Candidiasis

Candidiasis is a fungal infection due to any species of the genus Candida (a yeast).^[4] When it affects the mouth, in some countries it is commonly called thrush.^[3] Signs and symptoms include white patches on the tongue or other areas of the mouth and throat.^[3] Other symptoms may include soreness and problems swallowing.^[9] When it affects the vagina, it may be referred to as a yeast infection or thrush.^[2][10] Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina.^[11] Yeast infections of the penis are less common and typically present with an itchy rash.^[11] Very rarely, yeast infections may become invasive, spreading to other parts of the body.^[12] This may result in fevers, among other symptoms.^[12] Finally, candiasis of the esophagus is an important risk factor for contracting esophageal cancer in individuals with achalasia.^[13]

More than 20 types of Candida may cause infection with Candida albicans being the most common.^[14] Infections of the mouth are most common among children less than one month old, the elderly, and those with weak immune systems.^[5] Conditions that result in a weak immune system include HIV/AIDS, the medications used after organ transplantation, diabetes, and the use of corticosteroids.^[5] Other risk factors include during breastfeeding, following antibiotic therapy, and the wearing of dentures.^[5][15] Vaginal infections occur more commonly during pregnancy, in those with weak immune systems, and following antibiotic therapy.^[16] Individuals at risk for invasive candidiasis include low birth weight babies, people recovering from surgery, people admitted to intensive care units, and those with an otherwise compromised immune system.^[17]

Efforts to prevent infections of the mouth include the use of chlorhexidine mouthwash in those with poor immune function and washing out the mouth following the use of inhaled steroids.^[6] Little evidence supports probiotics for either prevention or treatment, even among those with frequent vaginal infections.^[18][19] For infections of the mouth, treatment with topical clotrimazole or nystatin is usually effective.^[6] Oral or intravenous fluconazole, itraconazole, or amphotericin B may be used if these do not work.^[6] A number of topical antifungal medications may be used for vaginal infections, including clotrimazole.^[20] In those with widespread disease, an echinocandin such as caspofungin or micafungin is used.^[21] A number of weeks of intravenous amphotericin B may be used as an alternative.^[21] In certain groups at very high risk, antifungal medications may be used preventively,^[17][21] and concomitantly with medications known to precipitate infections.

Infections of the mouth occur in about 6% of babies less than a month old.^[7] About 20% of those receiving chemotherapy for cancer and 20% of those with AIDS also develop the disease.^[7] About three-quarters of women have at least one yeast infection at some time during their lives.^[8] Widespread disease is rare except in those who have risk factors.^[22]