Opportunistic infections, including mycoses, represent a pressing problem in modern medicine. Paradoxically, it was precisely the achievements of science that ensured the success of clinical medicine that led to an increase in the number of patients with opportunistic mycoses. In particular, advances in the treatment of a number of oncological and autoimmune diseases (the use of chemotherapy, anti-cytokine therapy, glucocorticosteroids and immunosuppressants) are associated with the emergence of a population of patients with acute and chronic iatrogenic immunodeficiency states. In turn, immunodeficiencies and local disorders of antimicrobial resistance in humans are the basis for the development of opportunistic mycoses, primarily candidiasis. Diagnosis and treatment of candidiasis of the mucous membranes of the digestive tract in some cases are associated with significant difficulties.
Fungi (Latin fungus, Greek mykes) are an independent vast kingdom of eukaryotic microorganisms, including about 90 thousand studied species. Until the end of the 1960s. Fungi were mistakenly classified as members of the plant kingdom. Among fungi, macromycetes and micromycetes are distinguished. The former are visible with the naked eye, the latter - with the help of microscopes. Unicellular (lower fungi, for example, Mucor) and multicellular (higher fungi, for example, Penicillium) forms of micromycetes are known [1].
Yeast-like fungi of the genus Candida are single-celled microorganisms 6–10 microns in size. These micromycetes are dimorphic: under different conditions they form both blastomycetes (bud cells) and pseudomycelia (threads of elongated cells). This morphological feature has, as will be shown below, important clinical significance.
Micromycetes of the genus Candida are characterized by ubiquity - widespread occurrence in the environment. Viable cells of Candida spp. can be found in soil, drinking water, food products, on the skin and mucous membranes of humans and animals. Thus, contact with these micromycetes of a person’s “open systems,” i.e., his skin and mucous membranes, is an ordinary fact.
Intestinal candidiasis. Causes
It is generally accepted that the gastrointestinal tract is the main endogenous reservoir of Candida, from where the subsequent spread of infection throughout the body occurs. Candida albicans belongs to the opportunistic flora and is a component of the normal intestinal microflora. Determination of the presence of Candida albicans in 10x4 degrees in a bacteriological analysis of stool, according to official requirements, is not an indication for making a diagnosis of “intestinal candidiasis,” much less for antifungal therapy. In practice, the clinician has to deal with candidiasis, which is observed in the intestines up to 80% and it is better for Candida to be below the detection level in the analysis (0).
Risk factors for the development of candidiasis infection are varied, they are also caused by various diseases of organs and systems of the body, in which signs of impaired intestinal microflora develop, in particular diabetes mellitus, oncopathology, inflammatory bowel diseases (Crohn's disease and ulcerative colitis), irritable bowel syndrome, anemia , AIDS, decreased immune defense, stress. Therapy for underlying diseases can also contribute to the development of intestinal microbiocenosis disorders and excessive growth of candida - this is the use of cytostatics, immunosuppressants, radiation therapy, antibiotics, and surgical interventions in the treatment.
The physiological periods of a person’s life, neonatality, pregnancy, menopause, old age, and deteriorating environmental conditions that reduce a person’s anti-infective resistance are also important in the occurrence of overgrowth of Candida fungi, which leads to an imbalance between the normal flora and the body’s immune response. (Burova S.A., Kurbatova I.V., 2006). All the reasons that were described above, in which a violation of the microbiocenosis of the gastrointestinal tract develops, can lead to candidiasis. The most significant conditions should be highlighted: gastric surgery, disorders of the secretory and motor functions of the stomach and intestines, colonic diverticulosis, and cirrhosis of the liver.
Poor nutrition and, in particular, steroids contained in food and supplements and food intolerance seem to be important for the development of dysbiosis of the gastrointestinal tract.
Symptoms of thrush in infants
If you suspect your baby has thrush, you should visit your pediatrician to confirm the diagnosis and receive treatment recommendations.
Here's how thrush manifests itself in a baby:
- Difficulty feeding.
One of the first signs you may notice is that your baby acts restless during feeding, as if he is in pain or uncomfortable.
- White spots.
