongari-Bagtzoglou A | title = Oral candidiasis: pathogenesis, clinical presentation, diagnosis and treatment strategies | journal = Journal of the California Dental Association | volume = 41 | issue = 4 | pages = 263–8 | date = April 2013 | doi = 10.1080/19424396.2013.12222301 | pmid = 23705242 | s2cid = 46516738 }}</ref> Infections of the mouth occur in about 6% of babies less than a month old.<ref name="Oral2014Stat"/> About 20% of those receiving [[Medicine:Chemotherapy|chemotherapy]] for cancer and 20% of those with AIDS also develop the disease.<ref name="Oral2014Stat" />

It is estimated that 20% of women may be asymptomatically colonized by vaginal yeast.<ref>{{Cite journal|last=Sobel|first=Jack D| name-list-style = vanc |date=2007|title=Vulvovaginal candidosis|journal=The Lancet|volume=369|issue=9577|pages=1961–1971|doi=10.1016/s0140-6736(07)60917-9|pmid=17560449|s2cid=33894309|issn=0140-6736}}</ref> In the United States there are approximately 1.4 million doctor office visits every year for candidiasis.<ref>{{cite journal | vauthors = Benedict K, Jackson BR, Chiller T, Beer KD | title = Estimation of Direct Healthcare Costs of Fungal Diseases in the United States | journal = Clinical Infectious Diseases | volume = 68 | issue = 11 | pages = 1791–1797 | date = May 2019 | pmid = 30204844 | pmc = 6409199 | doi = 10.1093/cid/ciy776 }}</ref> About three-quarters of women have at least one yeast infection at some time during their lives.<ref name="CDC2014Epi"/>

Esophageal candidiasis is the most common esophageal infection in persons with AIDS and accounts for about 50% of all esophageal infections, often coexisting with other esophageal diseases. About two-thirds of people with AIDS and esophageal candidiasis also have oral candidiasis.<ref name="Yamada 2009" />

Candidal [[Medicine:Sepsis|sepsis]] is rare.<ref name="Gow 2002">{{cite journal|last=Gow|first=Neil A. R. G | name-list-style = vanc |title=Candida albicans - a fungal Dr Jekyll and Mr Hyde|journal=Mycologist|date=8 May 2002|volume=16|issue=1|doi=10.1017/S0269915X02006183|s2cid=86182033 |url=https://pdfs.semanticscholar.org/4190/f12a123810269fb91e6d9134c52ccfad096f.pdf|archive-url=https://web.archive.org/web/20200210161707/https://pdfs.semanticscholar.org/4190/f12a123810269fb91e6d9134c52ccfad096f.pdf|url-status=dead|archive-date=10 February 2020}}</ref> Candida is the fourth most common cause of bloodstream infections among hospital patients in the United States.<ref name=CDCCandida>{{cite web|title=Candida|url=https://www.cdc.gov/hai/eip/pdf/Candida-factsheet.pdf|website=CDC.gov|publisher=Center of Disease Control|access-date=April 19, 2015|url-status=live|archive-url=https://web.archive.org/web/20150427124739/http://www.cdc.gov/hai/eip/pdf/Candida-factsheet.pdf|archive-date=April 27, 2015}}</ref> The incidence of bloodstream candida in intensive care units varies widely between countries.<ref name="Vallab2016">{{cite book |last1=Vallabhaneni |first1=Snigdha |last2=Mody |first2=Rajal K. |last3=Walker |first3=Tiffany |last4=Chiller |first4=Tom |editor1-last=Sobel |editor1-first=Jack |editor2-last=Ostrosky-Zeichner |editor2-first=Luis |title=Fungal Infections, An Issue of Infectious Disease Clinics of North America |date=2016 |publisher=Elsevier |location=Philadelphia |isbn=978-0-323-41649-8 |pages=2–3|chapter-url=https://books.google.com/books?id=uwndCwAAQBAJ&pg=PA2 |language=en |chapter=1. The global burden of fungal disease}}</ref>

== History ==
Descriptions of what sounds like oral thrush go back to the time of [[Biography:Hippocrates|Hippocrates]] ''circa'' 460–370 BCE.<ref name=ID10>{{cite book|last1=Dolin|first1= Gerald L. | last2 = Mandell | first2 = John E. | last3 = Bennett | first3 = Raphael | name-list-style = vanc |title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia, PA|isbn=978-0-443-06839-3|pages=Chapter 250|edition=7th}}</ref>

