Who is at risk for invasive candidiasis. How can invasive candidiasis be prevented. What are the symptoms of invasive candidiasis. How is invasive candidiasis diagnosed and treated. What role do healthcare providers play in preventing invasive candidiasis.

Understanding Invasive Candidiasis: A Serious Fungal Infection

Invasive candidiasis is a severe fungal infection caused by Candida species that can affect various parts of the body. This condition occurs when Candida enters the bloodstream or internal organs, leading to potentially life-threatening complications. Unlike superficial Candida infections, invasive candidiasis requires prompt medical attention and can be particularly dangerous for individuals with weakened immune systems.

What distinguishes invasive candidiasis from other Candida infections?

Invasive candidiasis differs from common yeast infections in several ways:

• It affects internal organs and the bloodstream rather than just the skin or mucous membranes
• It is more severe and can be life-threatening
• It typically occurs in hospitalized or immunocompromised individuals
• It requires systemic antifungal treatment rather than topical medications

Identifying High-Risk Groups for Invasive Candidiasis

Certain individuals are more susceptible to developing invasive candidiasis due to various factors that compromise their immune system or increase their exposure to Candida species. Understanding these risk factors is crucial for prevention and early intervention.

Who falls into the high-risk category for invasive candidiasis?

The following groups are considered at high risk for invasive candidiasis:

1. Patients with prolonged stays in intensive care units (ICUs)
2. Individuals with central venous catheters
3. People with weakened immune systems, such as cancer patients undergoing chemotherapy or organ transplant recipients
4. Patients who have recently undergone multiple abdominal surgeries
5. Those who have received extensive antibiotic treatment in hospital settings
6. Individuals receiving total parenteral nutrition
7. People with kidney failure or on hemodialysis
8. Diabetic patients
9. Premature infants
10. Intravenous drug users

Transmission and Contagiousness of Invasive Candidiasis

Understanding how invasive candidiasis spreads is essential for implementing effective prevention strategies in healthcare settings and among high-risk populations.

Can invasive candidiasis be transmitted from person to person?

Invasive candidiasis does not spread directly from person to person. However, it’s important to note that some Candida species naturally reside on the skin. This means there is a possibility of Candida being transferred from one individual to another, potentially leading to an infection in someone who is already at high risk.

Preventive Measures for Invasive Candidiasis

Preventing invasive candidiasis involves a combination of medical interventions and personal hygiene practices. Healthcare providers play a crucial role in implementing preventive strategies, especially for high-risk patients.

What preventive measures can be taken against invasive candidiasis?

Several preventive measures can be implemented to reduce the risk of invasive candidiasis:

• Antifungal prophylaxis: Healthcare providers may prescribe antifungal medications to high-risk patients as a preventive measure.
• Proper hand hygiene: Thorough handwashing by both healthcare providers and patients can significantly reduce the spread of Candida.
• Careful management of central venous catheters: Minimizing the use of central lines and ensuring proper care when they are necessary can help prevent infections.
• Judicious use of antibiotics: Limiting unnecessary antibiotic use can help maintain the body’s natural balance of microorganisms.
• Enhanced infection control practices in healthcare settings: Implementing and adhering to strict infection control protocols can reduce the risk of Candida transmission in hospitals and other healthcare facilities.

Antifungal Prophylaxis: A Key Prevention Strategy

Antifungal prophylaxis is a proactive approach to preventing invasive candidiasis in high-risk individuals. This strategy involves administering antifungal medications to patients who are at an elevated risk of developing the infection.

Which patient groups are typically recommended for antifungal prophylaxis?

Antifungal prophylaxis is generally recommended for:

• Certain organ transplant patients
• Specific patients in intensive care units (ICUs)
• Patients undergoing particular types of chemotherapy or with low white blood cell counts (neutropenia)
• Individuals who have undergone stem cell or bone marrow transplants and have low white blood cell counts
• In some cases, very low birth weight infants (less than 2.2 pounds) in nurseries with high rates of invasive candidiasis

The Role of Patients in Preventing Invasive Candidiasis

While healthcare providers play a significant role in preventing invasive candidiasis, patients and their caregivers can also take proactive steps to reduce their risk of infection. Being an informed and engaged patient is crucial in maintaining overall health and preventing complications.