The spots resemble curdled milk and can appear on the tongue, lips, gums and roof of the mouth. Try to wipe them gently - if the stains do not go away this way, it may be thrush. If you don't look closely, these spots are not so noticeable, so make it a habit to look into your baby's mouth from time to time.
- Cracks in the corners of the mouth.
Another possible sign of thrush in a child's mouth.
- Mom's symptoms.
If you are breastfeeding and your nipples appear cracked, inflamed, there is a burning sensation, or you feel shooting pain in your nipples or breasts, these may be signs of thrush. Thrush can be transmitted to the mother from the baby during feeding. Later in this article we talk about how to continue breastfeeding if you have thrush.
Intestinal candidiasis. Indications for examination
Indications for examination of the gastrointestinal tract to exclude fungal infection should be the following:
- the presence of 2 risk factors for the possible occurrence of candidiasis,
- double superficial colonization of candida,
- the presence of reasons that can lead to disruption of the microflora of the gastrointestinal tract with excessive growth of fungi of the genus Candida.
- febrile conditions of unknown origin, resistant to antibiotic therapy,
- skin and allergic diseases, because Candida is a trigger for allergic diseases and a factor favoring their development.
Algorithm for diagnosing intestinal microflora disorders with overgrowth of Candida flbicans:
- Analysis of medical history, identification of risk factors,
- analysis of clinical data,
- microbiological and gas chromatographic methods for studying disorders of the microflora of the intestinal tract (various biological environments),
- smears - impressions from the mucous membranes of the mouth and esophagus,
- if systemic candidiasis is suspected, it is necessary to culture blood and biological fluids and tissues for the presence of a fungal infection,
- serological diagnosis and assessment of the effectiveness of treatment based on the levels of antibodies to candida,
- inflammatory markers (lysozyme, a-antitrypsin, elastase),
- secretory immunoglobulin A, which allows assessing the degree of activity of the intestinal-associated immune system,
- immunological status (screening) level 1.
All laboratory data should be assessed and analyzed in conjunction with the patient's current clinical situation.
Causes of candidiasis
Conventionally, the disease can be divided into childhood and adult. Infantile candidiasis can be transmitted during childbirth, by passing through infected mucous membranes of the mother, during feeding, and through everyday objects.
Due to the fact that children's immunity is poorly developed and largely depends on the mother, it is important to pay enough attention to one's own hygiene and the cleanliness of the space surrounding the child.
Adult candidiasis most often develops when the immune system is weakened, but the cause may be in factors that give impetus to the development of the disease.
Factors contributing to the development of candidiasis:
- External factors - temperature changes, humidity, skin damage, harmful environmental factors, chemical influences, leaching of one’s own microflora;
- Internal factors - metabolic disorders, non-inflammatory endocrine diseases, courses of treatment with hormonal drugs, taking hormonal contraceptives;
- Changes in the virulent properties of a fungal organism, tilting its qualities towards pathogenic ones.
Doctors note that candidiasis often occurs unnoticed by the patient, in a mild form. The body itself is able to cope with the fungus, and everything returns to normal quite quickly. However, if you notice symptoms of candidiasis, immediately contact GMS Clinic specialists to receive qualified treatment. We can provide the necessary and timely assistance to your immune system.
There are superficial and systemic candidiasis. Let's look at all types in more detail and analyze the systems of each type of candidiasis.
Intestinal candidiasis. Symptoms
Disturbances of intestinal microbiocenosis with excessive growth of fungi of the genus Candida or candidal dysbacteriosis are clinically manifested by fermentative dyspepsia, abdominal pain, more in the sigmoid region, flatulence, frequent abundant foamy loose stools with mucus are noted up to 6-10 times a day, accompanied by disturbances in vitamin metabolism, low-grade fever fever, severe weakness, headache. Symptoms of damage to the mucous membranes in the form of stomatitis, glossitis, and vulvovaginal thrush are often observed. Fungal infection sharply reduces immunity, which leads to a deeper development of visceral candidomycosis with damage to the upper respiratory tract, lungs, genitourinary and digestive systems. In the blood - moderate leukocytosis, accelerated ESR, with sigmoidoscopy - catarrhal hemorrhagic proctosigmoiditis.
