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.
 Diagnosis
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
 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.