Laboratory diagnosis of candidiasis

Candidiasis or thrush

is a fungal, infectious disease caused by opportunistic fungi of the genus Candida. Microorganisms are present in most healthy people. A person may encounter them for the first time in the womb, during childbirth, or during breastfeeding. Candidiasis develops against the background of reduced immunity, when the body can no longer restrain the active proliferation of the fungus.

The infection affects the mucous membranes of the mouth and genitals. It can develop on smooth skin, nails, and in the intestines, as a type of dysbacteriosis. There is visceral (systemic) candidiasis that affects internal organs. Despite the fact that Candida fungi are present in many people, and the disease itself is considered a neglected disease, it must be treated even if there are no external manifestations.

Causes of candidiasis

• Frequent damage to the skin and mucous membranes, for example, due to illness, working with aggressive chemicals, dry skin, age-related changes.
• Prolonged exposure to water, humid and warm environments. This includes a climate that is not suitable for your skin type, as well as occupational hazards.
• Mechanical damage to the skin and mucous membranes: injection drug addiction, long-term surgical interventions, catheters, shunts, endotracheal tubes.

After entering the body, the fungus may not manifest itself for a long time, since its reproduction will be suppressed by the immune system. In some cases, natural defenses weaken, leading to candidiasis (thrush). Among the factors that contribute to the proliferation of Candida:

• Chronic, endocrine and immune system diseases (diabetes, HIV).
• Metabolic disorders or taking medications that disrupt the natural microflora (antibiotics, hormonal contraceptives).
• Unbalanced diet, lack of sleep, stress and depression.

The fungus can be found in raw meat, unpasteurized dairy products, and, in more rare cases, on fresh vegetables and fruits. You can become infected with candidiasis from animals: dogs, calves, poultry.

Candidiasis of smooth skin

Candidiasis is a common disease classified as mycoses caused by opportunistic fungi. In our country, at the end of the 18th century, this fungal disease was known, but numerous reports of candidiasis, which developed as a complication after antibacterial therapy, began to appear after the introduction of broad-spectrum antibiotics into practice.

According to G. A. Samsygina (1997), there is an increase in various clinical forms of candidiasis in newborns, including children infected in the early neonatal period. When using antibacterial drugs in children of somatic departments, damage to the oral mucosa caused by yeast fungi of the genus Candida is observed in 6.6%, oral mucosa and skin - in 15%, intestinal mucosa - in 2.5%, candidiasis in the intestines - in 9.2% of patients (Zh.V. Stepanova, L.L. Smolyakova, 1999).

The increase in the incidence of candidiasis is associated with the use of modern means of therapy (antibiotics, hormonal drugs, cytostatics, immunosuppressants), as well as with an increase in the number of diseases that create a favorable background for its development: immunodeficiency states, dysfunction of the endocrine glands, malignant neoplasms, blood diseases, etc. In addition, the increase in the number of cases of candidiasis is influenced by increased background radiation and other factors that weaken the immune system. The increasing detection of this disease in patients after surgical treatment, as well as with gynecological, urological, hematological and other disorders in recent years, has increased interest in the problem of candidiasis among doctors of various specialties.

Candidiasis is caused by yeast fungi of the genus Candida, widespread in nature and classified as opportunistic pathogens. There are more than 130 species, but a little more than 10 species can be pathogenic for humans, such as C. albicans, C. tropicalis, C. krusei, etc.

The causative agents of candidiasis are isolated on average from every third person from the intestines, genitals, and bronchial secretions. Primary colonization of the body occurs in the mother's birth canal, and after birth - through contact and nutrition. Infection of a child can occur due to candidiasis of the mother’s nipples, through contact with service personnel, through household items, etc.

The leading factors in the development of candidiasis are the background condition or diseases of the body, in which opportunistic pathogens acquire pathogenic properties. In recent years, many researchers have come to the conclusion that the main predisposing factor for the occurrence of superficial forms of candidiasis, including in HIV infection and AIDS, is a violation of cellular immunity. A certain role in the development of candidiasis is played by the frequent and not always justified prescription of broad-spectrum antibiotics, including for prophylactic purposes, as well as the widespread use of drugs that have an immunosuppressive effect - glucocorticoid hormones and cytostatics.

Candidal paronychia and onychia on the fingers, as a rule, develops in women who have frequent contact with water, while separation of the nail skin (eponychion) from the nail plate is observed, creating favorable conditions for fungal infection in the matrix area. The disease can occur in people with diabetes. In recent years, women have begun to use false nails, which has created another risk factor for the development of fungal and bacterial infections.

Yeast fungi of the genus Candida can cause damage to the mucous membranes, skin and its appendages, and internal organs. The most common forms of mycosis are superficial.

On smooth skin, large (inguinal-femoral, intergluteal, under the mammary glands, axillary cavities) and small (interdigital) folds are affected, but rashes can also occur outside the folds on the smooth skin of the trunk and extremities, including the palms and soles. Outside the folds, foci of candidiasis develop mainly in infants or in adults suffering from diabetes mellitus or severe somatic illness. In large folds, small bubbles the size of millet grains appear, sometimes pustules, which quickly open with the formation of erosions. Due to peripheral growth, erosions quickly increase in size and merge with each other, forming large areas of damage. The lesions are dark red in color with a burgundy tint, shiny, with a moist surface, irregular in shape, with a strip of exfoliating epidermis along the periphery. Fresh small erosions (foci of elimination) form around large foci. In children, especially weakened ones, from the folds the lesion spreads to the skin of the thighs, buttocks, abdomen, and sometimes to the entire skin. There may be painful cracks deep in the folds. Candidiasis of smooth skin outside the folds (chest, abdomen, shoulders, forearms, legs, etc.) in children has a clinical picture of seborrheic dermatitis in the form of foci of erythematous-squamous nature or hyperemia. In adults, the disease can manifest itself as erythematous spots with peeling in the center and small blisters along the periphery. In small folds of the skin, the lesion usually occurs between the 3rd and 4th, 4th and 5th fingers of the hands, less often the feet, and is characterized by the formation of eroded lesions of a deep red color with a smooth, shiny, as if varnished surface, clear boundaries, with peeling of the stratum corneum of the epidermis along the periphery (Fig. 1). The disease can begin with the appearance of small blisters on the lateral touching hyperemic surfaces of the skin. Then it spreads to the area of ​​the interdigital fold, swelling, maceration, and peeling appear.