The first description of a fungus as the causative agent of an oropharyngeal and oesophageal candidosis was by Bernhard von Langenbeck in 1839.<ref>{{cite journal |last1=Knoke |first1=M. |last2=Bernhardt |first2=H. |title=The first description of an oesophageal candidosis by Bernhard von Langenbeck in 1839 |journal=Mycoses |date=July 2006 |volume=49 |issue=4 |pages=283–287 |doi=10.1111/j.1439-0507.2006.01237.x|pmid=16784441 |s2cid=19140039 }}</ref>

Vulvovaginal candidiasis was first described in 1849 by Wilkinson.<ref name="Lynch 1994" /> In 1875, Haussmann demonstrated the causative organism in both vulvovaginal and oral candidiasis is the same.<ref name="Lynch 1994" />

With the advent of antibiotics following World War II, the rates of candidiasis increased. The rates then decreased in the 1950s following the development of [[Biology:Nystatin|nystatin]].<ref name="Obladen 2012">{{cite journal | vauthors = Obladen M | title = Thrush - nightmare of the foundling hospitals | journal = Neonatology | volume = 101 | issue = 3 | pages = 159–65 | year = 2012 | pmid = 22024688 | doi = 10.1159/000329879 | s2cid = 5277114 }}</ref>

The colloquial term "thrush" refers to the resemblance of the white flecks present in some forms of candidiasis (e.g., pseudomembranous candidiasis) with the breast of the [[Biology:Thrush (bird)|bird of the same name]].<ref name="emedicine/Medscape">{{Cite journal|last=Scully|first=Crispian| name-list-style = vanc |title=Mucosal Candidiasis | journal = Medscape |url=http://emedicine.medscape.com/article/1075227-overview|publisher=WebMD LLC|access-date=8 September 2013|url-status=live|archive-url=https://web.archive.org/web/20131102083621/http://emedicine.medscape.com/article/1075227-overview|archive-date=2 November 2013|date=2018-09-24}}</ref> The term candidosis is largely used in British English, and candidiasis in American English.<ref name="Lynch 1994">{{cite journal | vauthors = Lynch DP | title = Oral candidiasis. History, classification, and clinical presentation | journal = Oral Surgery, Oral Medicine, and Oral Pathology | volume = 78 | issue = 2 | pages = 189–93 | date = August 1994 | pmid = 7936588 | doi = 10.1016/0030-4220(94)90146-5 }}</ref> ''Candida'' is also pronounced differently; in American English, the stress is on the "i", whereas in British English the stress is on the first syllable.{{cn|date=June 2022}}

The [[Biology:Genus|genus]] ''Candida'' and [[Biology:Species|species]] ''C. albicans'' were described by botanist Christine Marie Berkhout in her doctoral thesis at the University of Utrecht in 1923. Over the years, the classification of the genera and species has evolved. Obsolete names for this genus include ''Mycotorula'' and ''Torulopsis''. The species has also been known in the past as ''Monilia albicans'' and ''Oidium albicans''. The current classification is ''[[Biology:Nomen conservandum|nomen conservandum]]'', which means the name is authorized for use by the International Botanical Congress (IBC).<ref>{{cite book |url=http://www.bgbm.org/iapt/nomenclature/code/SaintLouis/0000St.Luistitle.htm |title=International Code of Botanical Nomenclature |year=2000 |isbn=978-3-904144-22-3 |location=Königstein |access-date=2008-11-23 |url-status=live |archive-url=https://web.archive.org/web/20081202001439/http://www.bgbm.org/iapt/nomenclature/code/SaintLouis/0000St.Luistitle.htm |archive-date=2008-12-02 | vauthors = Greuter W, McNeill J, Burdet HM, Barrie FR }}</ref>

The genus ''Candida'' includes about 150 different species. However, only a few are known to cause human infections. ''C. albicans'' is the most significant [[Biology:Pathogen|pathogen]]ic species. Other species pathogenic in humans include ''C. auris'', ''C. tropicalis'', ''C. parapsilosis'', ''C. dubliniensis'', and ''C. lusitaniae''.

The name ''Candida'' was proposed by Berkhout. It is from the Latin word ''toga candida'', referring to the white toga (robe) worn by candidates for the Senate of the ancient Roman republic.<ref name="Lynch 1994" /> The specific epithet ''albicans'' also comes from Latin, ''albicare'' meaning "to whiten".<ref name="Lynch 1994" /> These names refer to the generally white appearance of ''Candida'' species when cultured.

