CANDIDIASIS

Candida is a resident yeast of the mucous membranes. It becomes
pathogenic under favourable host conditions. These are:
- When host immunity is decreased such as in HIV-infected and cancer
patients or by systemic steroids, cytotoxic drugs, and radiotherapy.
- Pregnancy and contraceptive pill use.
- Warmth and moisture (babies’ nappy area, groins, under breasts,
between toes).
- Use of broad-spectrum antibiotics which kill resident non-pathogenic
bacteria.
- Diabetes mellitus.
Candidiasis or thrush presents on the skin as red macules often with
small pustules on their periphery which break down as the lesion spreads
outwards. On the oral and vulvo-vaginal mucosa redness, superficial
erosions and white adherent plaques may be seen. These can be itchy
and painful. When oral lesions extend to the throat and oesophagus they
can cause anorexia. Infection of lips / corners of the mouth also occurs.
Severe mucosal candidiasis is seen often in HIV infection.
Management of candidiasis
- Treat large oozing lesions with potassium permanganate dressings
or baths for 10 minutes twice daily. Keep lesional skin dry.
- Paint mucosal or smaller wet lesions with Gentian Violet
solution once daily until healed. Application on normal skin
or on large areas is very unsightly.
- Nystatin ointment or cream twice daily for skin, nystatin
oral suspension (1 ml) swirled around mouth four times daily
until two days after clinical cure for oral candidiasis, nystatin
pessaries nightly for 2 weeks for vaginal candidiasis.
- An imidazole cream twice daily for skin infections,
miconazole oral gel 5 ml 4 times daily for 1 week for oral
thrush, imidazole pessaries 1-3 nights for vaginal thrush.
- Nappy rash: apply an imidazole cream and cover with
zinkoxide cream or ointment.
- In severe cases e.g. oesophageal thrush ketaconazole
200 mg twice daily for 1-2 weeks or itraconazole 100 mg
once daily for 2 weeks or fluconazole 50-200 mg once daily
for 1-2 weeks.
- Treatment duration may need to be extended in
immunocompromised patients.
- Griseofulvin is not an effective treatment
for candida infections.