Interdigital candidiasis erosion is observed mainly in individuals who have prolonged contact with water, which contributes to the development of skin maceration, and, as a result, favorable conditions are created for the development of candidiasis infection. In addition to the folds between the 3rd and 4th, 4th and 5th fingers, others can be affected, not only on one, but also on both hands. Patients are concerned about itching, a burning sensation, and if there are cracks, pain. The course of the disease is chronic, with frequent relapses. Breastfeeding women may develop candidiasis of the smooth skin of the nipples. Clinical manifestations can be different: in the form of slight hyperemia in the area of ​​the isola; in the form of a lesion near the nipple with maceration, clear boundaries; in the form of a crack with maceration along the periphery and small bubbles between the nipple and the isola.

Candidiasis of the palms and soles is rare. On the palms, the disease can occur as dry lamellar dyshidrosis (superficial lamellar, ring-shaped or garland-shaped peeling); may have a vesicular-pustular form (vesicles and pustules against the background of hyperemic and edematous skin); can occur as hyperkeratotic eczema (against the background of diffuse hyperkeratosis or individual areas of keratinized skin, sharply limited wide skin furrows with a dirty brown color are observed). Candidiasis of the skin of the soles is observed mainly in children and is characterized by the presence of small blisters and pustules, hyperemic spots with peeling and exfoliating macerated epidermis along the periphery.

With candidiasis of the nail folds (candidal paronychia), the disease begins with the posterior fold, often in the area where it transitions to the lateral fold, with the appearance of hyperemia, swelling and swelling of the skin. Then the inflammatory phenomena spread to the entire roller, which becomes thicker and seems to hang over the nail, and peeling is observed along the edge of the roller. The skin of the cushion becomes thin, shiny, and the eponychion disappears. When pressing on the roller, ichor, a lump of white crumbly mass or a drop of pus may be released (due to the addition of a secondary infection). Later, the nail plate changes: it becomes dull, in the area of ​​the lunula it is separated from the bed, destroyed as onycholysis, or transverse grooves and elevations appear. These changes are associated with impaired blood supply in the area of ​​the matrix, i.e. they are trophic in nature and caused by inflammation in the area of ​​the cushion. Nail damage caused by a yeast fungus of the genus Candida begins from the lateral edges, the nails become thinner, separate from the bed, acquire a yellow-brown color and look as if they are trimmed on the sides (Fig. 2). In young children, inflammatory phenomena in the area of ​​the cushion are more pronounced, and the nail plate changes from the distal edge. There is candidiasis of the nails without inflammation of the ridge. In this case, the change in the plate begins from the distal edge and develops according to the type of onycholysis: the plate becomes thinner, does not adhere to the bed, and multiple lesions of the nails may occur.

In a special type of the disease - chronic generalized (granulomatous) candidiasis - clinical manifestations on the skin can be varied.

• Lesions with clear boundaries, round and oval in shape, ranging in size from 1.5 to 5 cm in diameter, of an erythematous-squamous nature develop on any part of the skin; they often merge with each other and form large areas; in some cases, the lesion takes on the character of erythroderma.
• Lesions in the form of plaques ranging in size from 1 to 5 cm in diameter, with hyperemia, a bluish or bright red rim, sometimes with papillomatous or verrucous growths on the surface, covered with horn-like formations, can occur on the scalp, face, trunk and limbs ; when the crusts are rejected, an easily bleeding surface opens; after resolution of such elements, cicatricial atrophy of the skin is formed (Fig. 3).
• Foci with clear boundaries are surrounded by a continuous infiltration ridge, consisting of tubercles, vesicles, with layering of yellow crusts and pronounced exudation; lesions are located predominantly on the dorsum of the hands and (or) feet with transition to the palmar and plantar surfaces; some patients experience dry skin on the palms and (or) soles, often spreading to the dorsum of the fingers and (or) feet (Fig. 4 ).

Candida balanoposthitis is quite common. The disease can occur in a mild form with minor lamellar ring-shaped peeling or be more pronounced. In this case, hyperemia, maceration, erosions appear on the skin of the glans penis and the inner layer of the preputial sac, as well as in the coronary groove on the contacting surfaces. Skin looks damp. Erosions can merge, and foci with clear boundaries, polycyclic outlines, with a shiny, varnished surface are formed; a fringe of exfoliating epidermis is observed along the periphery. Subjectively, patients are bothered by itching and a burning sensation. The disease can be complicated by ulceration and the development of phimosis.

In superficial forms of candidiasis, the diagnosis is based on the presence of a characteristic clinical picture in the patient and the detection of the fungus in pathological material (skin flakes, scrapings from nails) during microscopic examination. The diagnosis can be considered reliable if pseudomycelium or true mycelium and budding cells are detected. Sowing on a nutrient medium is carried out to identify the type of yeast fungus of the genus Candida and to determine its sensitivity to antimycotic drugs. Isolating only a culture of the fungus has no diagnostic value, since it can be obtained by culturing scrapings from the skin and nails of healthy people.

With candidiasis of smooth skin of large folds and outside the folds, the disease should be differentiated from seborrheic eczema, psoriasis, other mycoses - inguinal epidermophytosis, superficial trichophytosis, pseudomycosis - erythrasma (complicated form); with interdigital candidiasis erosion on the hands - from dyshidrotic eczema, on the feet - from mycosis caused by Trichophyton interdigitale and Trichophyton rubrum; for damage to nails and ridges - from onychia and paronychia of bacterial etiology, eczema and psoriasis; with balanoposthitis - from a similar disease of bacterial etiology.

Limited, sometimes widespread, forms of smooth skin lesions, especially those that developed during treatment with antibacterial drugs, as a rule, are easily treated with local antimycotic agents and can resolve without treatment after discontinuation of antibiotics. Local and systemic antimycotics are prescribed as etiotropic therapy. In recent years, azole drugs with a broad spectrum of action, as well as polyene antibiotics, have been widely used in the treatment of candidiasis.