How can patients contribute to preventing invasive candidiasis?

Patients can take several actions to protect themselves from invasive candidiasis:

• Speak up: Ask healthcare providers about the necessity and duration of central venous catheters. Report any redness or pain around the catheter site promptly.
• Practice good hand hygiene: Ensure that you and those around you, including healthcare providers, clean hands regularly, especially before any physical contact.
• Stay informed: Learn about the risks associated with invasive candidiasis and the preventive measures recommended for your specific situation.
• Adhere to treatment plans: If prescribed antifungal prophylaxis, follow the medication regimen as directed by your healthcare provider.
• Maintain overall health: Focus on a healthy lifestyle, including proper nutrition and managing underlying conditions like diabetes, which can increase the risk of fungal infections.

Healthcare Provider Responsibilities in Preventing Invasive Candidiasis

Healthcare providers are at the forefront of preventing invasive candidiasis, especially in hospital settings where the risk is highest. Their adherence to proper infection control practices is crucial in reducing the incidence of this serious fungal infection.

What specific actions should healthcare providers take to prevent invasive candidiasis?

Healthcare providers should follow these guidelines to prevent invasive candidiasis:

1. Implement and strictly adhere to CDC-recommended infection control practices, particularly when working with central lines.
2. Practice proper hand hygiene before and after patient contact, and when handling medical devices.
3. Carefully assess the need for central venous catheters and remove them as soon as they are no longer necessary.
4. Provide appropriate antifungal prophylaxis to high-risk patients as per established guidelines.
5. Monitor patients for signs of Candida infection and initiate prompt treatment when necessary.
6. Educate patients and their caregivers about the risks of invasive candidiasis and preventive measures.
7. Participate in ongoing training and education regarding the latest prevention and treatment strategies for invasive fungal infections.

Diagnosis and Treatment of Invasive Candidiasis

Early diagnosis and appropriate treatment are critical in managing invasive candidiasis effectively. Healthcare providers must be vigilant in identifying symptoms and initiating timely interventions to improve patient outcomes.

How is invasive candidiasis diagnosed and treated?

The diagnosis and treatment of invasive candidiasis typically involve the following steps:

1. Clinical assessment: Healthcare providers evaluate symptoms and risk factors associated with invasive candidiasis.
2. Laboratory tests: Blood cultures and other diagnostic tests are performed to identify the presence of Candida species.
3. Imaging studies: In some cases, imaging techniques like CT scans may be used to detect organ involvement.
4. Antifungal therapy: Once diagnosed, treatment usually involves systemic antifungal medications, with the choice of drug depending on the Candida species identified and the patient’s overall health status.
5. Supportive care: Additional measures may be necessary to manage complications and support the patient’s recovery.
6. Monitoring and follow-up: Close monitoring of the patient’s response to treatment and adjusting therapy as needed is crucial for successful outcomes.

Understanding the complexities of invasive candidiasis, from risk factors to prevention and treatment, is essential for both healthcare providers and patients. By implementing comprehensive prevention strategies and ensuring prompt diagnosis and treatment, the impact of this serious fungal infection can be significantly reduced. Continued research and surveillance efforts, such as those conducted by the CDC’s Emerging Infections Program, play a vital role in enhancing our understanding of invasive candidiasis and improving patient care.

Risk and Prevention | Invasive Candidiasis | Candidiasis | Types of Diseases | Fungal Diseases

Groups at risk for invasive candidiasis

People who are at high risk for developing invasive candidiasis include those who:¹

• Have spent a lot of time in the intensive care unit (ICU)
• Have a central venous catheter
• Have a weakened immune system (for example, people on cancer chemotherapy, people who have had an organ transplant, and people with low white blood cell counts)
• Have recently had surgery, especially multiple abdominal surgeries
• Have recently received lots of antibiotics in the hospital
• Receive total parenteral nutrition (food through a vein)
• Have kidney failure or are on hemodialysis
• Have diabetes
• Are pre-term babies

People who inject drugs are also at risk for invasive candidiasis, especially for bloodstream infections, heart valve infections, and bone and joint infections. ⁶

Is invasive candidiasis contagious?