== Alternative medicine ==
A 2005 publication noted that "a large [[Unsolved:Pseudoscience|pseudoscientific]] cult"<ref>{{cite journal | vauthors = Odds FC | title = Candida infections: an overview | journal = Critical Reviews in Microbiology | volume = 15 | issue = 1 | pages = 1–5 | date = 1987 | pmid = 3319417 | doi = 10.3109/10408418709104444 }}</ref> has developed around the topic of ''Candida'', with claims stating that up to one in three people are affected by yeast-related illness, particularly a condition called "Candidiasis hypersensitivity".<ref name="Barrett_2005">{{cite web| first = Stephen | last = Barrett | name-list-style = vanc |title = Dubious "Yeast Allergies" | work = Quackwatch |url = http://www.quackwatch.org/01QuackeryRelatedTopics/candida.html|date=October 8, 2005|url-status=live|archive-url=https://web.archive.org/web/20080513203124/http://www.quackwatch.org/01QuackeryRelatedTopics/candida.html|archive-date=May 13, 2008}}</ref> Some practitioners of alternative medicine have promoted these purported conditions and sold dietary supplements as supposed cures; a number of them have been prosecuted.<ref name="Barrett_2005" /><ref name="NCAHF">{{cite web |url=http://www.ncahf.org/articles/c-d/candida.html |title=Candidiasis Hypersensitivity |access-date=18 January 2014 |publisher=National Council Against Health Fraud |author=Jarvis WT}}</ref> In 1990, alternative health vendor Nature's Way signed an FTC consent agreement not to misrepresent in advertising any self-diagnostic test concerning yeast conditions or to make any unsubstantiated representation concerning any food or supplement's ability to control yeast conditions, with a fine of $30,000 payable to the [[Organization:National Institutes of Health|National Institutes of Health]] for research in genuine candidiasis.<ref name="NCAHF" />

== Research ==
High level ''Candida'' colonization is linked to several diseases of the gastrointestinal tract including [[Medicine:Crohn's disease|Crohn's disease]].<ref>{{cite journal | vauthors = Kumamoto CA | title = Inflammation and gastrointestinal Candida colonization | journal = Current Opinion in Microbiology | volume = 14 | issue = 4 | pages = 386–91 | date = August 2011 | pmid = 21802979 | pmc = 3163673 | doi = 10.1016/j.mib.2011.07.015 }}</ref><ref>{{cite journal | vauthors = Gerard R, Sendid B, Colombel JF, Poulain D, Jouault T | title = An immunological link between Candida albicans colonization and Crohn's disease | journal = Critical Reviews in Microbiology | volume = 41 | issue = 2 | pages = 135–9 | date = June 2015 | pmid = 23855357 | doi = 10.3109/1040841X.2013.810587 | s2cid = 39349854 | url = https://zenodo.org/record/3440733 }}{{Dead link|date=February 2022 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

There has been an increase in resistance to antifungals worldwide over the past 30–40 years.<ref name=Fisher>{{cite news|title=Growing resistance to antifungal drugs 'a global issue'|url=https://www.bbc.co.uk/news/amp/health-44160730|access-date=18 May 2018|work=BBC News|date=17 May 2018}}</ref><ref>{{cite journal | vauthors = Pappas PG, Lionakis MS, Arendrup MC, Ostrosky-Zeichner L, Kullberg BJ | title = Invasive candidiasis | journal = Nature Reviews. Disease Primers | volume = 4 | pages = 18026 | date = May 2018 | pmid = 29749387 | doi = 10.1038/nrdp.2018.26 | s2cid = 12502541 | doi-access = free }}</ref>

== References ==
{{Reflist}}

== External links ==
* {{Curlie|Health/Conditions_and_Diseases/Infectious_Diseases/Fungal/Candida/}}
* {{cite web | url = https://medlineplus.gov/yeastinfections.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Yeast Infections }}

{{Medical resources
|  DiseasesDB     = 1929
|  ICD11          = {{ICD11|1F23}}
|  ICD10          = {{ICD10|B37}}
|  ICD9           = {{ICD9|112}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    = 001511
|  eMedicineSubj  = med
|  eMedicineTopic = 264
|  eMedicine_mult = {{eMedicine2|emerg|76}} {{eMedicine2|ped|312}} {{eMedicine2|derm|67}}
|  MeshID         = D002177
}}
{{Mycoses}}

[[Category:Mycosis-related cutaneous conditions]]
[[Category:Wikipedia medicine articles ready to translate]]

{{Sourceattribution|Candidiasis}}