For candidiasis of smooth skin of large folds with acute inflammatory phenomena, treatment should begin with the use of an aqueous solution of brilliant green (1–2%) in combination with powder and continue for 2–3 days, then antifungal drugs are prescribed until the clinical manifestations resolve.

For candidiasis of smooth skin of large, small folds and other areas of the skin, antifungal agents are used in the form of cream, ointment and solution: ketoconazole (ketoconazole, mycozoral, nizoral), clotrimazole (clotrimazole, canizon, canestene, candide), oxyconazole (mifungar), bifonazole ( mycospor, bifosin), sertaconazole (zalain), natamycin (pimafucin). Cream or ointment is applied in a thin layer to the affected areas and rubbed in 1-2 times a day. The duration of treatment is until clinical manifestations resolve, then continue to use the cream for another 7-10 days to prevent relapse. In case of common skin processes and the ineffectiveness of local therapy, systemic antimycotics are prescribed: fluconazole (Diflucan, Flumicon, Mycosist, Flucostat, etc.) for adults at a dose of 100–200 mg 1 time per day, for children at a rate of 5 mg/kg body weight 1 time per day; itraconazole (orungal, irunin, rumicosis) for adults, 100–200 mg 1–2 times a day; ketoconazole (nizoral, mycozoral) for adults 200 mg once a day daily, as well as the polyene antibiotic natamycin (pimafucin) for adults 100 mg 4 times a day, children 50 mg 2–4 times a day. The duration of therapy is 2–4 weeks.

In case of candidiasis of the skin of the nail folds, anti-inflammatory treatment of the nail folds is first carried out using applications with pure ichthyol, which are prescribed once a day, until the inflammatory phenomena subside. Then use antimycotic agents (ketoconazole, mifungar, travogen, clotrimazole, zalain, etc.) for topical use, rubbing them under and around the roller. The procedures are carried out 2 times a day, in the evening they can be applied under an occlusive dressing. It is effective to prescribe a combination of ointment (cream) and solution, alternating them. If local therapy is ineffective and if the nail plates are affected, systemic antimycotics are indicated: fluconazole (Diflucan, Flumicon, Mycosist, Flucostat, etc.) according to an intermittent regimen (adults 150 mg once a week, children 5–7 mg/kg body weight); itraconazole (orungal, irunin, rumicosis) for adults using the pulse therapy method (200 mg 2 times a day for 7 days, then a 3-week break) for 2–3 months; ketoconazole (nizoral, mycozoral) for adults, 200 mg per day daily for 2–4 months.

Considering the fact that candidiasis is an opportunistic mycosis, it is first necessary to identify and, if possible, eliminate the pathogenetic factors of the disease (a study of the immune and endocrine status, the gastrointestinal tract and corrective therapy are indicated).

Prevention of candidiasis includes the following measures.

• Prevention of the development of candidiasis in patients with severe somatic and endocrine diseases, as well as immunodeficiency. They should be tested repeatedly for fungi.
• To prevent the development of candida infection in children who are in somatic departments and receiving antibacterial drugs, it is necessary to prescribe fluconazole (Diflucan, Flumicon, Mikosist, Flucostat, etc.) at a rate of 3–5 mg/kg body weight, 1 time per day. The daily dose of the drug depends on the degree of risk, treatment is carried out in parallel with therapy for the underlying disease.
• Prevention of dysbiosis.
• Prevention of the development of candidiasis in newborns.

Literature

1. Stepanova Zh. V. Fungal diseases: diagnosis and treatment. M.: Miklos, 2005. 124 p.
2. Stepanova Zh. V., Smolyakova L. L. Candida infection as a complication of antibiotic therapy in children // Bulletin of Dermatology and Venereology. 1999. No. 1. P. 55–56.

Zh. V. Stepanova , Doctor of Medical Sciences, Professor TsNIKVI, Moscow

Risk factors for development

The likelihood of infection increases with casual sexual intercourse, uncontrolled use of antibiotics and drugs that disrupt the natural microflora. Foods with large amounts of sugar and carbohydrates create a favorable environment for fungal growth. Excessive sweating also leads to an exacerbation of candidiasis, so it is necessary to wear cotton underwear that allows the skin to breathe and moisture to evaporate.

At the same time, excessive cleanliness can also cause harm. We are talking about douching. It should not be used as a method of contraception, since it is not effective, and also as a means of hygiene, because it leads to the leaching of the protective flora. If you experience discomfort, you should first consult a doctor.

Fungi of the genus Candida that cause the development of urogenital candidiasis (UGC) include Candida albicans, the dominant causative agent of the disease (detected in 90-95% of patients with UGC), as well as representatives of Candida non-albicans species (more often - C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, less often - C. lipolytica, C. rugosa, C. norvegensis, C. famata, C. zeylanoides), detected, as a rule, with recurrent UGC occurring against the background of diabetes mellitus, HIV infection, postmenopause. Candida spp. - opportunistic microorganisms that are facultative anaerobes and have a tropism for tissues rich in glycogen (for example, the vaginal mucosa).

UHK is a widespread disease, more often observed in women of reproductive age. The frequency of registration of vulvovaginal candidiasis is 30-45% in the structure of infectious lesions of the vulva and vagina. According to researchers, 70-75% of women have at least one episode of vulvovaginal candidiasis during their lives, while in 5-10% of them the disease becomes recurrent. By the age of 25, about 50% of women, and by the beginning of menopause, about 75% of women have at least one episode of the disease diagnosed by a doctor. Vulvovaginal candidiasis is rarely observed in postmenopausal women, with the exception of women receiving hormone replacement therapy.

UGK is not a sexually transmitted infection, but this does not exclude the possibility of candidiasis balanoposthitis in men who are sexual partners of women with UGK.

Endogenous risk factors for the development of UGC include endocrine diseases (diabetes mellitus, obesity, thyroid pathology, etc.), underlying gynecological diseases, disorders of local immunity; exogenous risk factors - taking antibacterial, glucocorticosteroid, cytostatic drugs, immunosuppressants, radiation therapy; wearing tight clothing, underwear made of synthetic fabrics, regular use of sanitary pads, prolonged use of intrauterine devices, vaginal diaphragms, douching, use of spermicides.