Invasive candidiasis doesn’t spread directly from person to person. However, some species of the fungus that causes invasive candidiasis normally live on skin, so it’s possible that Candida can be passed from one person to another and possibly cause an infection in someone who is at high risk.²,³

Preventing invasive candidiasis

• Antifungal medication. If you’re at high risk for developing invasive candidiasis, your healthcare provider may prescribe antifungal medication to prevent the infection. This is called “antifungal prophylaxis,” and it is typically recommended for:⁴
  • Some organ transplant patients
  • Certain patients in the intensive care unit (ICU)
  • Patients who are on certain types of chemotherapy or have low white blood cell counts (neutropenia)
  • Patients who have a stem cell or bone marrow transplant and have low white blood cell counts (neutropenia)
• Some doctors may also consider giving antifungal prophylaxis to very low birth weight infants (less than 2. 2 pounds) in nurseries with high rates of invasive candidiasis.
• Be a safe patient. There are some actions that you can take to help protect yourself from infections, including:
  • Speak up. Patients and caregivers can ask whether a central venous catheter (central line) is needed, and if so, how long it should stay in place. Tell your doctor if the skin around the catheter becomes red or painful.
  • Keep hands clean.  Be sure everyone cleans their hands before touching you. Washing hands can prevent the spread of germs.
  • For more tips, please see CDC’s webpage about What You Can Do to Be a Safe Patient.
• Healthcare providers can follow CDC-recommended infection control practices every time they work with a central line. For more prevention information, please visit CDC’s Healthcare-Associated Infections website.

1. Kullberg BJ, Arendrup MC. Invasive candidiasisexternal icon. N Engl J Med 2015; 373:1445-1456.
2. Pappas PG, Kauffman CA, Andes DR, Clark CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of Americaexternal icon. Clin Infect Dis. 2016;62:e1-50.
3. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problemexternal icon. Clin Microbiol Rev. 2007 Jan;20(1):133-63.
4. Strausbaugh LJ, Sewell DL, Ward TT, Pfaller MA, Heitzman T, Tjoelker R. High frequency of yeast carriage on hands of hospital personnelexternal icon. J Clin Microbiol. 1994 Sep;32(9):2299-300.
5. Yildirim M, Sahin I, Kucukbayrak A, Ozdemir D, Tevfik Yavuz M, Oksuz S, et al. Hand carriage of Candida species and risk factors in hospital personnelexternal icon. Mycoses. 2007 May;50(3):189-92.
6. Zhang AY, Shrum S, Williams S, Petnic S, Nadle J, Johnston H, et al. The changing epidemiology of candidemia in the United States: injection drug use as an increasingly common risk factor – active surveillance in selected sites, United States, 2014–17external icon.  Clin Infect Dis. 2019 Nov.

Page last reviewed: November 18, 2020

Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)

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• Fungal Meningitis
• National Center for Emerging and Zoonotic Infectious Disease
• Division of Foodborne, Waterborne, and Environmental Diseases
• Mycotic Diseases Branch

Statistics | Invasive Candidiasis | Candidiasis | Types of Diseases | Fungal Diseases

Public health surveillance for candidemia in the United States

Since 2008, CDC has performed continuous, active population-based surveillance for Candida bloodstream infections (candidemia) through the Emerging Infections Program (EIP). EIP is a network of 10 state health departments and their collaborators in local health departments, academic institutions, other federal agencies, public health and clinical laboratories, and healthcare facilities.

Active, population-based surveillance for candidemia is being conducted in 10 EIP sites: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee (Figure 1). CDC and its partners recruit laboratories and hospitals serving the counties under surveillance to submit reports of candidemia in patients within the surveillance area.

Learn more about methods used for CDC’s candidemia surveillance through EIP.