Indications for therapy are subject to clinical, microbiological, serological or histological confirmation of candidal infection, detection of candida with clinical manifestations from two or more surfaces of fungal colonization.
Skin candidiasis
Candidiasis of the skin, namely skin folds
: redness and itching, pustules and erosions, weeping in the armpits, inguinal, intergluteal folds, under the mammary glands.
Interdigital candidiasis
: itching, burning, erosion between the fingers and toes.
Often combined with damage to the periungual ridges and nails. Balanitis, balanoposthitis
: irritation of the glans penis, pain, burning, discharge from the cavity of the foreskin. Pustules and erosions, redness, white plaques, swelling, ulcers, cracks in the foreskin appear (usually in patients with diabetes).
Nail candidiasis
Candidiasis of nails and nail folds.
Redness and swelling of the nail folds. The swollen rollers seem to hang over the nail. When pressed, creamy pus is released from under the nail folds. Palpation is painful. Dystrophic changes in the nail plate: color change to yellow, green, black, appearance of grooves. Nail destruction. A possible complication is a purulent infection.
Localization of Candida
It should be noted that Candida primarily affects the stratified squamous epithelium of the oral cavity and esophagus and, less often, the single-layer cylindrical epithelium of the intestine. As a result, Candida fungi cause invasive lesions in the upper gastrointestinal tract and colonization (adhesion) in the areas below the stomach. At the same time, clinical symptoms discussed above as signs of non-invasive candidiasis may appear in the intestine, even at the adhesion stage. (Burova S.A., 2006). Consequently, among all localizations of candidiasis of the digestive tract, oropharyngeal candidiasis comes first, followed by candidal esophagitis, gastric candidiasis (often it can be suspected with ineffective Helicobacter pylori therapy and prolonged healing of the ulcer), intestinal candidiasis, which must be differentiated from pseudomembranous colitis caused by Clostridium difficile and acute process in the intestines caused by rotoviruses and Escherichia coli.
Risk factors for mucosal candidiasis
Defects in the antifungal resistance system briefly described above are factors contributing to the occurrence of candidiasis, or so-called. risk factors. Risk groups for the development of candidiasis of the digestive tract are presented below: • physiological immunodeficiencies (early childhood, old age, pregnancy); • genetically determined immunodeficiencies (for example, selective IgA deficiency); • iatrogenic immunodeficiencies – (for example, the consequences of treatment with glucocorticosteroids, immunosuppressants, anticytokine, radiation and polychemotherapy); • diseases of the endocrine system (for example, diabetes mellitus, autoimmune polyendocrine syndrome, hypothyroidism); • dysbiosis of mucous membranes after antibiotic therapy; • AIDS; • chronic “debilitating” diseases (for example, cirrhosis of the liver); • nutritional status disorders (for example, starvation and vitamin deficiencies).
In these groups, candidiasis is detected more often than usual. Note that sometimes the clear cause of the violation of antifungal resistance cannot be determined.
Intestinal candidiasis. Therapy
Therapeutic approaches to the treatment of gastrointestinal dysbiosis with overgrowth of Candida fungi include the following:
- A balanced diet excluding sugar and the consumption of complex carbohydrates, foods with prebiotic properties, and probiotic foods.
- Antifungal drugs.
2.1.Polyene antibiotics (nystatin, natamycin, levorin).
- Nystatin is most appropriate to use in the presence of candida in the esophagus, stomach and is practically ineffective when candida is localized in the intestine, which makes it also not effective when administered prophylactically along with antibiotic treatment.
- Pimafucin (natamycin) is the most effective drug for overgrowth of Candida in the intestines. The drug has an antifungal (fungicidal) effect. Interacts with sterols in fungal cell membranes, disrupting their structure and function and causing their death. Active against many pathogenic yeast fungi, especially Candida albicans. No resistance to natamycin was observed. For intestinal candidiasis, 1 tablet is prescribed. 4 times a day after meals for 7-10 days.
2.2. Triazole derivatives (flucanazole, Diflazon, Diflucan, Mikosist, Flucostat, rumicosis, intraconazole, terbizil, etc.), caspofungin derivatives - Cancidas (for administration of the drug), Noxafil (posaconazole) suspension for oral administration.