The question of the reasons for the formation of recurrent UGC has not been completely resolved, since recurrent forms of the disease also occur in women who do not have the above risk factors. The leading role in the development of recurrent forms of UGC is given to local immune disorders caused by the innate qualities of vaginal epithelial cells.

Classification of the disease

Based on the depth of damage, candidiasis is divided into superficial and systemic forms. The first appear on visible parts of the body: mucous membranes, skin and its appendages. The second, systemic, are combined forms of the disease affecting internal organs. Without proper treatment, systemic (visceral) candidiasis can lead to the development of candidal sepsis. Most often, the fungus affects:

• gastrointestinal tract (esophagus, stomach, intestines);
• urinary organs (bladder, urinary tract, kidneys);
• lower respiratory tract (trachea, bronchi, lungs).

The disease is also classified based on the rate of spread of infection and the presence of relapses. Candidiasis of the liver and spleen often takes a chronic form. The acute, generalized form is asymptomatic candidemia, candida septicemia, candida thrombophlebitis, myositis, arthritis, cerebral candidiasis and other forms.

Classification of candida lesions according to ICD-10

• Candidiasis.
• Candidal stomatitis.
• Pulmonary candidiasis.
• Candidiasis of the skin and nails.
• Candidiasis of the vulva and vagina.
• Candidiasis of other urogenital locations.
• Candidal meningitis.
• Candidal endocarditis.
• Candidal septicemia.
• Candidiasis of other locations.
• Candidiasis, unspecified.

Officially, the diagnosis is made in accordance with ICD-10. In practical healthcare, such a classification is not entirely convenient, so they use the classification of deep candidiasis, which is a deeper list. When making a diagnosis, first indicate the name and form of the infection with a description of all localization points.

Skin treatment is carried out by a pediatrician in children and by a dermatologist in adults. Therapy is also carried out by doctors of other specializations, depending on the affected organ. For example, this could be a dentist, neurologist, gynecologist, pulmonologist.

Candidiasis

Candidiasis

is an infection caused by the genus Candida. The genus Candida has about 200 species that are present in food, soil, plants, and some are part of the human microflora. Several types of fungi are clinically significant, but C. albicans and C. tropicalis play a leading role in the development of candidiasis in humans.

C. albicans colonizes mucous membranes during fetal development or during the first year of life. C. albicans is present in the body of every person. Candida helps control bacteria involved in the production of vitamin K and B12, and is also involved in the breakdown of sugars. Under certain circumstances: against the background of decreased immunity, stress, a long course of antibiotic therapy and hormone therapy (including oral contraceptives), poor nutrition, the number of colonies increases and candidiasis or yeast infection develops.

Candida infection most often affects the mucous membranes of the mouth, intestines or vagina.

Candidiasis causes a wide range of symptoms: from the mildest but common forms, which are usually found in the mouth and vagina, to rare and severe forms associated with damage to the endocardium, meninges and the development of septicemia.

In accordance with ICD-10, there are:

• Candidiasis of the vulva and vagina
• Candidal stomatitis
• Pulmonary candidiasis
• Candidiasis of the skin and nails (onychia and paronychia)
• Candidiasis of other urogenital localizations
• Candidal meningitis
• Candidal endocarditis
• Candidal septicemia
• Candidiasis of other localizations
• Candidiasis, unspecified

Vulvovaginitis or vaginitis.

Also known as thrush. The disease is characterized by thick white or yellow cheesy vaginal discharge. The discharge is accompanied by itching, burning, swelling and redness of the intimate area, and an unpleasant odor. Pain and discomfort during urination or sexual intercourse are less common. Pregnant women or women with diabetes are more susceptible to the disease.

Candidal stomatitis

. The disease is characterized by the presence of ulcerative lesions and the accumulation of whitish cheesy deposits on the tongue and on the inner surface of the cheeks. The ulcers may be painful and bleed when they are scratched. Sometimes oral thrush can spread to the mouth, gums, tonsils, or the back of the throat. Candidal stomatitis can appear at any age, but is especially common in children.

Skin candidiasis

. The skin is a favorite place for the proliferation of fungi, especially in skin folds: armpits, inguinal and buttock folds, membranes between the fingers. The lesions appear as small nodules, itchy spots and reddish blisters. More often the disease develops in newborns.

Candidiasis infection of the nails (onychia) and surrounding area (paronychia)

. This form of candidiasis first manifests itself as painful swelling, which is later accompanied by the formation of pus. The infection often develops under the nail, leading to loss of the nail plate.

In addition to the main noticeable symptoms, such as thrush and a white coating on the tongue, candida has the following manifestations: craving for sweets, irritability, apathy, memory impairment, inability to concentrate and pay attention, poor sleep, mood swings, constipation, flatulence, constant feeling of fatigue .

At-risk groups

Risk groups for candidiasis include the following categories:

• children;
• overweight people;
• people diagnosed with diabetes mellitus;
• people with an underactive thyroid gland (hypothyroidism);
• people with inflammatory diseases;
• people with a weakened immune system (immunodeficiency);
• people working in wet conditions;
• pregnant women.

Protective barriers within the body

In the pathogenesis of the development of candidiasis, disturbances in the functioning of the digestive organs play an important role. There are three barriers inside the body: mechanical, physicochemical and immunobiological, which prevent the colonization of mucous membranes and skin by pathogenic microorganisms, and also cause a direct antifungal effect against candida.

The production of secretory immunoglobulin A (IgA) by the mucous membranes of the oral cavity and intestines is an immunological barrier that protects the mucous membranes from colonization by Candida fungi.

Antibacterial enzymes such as lysozyme, mucin, lactoferrin, peroxidase, found in saliva, are the first lines of defense. Long-term presence of food in the oral cavity, as well as the absence of washing it down with water or other drinks, increases the protective effect of saliva components and reduces the load on other parts of the gastrointestinal tract. The aggressive acidic environment of the stomach is the next factor of nonspecific protection. Digestion in the duodenum, the work of which equally depends on the activity of the pancreas and liver, contributes to the proper digestion of carbohydrates, fats and proteins of food and their better absorption in the small intestine. The intestine is the last authority regulating the flow of food components into the bloodstream, therefore its function, including the barrier function, will depend on the state of the enterocytes, the quality of mucin-like mucus and the presence of symbiotic flora. Treatment of candida first begins with restoring intestinal function.