Figure 1. Emerging Infections Program sites where candidemia surveillance is being conducted; dark green represents counties under surveillance at each EIP site.

Through this program, CDC monitors epidemiologic trends in candidemia and performs species confirmation and susceptibility testing on all available Candida bloodstream isolates to:

• Track incidence of candidemia and monitor laboratory and epidemiologic trends
• Identify new risk factors for candidemia
• Detect changes in resistance to antifungal agents and communicate these results back to submitting laboratories
• Determine the burden (number of cases, treatment costs, etc. ) of infections caused by antimicrobial-resistant Candida species and understand the causes of resistance. Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow.
• Identify areas where candidemia prevention and intervention strategies should be focused

CDC also collects data on healthcare-associated infections, including central line-associated Candida infections, through the National Healthcare Safety Network (NHSN), the largest healthcare-associated infection reporting system in the United States.

Candidemia trends in the United States

Although there are notable differences by site, overall candidemia incidence has declined. Candidemia incidence declined during 2008–2013 and then stabilized at approximately 9 cases per 100,000 population per year during 2013–2017.^3,4 The observed declines in candidemia during 2008–2013 may be related to healthcare delivery improvements such as those involving catheter care and maintenance. ³ Increases in incidence for certain surveillance areas may be due to increases in the number of candidemia cases related to injection drug use, which has recently re-emerged as a risk factor for candidemia.^5-7

Demographic trends

Candidemia rates by age group have recently changed. Rates decreased significantly among infants and the elderly during 2009–2012, but have remained more stable since 2012.^8,9 The reasons for the decline in candidemia rates in some age groups are not fully understood but might be related to factors such as changes in prophylaxis guidelines and improved infection control practices, such as hand hygiene and catheter care. Among all ages, candidemia rates are approximately twice as high among Black people compared with other races/ethnicities. The differences by race might be due to differences in underlying conditions, socioeconomic status, healthcare access and availability, or other factor.

Learn more about candidemia incidence rates by age group and race.

Trends in species distribution

Up to 95% of all invasive Candida infections in the United States are caused by five species of Candida: C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei. The proportion of infections caused by each species varies by geographic region and by patient population.¹⁰ Although C. albicans is still the leading cause of candidemia in the United States, increasing proportions of cases in recent years have been attributed to non-albicans species that are often resistant to antifungal drugs.^11-13 Altogether, non-C. albicans species cause approximately two-thirds of candidemia cases in the United States.^3,11 In some locations, C. glabrata is the most common species. Since 2015, an emerging species called Candida auris (C. auris) has been an increasing cause of invasive Candida infections in the United States.¹⁴

Learn more about Candida species distribution.

Trends in antimicrobial resistance

Some types of Candida are increasingly resistant to the first-line and second-line antifungal medications, such as fluconazole and the echinocandins (anidulafungin, caspofungin, and micafungin). About 7% of all Candida bloodstream isolates tested at CDC are resistant to fluconazole. More than 70% of these resistant isolates are the species C. glabrata or C. krusei.^11,15 CDC’s surveillance data indicate that the proportion of Candida isolates resistant to fluconazole has remained fairly constant over the past 20 years.^11,16,17 Echinocandin resistance, however, appears to be emerging, especially among C. glabrata isolates. Approximately 3% of C. glabrata isolates are resistant to echinocandins, but the percentage may be higher in some hospitals. This is especially concerning because echinocandins are the first-line treatment for C. glabrata, which already has high levels of resistance to fluconazole.¹⁵

Learn more about trends in antimicrobial resistance in Candida spp. isolates.