2.3. MPH (copper derivative of chlorophyll) is a plant antiseptic from brown algae, a natural immunomodulator due to stimulation of phagocytosis and the activity of copper cations, enhanced by the influence of alcohol, has a bactericidal effect against staphylococci, streptococci, pneumococci, fungi, putrefactive bacteria and E. coli and an antiviral effect. MPH protects and stimulates hematopoiesis, the anti-inflammatory effect is due to an excellent complex of microelements. Prescribed by a doctor orally, 1 drop per 5 kg of body weight daily in a small amount of water. The course of treatment is 30 days,
2.4. Citrosept is a herbal antimicrobial agent made from grapefruit seed extract, which has a bactericidal effect, including. and against fungi of the genus Candida and Helicobacteriosis of the stomach, promotes the absorption of vitamin C, contains bioflavonoids that strengthen the vascular wall of capillaries and prevent blood clots and cholesterol plaques, stimulates the body's natural resistance. It is prescribed as drops diluted in water or juice in different dosage regimens depending on the disease.
2.5. Self-eliminating bacillary preparations (B subtilis, L.bulgaricus) - Flonivin-IS, Baktisubtil, Sporobacterin, biosporin, Baktisporin, Gastrofarm, etc.
2.6. Saccharomyces boulardi - Enterol, 1 capsule contains 250 mg Saccharomyces boulardi, suppresses the growth of opportunistic flora and fungi Candida Krusei, Candida pseudotropical
2.7. Probiotics – lactose-containing preparations (Lactobacterin, Gastrofarm, Primadophyllus, Acidophyllus, Narine, etc.)
- Enterosorbents.
- Hepatoprotectors (Heptral, Hofitol, Karsil, milk thistle preparations, Floravit, etc.)
- Immunomodulatory drugs (Kipferon, Polyoxidonium, Dopolan, Marispan, etc.)
How to treat thrush in a baby
If you notice possible symptoms of thrush in yourself or your child, contact your doctor to confirm the diagnosis. The doctor will prescribe the necessary treatment.
Sometimes thrush will go away on its own within a few weeks, but your doctor may also prescribe antifungal medications.
Thrush: treatment with folk remedies
It is not recommended to buy medications to treat thrush in infants without consulting a doctor.
Mothers often resort to folk remedies: they treat spots in the baby’s mouth and their nipples with a soda solution, remove sugar, dairy products, and products containing yeast from their diet.
There is no scientific evidence that these methods are effective, and they should only be used in conjunction with treatment prescribed by your doctor, and not instead of it. Do not use over-the-counter medications or home remedies without your doctor's approval.
If the inflammation does not go away after a few weeks of treatment or goes away and starts again - especially if the baby is over nine months old - talk to your doctor about the possible causes.
Intestinal candidiasis. Prolonged treatment
The duration of treatment is at least 6 weeks, and then prolonged pulse therapy in short courses with individual selection of drugs for 6 months, but observing the principles of prolonged treatment of gastrointestinal dysbiosis with overgrowth of Candida fungi.
- Rational nutrition continues mainly with the limitation of sugar-containing foods and dishes.
- Repeated courses of citrosept.
- Lactose-containing probiotics 10 days each month.
- Immunomodulatory drugs (repeated courses after 3 months)
- Hepatoprotectors – 2 courses over 6 months.
Assessment of the treatment effect according to the clinical and laboratory data discussed above, during treatment and after 6 months.
What is thrush?
Thrush in the mouth is an inflammation of the mucous membranes caused by fungi of the genus Candida, which can be found anywhere on the human body, including in the mouth and intestines. Thrush in the mouth can happen to people of any age, but it most often occurs in infants, especially those under six months of age.
There is a possibility that the child has already had contact with the fungus. It is transmitted through saliva through hand-to-mouth contact, as well as when a baby passes through the birth canal during vaginal delivery.
If the fungus actively grows in the mouth, a child may develop thrush, which appears as a white coating. Thrush can be uncomfortable or painful, especially during feeding.
Thrush from the baby can spread to the mother's nipples if she is breastfeeding, which can also cause pain and discomfort when feeding.