The spread of candida is the result, on the one hand, of a violation of the barrier functions of the gastrointestinal tract, and on the other, the creation by the person himself of favorable conditions for the proliferation of yeast. These primarily include nutrition. One of the key factors on which 80% of the effect in the treatment of candidiasis depends is nutritional adjustments.

Nutrition

List of foods that contribute to the proliferation of candida:

• sugar and sugar-containing products;
• simple carbohydrates (baked goods, jam, preserves, carbonated drinks, ice cream);
• vegetables with a high glycemic index (potatoes);
• gluten-containing cereals;
• alcohol, caffeine.

List of products that will improve the condition of candidiasis:

• fermented foods;
• coconut oil, milk and pulp;
• ginger;
• herbal teas;
• unsweetened berries (cranberries, lingonberries);
• chia seeds, flax seeds.

Tests for candidiasis

There are several ways to detect candida directly on visible mucous membranes. To do this, a PCR study is carried out or a culture test is performed. In both cases, the subject of the study is a smear taken from the site of the lesion. Both methods determine the presence of the main culprits of the problem: fungi of the genus Candida based on the determination of DNA in the sample or the growth of a colony of fungi on a nutrient medium.

The microbiocenosis of the small intestine can be assessed using gas chromatography-mass spectrometry. The results of the analysis allow us to draw a conclusion about the state of the intestinal parietal microflora and identify which communities of microorganisms are in imbalance. The material for the study is whole venous blood.

Analysis of stool for dysbacteriosis will help to draw a conclusion about the state of the luminal microflora of the large intestine. The presence of E. coli, Klebsiella, Candida, and some types of staphylococci indicates candidiasis.

Symptoms of candidiasis

The symptoms of the disease are directly related to the affected organ. Superficial forms have obvious signs, while systemic forms can be asymptomatic or be similar to other diseases. In the presence of chronic diseases (diabetes mellitus, HIV, AIDS, leukemia and other types of oncology), candidiasis may not be detected at all. Since its symptoms will be perceived by the patient as an unhealthy state due to the existing disease. To make matters worse, Candida susceptibility testing is not considered a routine procedure in many teaching hospitals and laboratories.

Candidiasis of the skin and nails

The infection is expressed in the form of allergic rashes (candidamycids), erythematous-squamous spots, urticarial and bullous type rashes. Nail pathologies are divided into:

• parochinia - purulent inflammation of the periungual and subungual spaces, absence of eponychium (skin at the base of the nail plate);
• onychia - purulent inflammation of the nail fold, deformation of the nail with discoloration and brittleness.

Candidal skin lesions may be accompanied by fever, inflammation and swelling of the lesions.

Candidiasis (thrush) of the oral mucosa

The fungus can affect both individual areas of the oral cavity and completely all mucous membranes: lips, gums, cheeks, palate, tongue, tonsils, uvula and pharynx. This is expressed in the presence of a white coating, compared to a curd mass. Swelling and redness may appear. There is often pain when swallowing, talking, or palpating. Saliva becomes viscous and bad breath appears.

Thrush may be accompanied by candidal cheilitis - damage to the lips and corners of the mouth. Painful cracks appear, covered with a white coating, and pieces of skin peel off from the lips. The disease is characterized by a long course with the possible addition of bacterial infections.

Intestinal candidiasis

Intestinal infection with fungi of the genus Candida can be an independent disease or develop as a result of damage to the oral cavity. Expressed as severe dysbacteriosis with the following symptoms:

• diarrhea;
• excessive gas formation;
• nagging pain in the rectum;
• an admixture of white flakes in the stool.

In most cases, symptoms are sluggish or completely absent. The disease is dangerous because the body does not receive enough vitamins and microelements, which is especially dangerous for a growing child.

Candidiasis of the genitourinary system (urogenital candidiasis)

Unlike sexually transmitted diseases, candidiasis of the genitourinary system is often hidden and asymptomatic. The fungus is discovered during a planned infection or against the background of other diseases. Symptoms begin to appear against the background of declining immunity, ongoing pathological processes of microflora destabilization and re-infection. In women, candidiasis manifests itself as follows:

• itching and burning of the external genitalia;
• swelling and redness;
• white, cheesy discharge;
• pain during sexual intercourse.

In men, the symptoms are similar:

• itching and burning of the head of the penis;
• white plaque and discharge:
• pain during sexual intercourse and urination.

Fungal infections of the bladder, excretory tract and kidneys are characterized by frequent urination, including false urges, pain in the suprapubic region. Candidiasis can be accompanied by bacterial infections. Complications include: cystitis, pyelonephritis, necrosis of the papillae, abscesses, formation of mycelium in the renal pelvis. Without proper treatment, against the background of chronic diseases, there is a risk of developing kidney failure.

Candida

Candida

(
Candida
) is a genus of yeast-like fungi.
Yeast-like fungi of the genus Candida
are single-celled microorganisms 6–10 microns in size.
Fungi of the genus Candida
are dimorphic: under different conditions they form blastospores (bud cells) and pseudomycelia (threads of elongated cells).
Fungi of the genus Candida
are widespread in the environment.
They are found in soil, drinking water, food products, on the skin and mucous membranes of humans and animals. Favorable conditions for the growth of Candida
are considered to be a temperature of 21–37 °C and an acidity of the environment of 5.8–6.5 pH.