Deaths due to invasive candidiasis

Invasive Candida infections are often associated with high rates of morbidity and mortality, as well as increased length of hospital stay. CDC’s surveillance data indicate that the in-hospital all-cause (crude) mortality among people with candidemia is approximately 25%. However, because people who develop invasive candidiasis are typically already sick with other medical conditions, it can be difficult to determine the proportion of deaths directly attributable to the infection. One study estimated the candidemia attributed mortality to be 19–24%.¹⁸

Candida infections lead to high costs

Candida is a leading cause of healthcare-associated bloodstream infections in U. S. hospitals. Invasive Candida infections are costly for patients and healthcare facilities because of the long hospital stays. Each case of candidemia is estimated to result in an additional 3 to 13 days of hospitalization and $6,000 to $29,000 in healthcare costs.¹⁹

Invasive candidiasis outbreaks

Most cases of invasive candidiasis are not associated with outbreaks. However, periodic outbreaks of C. parapsilosis infection have been reported for decades, including clusters of invasive candidiasis in neonatal intensive care units likely transmitted via healthcare workers’ hands.^20-22 Recently, Candida auris has caused outbreaks of invasive infections around the world likely because of its ability to colonize patient skin and persist on healthcare surfaces. Of concern, C. auris is commonly resistant to antifungal medications, and some disinfectants used in healthcare settings do not kill C. auris.

Vaginal candidiasis.

What is Vaginal Candidiasis?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Vaginal candidiasis is mycosis of the vaginal mucosa that occurs when it is colonized by strains of yeast-like fungi Candida. In the acute stage, redness, swelling and itching of the vulva are noted; soreness, burning and itching in the vagina; abundant, cheesy type of discharge from the genital tract; in chronic – dryness and atrophy of the mucous membrane, excoriation, severe lichenification. The diagnosis of vaginal candidiasis is established according to the clinical picture, microscopic and cultural studies. With vaginal candidiasis, systemic and local antimycotic agents, multivitamins, and immunostimulants are prescribed.

• Causes
• Symptoms of vaginal candidiasis
• Diagnosis of vaginal candidiasis
• Treatment and prevention of vaginal candidiasis
• Prices for treatment

General

Vaginal candidiasis, or thrush, is a type of vaginal fungal infection caused by microscopic yeast-like fungi of the genus Candida albicans. Candida infection is of great importance in obstetrics and gynecology due to the widespread and increased incidence in recent years. Among vaginal infections, candidiasis is in second place after bacterial vaginosis. Vaginal candidiasis usually affects women of childbearing age (pregnant women – 2-3 times more often), before the onset of menarche and postmenopause is rare. A yeast infection of the vagina can exist in the form of asymptomatic candidiasis and true vaginal candidiasis – acute (lasting up to 2 months) and chronic recurrent (more than 2 months).

Reasons

Vaginal candidiasis is caused by opportunistic yeast-like fungi of the genus Candida, which live on the skin and mucous membranes of the oral cavity, gastrointestinal tract, external genital organs and vagina of healthy women. The change in growth phases (pseudomycelia and blastospores) allows fungi to survive in a wide temperature and acid range. The death of candida causes boiling for 10-30 minutes, treatment with formalin, copper sulphate, carbolic and boric acid. The presence of a mannoprotein shell and enzymes (proteinases and catalases) in mushrooms makes it easier to resist the immune system of the macroorganism.

The dominant pathogens of vaginal candidiasis (in 75-80% of cases) are strains of C. albicans, which have a high pathogenic potential. Vaginal candidiasis caused by other species (C.glabrata, C. tropicalis, C. krusei, C. parapsilosis) is more typical for certain ethnic groups (representatives of the African race) and geographical areas (Mediterranean coast, Middle East), which is associated with specificity microbiocenosis of mucous membranes and skin, nutrition and living conditions.

As a rule, vaginal candidiasis is an endogenous infection that develops in conditions of asymptomatic candidiasis, usually vaginal, less often on the oral mucosa, intestines and skin. For example, the recurrent form of vaginal candidiasis is due to the persistence of candida in the intestine and the periodic entry of the pathogen into the vagina and its colonization. With vaginal candidiasis, pseudomycelium candida usually penetrates only into the superficial layers of the vaginal epithelium, rarely affects deeper tissues, followed by hematogenous spread and damage to various organs.

The appearance of vaginal candidiasis contributes to the insufficiency of the host’s defense system, manifested by a decrease in local immunity of the vagina. Local immunodeficiency in relation to Candida antigens (decrease in the activity of macrophages and lymphocytes) does not allow blocking fungal receptors and enzymes.