Prevalence of Candida fungi in healthy people

The frequency of carriage of fungi of the genus Candida
in healthy individuals reaches 25% in the oral cavity, and up to 65–80% in the intestines (Shevyakov M.A.).
According to OST 91500.11.0004-2003 “Protocol for the management of patients. Intestinal dysbiosis" in the composition of the main microflora of the colon in a healthy person, calculated per 1 g of feces, should contain no more than 104 colony-forming units (CFU) of fungi of the genus Candida
(and for children under one year old - less than 103). They are found in the vagina and genital tract in 10–17% of healthy women (as well as in 26–33% of pregnant women), on the skin of healthy people, without manifesting themselves in any way. In gastric juice, the ratio of different types of Candida fungi is approximately the following (Lazebnik L.B. et al.):

• Candida albicans
  - 41% of all Candida fungi
• Candida tropicalis
  — 30 %
• Candida glabrata
  — 9 %

Diseases caused by fungi of the genus Candida (Candida)

Fungi of the genus Candida
are the most common opportunistic fungi found in humans.
Among other human candidiasis caused by fungi of the genus Candida
, in 86% of cases the infectious agent is fungi of the species
Candida albicans
, in 9% of cases -
Candida tropicalis.
Also pathogenic for humans are the following species:
Candida krusei, Candida glabrata, Candida parapsilosis, Candida guillermondii, Candida tropicalis
.

Thrush (vulvovaginal candidiasis)

manifested in the form of white cheesy discharge from the female genital organs, their itching, burning, redness, swelling.

Candidal balanitis

(inflammation of the glans penis) and
urethritis
.

Candidiasis of the gastrointestinal tract

Colonization
of the gastrointestinal tract (GIT)
Candida In healthy Europeans, Candida
are present:

• in the oral cavity - in 10–25%
• in the oropharyngeal zone - in 20–30%
• in the small intestine - in 50–54%
• in the colon - in 55–70%
• in feces - in 65–70%
• in cystic and ductal bile - in 0.8–4%

Normal biochemical, histochemical and physiological processes in the gastrointestinal tract, timely regeneration of epithelial cells, acid-enzyme barrier, and full peristalsis are also protective factors that prevent the penetration of pathogenic microorganisms. The important role of stomach acid in preventing the introduction of fungi into the mucosa has been established. In an environment with low acidity, Candida
acquire pathogenic properties, vegetative forms appear, and pseudomycelium or mycelium is formed, damaging the mucous membrane.
In HIV-infected individuals, who are characterized by achlorhydria, ingested Candida
can cause gastric candidiasis, while in people with normal immunity this localization is rare. The role of gastric acidity in the development of bacterial and fungal infections of the intestine has not been confirmed (Burova S.A.).

Candidal esophagitis

Infectious esophagitis is most often associated with fungi of the genus Candida
, among which the most common pathogen is
Candida albicans
. Infectious esophagitis is characterized by an acute onset with the appearance of symptoms such as dysphagia and odynophagia. Heartburn, chest discomfort, nausea and vomiting are possible. Sometimes abdominal pain, anorexia, weight loss and even cough are observed.

Local oropharyngeal candidiasis is a common infection, recorded mainly in children and elderly patients, people with dentures, patients receiving antibiotics, chemotherapy treatment and/or radiation therapy to the head and neck area, and in patients with AIDS. There is also an increased risk of developing candidiasis in patients using inhaled steroids. Symptoms of oropharyngeal candidiasis include loss of taste, pain when chewing and swallowing, and when trying to put on dentures. Some patients do not have any symptoms. The diagnosis is most often established during an examination of the oral cavity, during which white plaques, sometimes a cheesy plaque, are discovered, and under removable dentures there are zones of hyperemia without plaques.

Esophageal candidiasis is most often diagnosed in patients with hematological malignancies, AIDS, after organ transplantation and in those receiving steroid therapy. In this case, candidiasis of the oral cavity may also be observed, but its absence does not exclude independent candidiasis of the esophagus. Candidal esophagitis occurs in general patients in 1-2% of cases, in patients with type 1 diabetes mellitus - in 5-10%, in patients with AIDS - in 15-30%. The most characteristic symptom of esophageal candidiasis is odynophagia, i.e. pain along the esophagus when swallowing food. The diagnosis of candidal esophagitis is established, as a rule, by endoscopy, when white and whitish-yellow plaques and plaque-like plaques are detected on the mucous membrane of the esophagus.

When writing the first three paragraphs of this section, materials from the Clinical Guidelines of the Russian State Administration for the diagnosis and treatment of infectious esophagitis were used / Ivashkin V.T. and others. RZHGK, No. 6, 2015.

Fungal esophagitis is most often caused by colonization with
Candida albicans
, less commonly
with Candida glabrata, Candida tropicalis, Candida parapsilosis and Candida krusei.
Clinically manifested by pain, a burning sensation. It develops against the background of systemic chemotherapy, with immunodeficiency of various origins, with the use of corticosteroids, especially in inhaled forms, diabetes mellitus, and during chemoradiotherapy. Whitish-yellow focal deposits are difficult to remove; often, after removing the deposits, the mucous membrane of the esophagus bleeds (Pirogov S.S.).

Associations of microbial pathogens of the oropharynx of patients with GERD (Khrustaleva E.V. et al.).

Medicines active against Candida fungi

The first-line drug for the treatment of oropharyngeal candidiasis and esophageal candidiasis is fluconazole, prescribed 100–200 mg per day orally or intravenously for 2–4 weeks. Only in cases of intolerance to fluconazole or resistance of the pathogen (usually Candida krusei, Candida glabrata, Candida pseudotropicalis
) second-line drugs are indicated (also within 2-4 weeks). Second-line drugs for esophageal candidiasis are (Shevyakov M.A.):

• itraconazole in oral solution 200–400 mg per day
• ketoconazole 200–400 mg per day
• amphotericin B 0.3–0.7 mg per day per kg of patient weight
• caspofungin intravenously 70 mg per day on the first day, then 50 mg per day intravenously in one administration
• voriconazole IV 6 mg per day per kg of patient weight every 12 hours on the first day, then 4 mg per day per kg of patient weight every 12 hours
• posaconazole 400 mg (10 ml suspension) 2 times a day orally with meals.

Of the antimicrobial drugs (antibiotics) listed in this reference book, the following are active against Candida fungi: fluconazole, nifuratel (MacMirror), clotrimazole (exception: Candida guillermondii
is resistant to clotrimazole).

Antifungal activity against fluconazole-resistant strains of Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis

and
Candida tropicalis
has lactoferrin (in combination with fluconazole).

Enterol (Saccharomyces Boulardii) inhibits the growth of Candida albicans, Candida kruesei, Candida pseudotropicalis

.

Professional medical work addressing the role of Candida in diseases of the gastrointestinal tract

• Shevyakov M.A. Candidiasis of the esophagus: diagnosis and modern choice of treatment // Journal “Treating Doctor”. – 2008. – No. 9.
• Pankova L.Yu., Osipenko M.F., Vergazov V.M. Risk factors for the attachment of opportunistic fungi to defects in the gastric mucosa in peptic ulcers // RZHGGK. – No. 1. – 32–37. – 2007.
• Lazebnik L.B., Khomeriki S.G., Morozov I.A., Kasyanenko V.I., Zvenigorodskaya L.A., Khomeriki N.M., Goncharenko L.S. Yeast-like fungi in gastric mucus in acid-dependent diseases // Experimental and clinical. gastroenter. 2005. No. 4. P. 27-32.
• Khrustaleva E.V., Pedder V.V., Shishkina N.M., Lubyanskaya T.G. Relationship between the pH level of the mucous membrane of the oropharynx and the presence of fungal flora in patients with GERD // Medical Sciences. — 2013 — No. 6.

On the website GastroScan.ru in the Literature section there is a subsection “Parasitic and infectious diseases of the gastrointestinal tract”, containing articles that touch upon, among other things, the treatment of candidiasis
.

Candida in the taxonomy of biological species

The genus of fungi Candida ( Candid
a) belongs to the family Saccharomycetaceae
,
which is included in the order Saccharomycetales
,
class Saccharomycetes
,
subphylum Saccharomycotina
,
phylum
Ascomycota
, kingdom
Fungi
.

Genus Candida ( Candid

a) includes a large number of species:
C. albicans, C. ascalaphidarum, C. amphixiae, C. antarctica, C. argentea, C. atlantica, C. atmosphaerica, C. blattae, C. carpophila, C. carvajalis, C. cerambycidarum, C. chauliodes, C. corydali, C. dosseyi, C. dubliniensis, C. ergatensis, C. fermentati, C. fructus, C. glabrata, C. guilliermondii, C. haemulonii, C. insectamens, C. insectorum, C. intermedia, C. jeffresii, C. kefyr, C. krusei, C. lusitaniae, C. lyxosophila, C. maltosa, C. marina, C. membranifaciens, C. milleri, C. oleophila, C. oregonensis, C. parapsilosis, C. quercitrusa, C. rugosa, C. sake, C. shehatea, C. temnochilae, C. tenuis, C. theae, C. tropicalis, C. tsuchiyae, C. sinolaborantium, C. sojae, C. subhashii, C. viswanathii, C. utilis
.

Appendix 1. Candidiasis in ICD-10

In the International Classification of Diseases ICD-10 in “Class I. Some infectious and parasitic diseases (A00-B99)”, in block “B 3
5-B49 Mycoses” there is a heading:

B37 Candidiasis

Included:
candidiasis, moniliasis
Excluded:
neonatal candidiasis (P37.5)

B37.0 Candidal stomatitis

Thrush

B37.1 Pulmonary candidiasis
B37.2 Candidiasis of the skin and nails

Candida:

• onychia
• paronychia

Excludes
: diaper dermatitis (L22)

B37.3† Candidiasis of the vulva and vagina (N77.1*)

Candidal vulvovaginitis Monilial vulvovaginitis Vaginal thrush

B37.4† Candidiasis of other urogenital sites

Candida:

• balanitis † (N51.2*)
• urethritis † (N37.0*)

B37.5† Candidal meningitis (G02.1*)
B37.6† Candidal endocarditis (I39.8*)

B37.7 Candidal septicemia

B37.8 Candidiasis of other sites

Candida:

• cheilitis
• enteritis

B37.9 Candidiasis, unspecified

Thrush NOS

Notes. 1. An asterisk * marks optional additional codes related to the manifestation of a disease in a separate organ or area of ​​the body, which represents an independent clinical problem. 2. The main codes of the underlying disease that must be used are marked with a cross †.

Appendix 2. Gastroduodenal candidiasis in the Kyoto global consensus

The Kyoto global consensus recommends that the following candidiasis of the gastroduodenal zone be included in the new ICD-11 categories as separate clarifying lines:

• to the new section “Fungal gastritis”: gastric candidiasis
• to the new section “Fungal duodenitis”: duodenal candidiasis

Appendix 3. Medical services aimed at identifying fungi of the genus Candida

Order of the Ministry of Health and Social Development of Russia No. 1664n dated December 27, 2011 approved the nomenclature of medical services. Section 26 of the Nomenclature provides for a large number of different medical services related to the study of Candida fungi in humans:

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Diagnosis of candidiasis

The study is based on the isolation and identification of a species of fungus of the genus Candida. Currently, there are about 150 species, differing in morphological and biochemical properties. The most common fungus is C. albicans, accounting for up to 80% of cases of candidiasis of the digestive tract and up to 70% of genital infections. Before prescribing treatment, it is also necessary to determine the sensitivity of the isolated strain to antimycotics (antifungal medications): amphotericin B, voriconazole, itraconazole, fluconazole, flucytosine.

Microscopic diagnostics

1. Microscopy of a smear is taken from the area of ​​the affected mucosa. Allows for comparative characterization of blastospores and pseudomycelia. During the study, fixed and native preparations that stain microorganisms are used. To increase the information content, pseudomycelia of cells are treated with dyes. The contrast in staining of microorganisms makes it easy to distinguish candida from other forms, including bacteria, under a microscope.

2. Bacterial culture allows you to identify the causative agent of infection and determine its concentration. The analysis is used to monitor the effectiveness of treatment, as well as to identify the sensitivity of candida fungi to various antimycotics.

Diagnostics by ELISA and PCP

1. Enzyme-linked immunosorbent assay (ELISA) is based on the determination of antibodies that are produced by the immune system in response to foreign substances in the blood. This technique allows you to identify the pathogen and the degree of its development, establishing whether the disease occurs in an acute or chronic stage.

2. Polymerase chain reaction (PCR) is a highly sensitive test that allows you to directly detect the infectious agent. Thanks to it, it is possible to differentiate Candida fungi with pseudomycelium from those that do not have it. These data are important for subsequent interpretation of results and deeper diagnosis.

Oral candidiasis

Manifestations of candidiasis of the oral mucosa are varied and depend on the patient’s age, the state of the immune system, the presence of concomitant diseases, medications (antibiotics, corticosteroids) and other factors.

According to the clinical course, acute and chronic forms are distinguished. Acute candidiasis can occur in the form of thrush (acute pseudomembranous candidiasis) or acute atrophic candidiasis. Chronic candidiasis also exists in two clinical forms: chronic hyperplastic and chronic atrophic. They can develop as independent forms or transform into one another.

Acute pseudomembranous candidiasis , or thrush (candidosis acuta, s. soor), is one of the most common forms of candidiasis of the oral mucosa. In infants, thrush occurs frequently and is relatively mild. In adults, acute pseudomembranous candidiasis is often accompanied by any general somatic diseases: diabetes mellitus, blood diseases, hypovitaminosis, malignant neoplasms, etc.

Most often the mucous membrane of the back of the tongue, cheeks, palate, and lips are affected. She is hyperemic and dry. Against the background of hyperemia, there is a white coating, reminiscent of curdled milk or cottage cheese, rising above the level of the mucous membrane. At the beginning of the disease, it is easily removed by scraping with a spatula, revealing a smooth, slightly swollen, hyperemic surface underneath. In severe, advanced cases, plaque becomes denser and is difficult to remove, revealing the erosive surface of the oral mucosa underneath.

Patients complain of a burning sensation in the mouth, pain when eating, especially spicy food.

Acute pseudomembranous glossitis should be differentiated from desquamative glossitis, in which areas of epithelial desquamation appear on the back of the tongue, constantly migrating along the back of the tongue and surrounded by a rim of exfoliating epithelium. Acute candidal stomatitis is differentiated from leukoplakia and lichen planus. With the latter, whitish films and nodules on the surface of the mucous membrane are formed due to hyperkeratosis, and therefore it is impossible to remove them by scraping. A differential diagnosis of candidiasis and soft leukoplakia, or white spongy nevus, is carried out, in which the lesion is localized mainly along the line of closure of the teeth and on the mucous membrane of the lips. The color of the mucous membrane in soft leukoplakia in the affected area is whitish-gray, its surface is rough, uneven, and there are multiple small superficial erosions (abrasions). The final diagnosis is made on the basis of bacterioscopic examination data.

Acute atrophic candidiasis (candidosis acuta atrophica) is characterized by significant pain, burning and dryness in the mouth. The mucous membrane is fiery red, dry. When the tongue is affected, its back becomes crimson-red, dry, shiny, and the filiform papillae are atrophied. The plaque is absent or remains in deep folds, is difficult to remove and is a conglomerate of deflated epithelium and a large number of fungi of the genus Candida in the stage of active budding (mycelium, pseudomycelium).

Acute atrophic candidiasis should be differentiated from an allergic reaction to the plastic of removable dentures. An important role in this case is played by clinical observation of the dynamics of changes in the oral mucosa after eliminating the prosthesis and conducting a bacterioscopic examination.

The general condition of patients with acute candidiasis does not suffer.

Chronic hyperplastic candidiasis (candidosis chronica hyper plastica) is characterized by the formation of a thick layer of plaque in the form of nodules or plaques on the hyperemic oral mucosa. The plaque is usually located on the back of the tongue, on the palate. The tongue is most often affected by the area typical of rhomboid glossitis.

Chronic hyperplastic candidiasis on the palate has the appearance of papillary hyperplasia. In cases of long-term, persistent disease, the plaque becomes saturated with fibrin, and yellowish-gray films are formed, tightly fused to the underlying mucous membrane. When scraped with a spatula, the plaque is removed with difficulty, revealing a hyperemic, bleeding, erosive surface underneath. Patients complain of dry mouth, burning, and, in the presence of erosions, pain. This form of candidiasis should be differentiated from leukoplakia and lichen planus.

Chronic atrophic candidiasis (candidosis chronica atrophica) is manifested by dry mouth, burning, pain when wearing a removable denture. The area of ​​the mucous membrane corresponding to the boundaries of the prosthetic bed is hyperemic, swollen, and painful.

Chronic atrophic candidiasis in people who have been using removable lamellar dentures for a long time is most often characterized by damage to the oral mucosa under the dentures (hyperemia, erosion, papillomatosis) in combination with mycotic (yeast) infection and candidal atrophic glossitis, in which the back of the tongue is crimson-red, dry, shiny, filiform papillae atrophic. There is a small amount of whitish-gray coating only in deep folds and on the lateral surfaces of the tongue; it is difficult to remove. Under a microscope, spores and mycelium of the fungus of the genus Candida are found in the plaque. This triad (inflammation of the palate, tongue and corners of the mouth) is so characteristic of atrophic candidal stomatitis that diagnosing it is not difficult.

Interpretation of results

If there are clear signs of candidiasis (thrush), and during a laboratory test blastospores and pseudomycelia of the fungus were identified, the study ends here. A diagnosis is made and treatment begins.

If a microscopic examination gives a negative result, this does not indicate the absence of infection. The disease can occur in a latent chronic form. It is necessary to carry out a number of other tests, for example, microscopic examination of scrapings, determination of Candida DNA in scrapings, urine, and prostate secretions. Also prescribed:

• Clinical blood test.
• Test for HIV infection.
• Determination of trace element reserves in the body.
• Test for glucose and carbohydrate metabolism metabolites.

These laboratory tests can help identify conditions that may be causing the fungus to grow.

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Analyzes

• Bacteriological study for opportunistic pathogenic flora (OPF)
• NC yeasts of the genus Candida: C.albicans, C.krusei, C.glabrata
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• Candida albicans
• Mycoses: identification of clinically significant fungi with determination of sensitivity to antimycotic drugs (only for fungi of the genus Candida and Cryptococcus neoformans)
• Specific immunoglobulin E - Candida albicans

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