Vaginal candidiasis is usually not accompanied by a noticeable decrease in the level of lactobacilli and a change in the normal microflora of the vagina; but with the formation of polymicrobial associations, it can be combined with bacterial vaginosis.

The development of vaginal candidiasis has an imbalance of sex hormones during pregnancy, taking hormonal contraceptives, endocrine pathology. The influence of estrogen and progesterone fluctuations on the vaginal mucosa is manifested by an increase in the concentration of glycogen in epitheliocytes, stimulation of their sensitivity to candida and more effective adhesion of fungi. Vaginal candidiasis much more often accompanies various conditions associated with immunosuppression (HIV infection, diabetes mellitus, tuberculosis, hypovitaminosis, excessive use of antibiotics, corticosteroids, cytostatics, radiation therapy, etc.). Vaginal candidiasis may be associated with atopic manifestations (allergic rhinitis, food allergy).

Nutritional errors, the use of hygiene products (pads, tampons), wearing tight clothing are not considered significant factors in the development of vaginal candidiasis. There is a possibility of transmission of candida infection to a newborn when passing through the birth canal of a sick mother; the sexual way of infection is possible; the risk of infection is higher with frequent oral-genital contact.

Symptoms of vaginal candidiasis

With candidiasis, there are no clinical manifestations, patients, as a rule, do not present complaints. In acute vaginal candidiasis, abundant thick white-gray discharge from the vagina, curdled appearance with a sour smell occurs. The mucous membrane affected by vaginal candidiasis is edematous, hyperemic and prone to bleeding. It shows sharply delimited or merging with each other round and oval foci of cheesy plaque and films, ranging in size from punctate to 5-7 mm in diameter. In the acute phase, the plaques are tightly attached to the mucosa and are difficult to peel off, exposing a shiny, eroded surface with a scalloped edge; later they are easily removed, standing out from the genital tract. Typical for vaginal candidiasis is itching and burning in the vulva, aggravated during menstruation, after physical activity, water procedures. Patients are also concerned about the sharp pain during intercourse.

In chronic vaginal candidiasis, there may be no characteristic secretions, slight hyperemia of the mucous membrane, scanty films and dry erosion, severe lichenization and excoriation are noted. The mucous membrane becomes flabby, atrophic, the entrance to the vagina narrows, hemorrhagic rashes may appear. The chronic form has a long perennial course.

Vaginal candidiasis usually spreads to the external and internal genital organs, the urethra with the development of vulvovaginal candidiasis, cervicitis and urethritis. Vaginal candidiasis can cause abortion (miscarriage, premature birth), development of endometritis in the postpartum period, and infertility.

Diagnosis of vaginal candidiasis

The diagnosis of vaginal candidiasis is confirmed by the presence of clinical signs of infection and the isolation of a culture of fungi from the vaginal mucosa during a microbiological study. Examination of the cervix and vagina with the help of mirrors reveals hyperemia, swelling of the mucosa, gray-white curdled deposits in its folds. When stained with Lugol’s solution, small-dot inclusions and a pronounced vascular pattern appear. Allocations with vaginal candidiasis are found in about 76% of cases, itching – in 32%.

Microscopic examination of the smear reveals round-oval, sometimes budding cells. When bakposev on Sabouraud’s medium, convex shiny white colonies of a rounded shape are found. Species identification of fungi and determination of their sensitivity to drugs, complex PCR diagnostics and ELISA for STI pathogens are carried out. If necessary, the examination is supplemented with a bacteriological examination of urine and a smear of the urethra for microflora, analysis of feces for dysbacteriosis, determination of blood sugar, ultrasound of the pelvic organs, abdominal cavity and bladder.

Treatment and prevention of vaginal candidiasis

Comprehensive treatment of vaginal candidiasis includes exposure to the pathogen – Candida fungi, elimination of provoking factors, and treatment of comorbidities.

In vaginal candidiasis, various groups of antifungal agents are used systemically and locally: polyene antibiotics (nystatin, natamycin), antimycotics of the imidazole and triazole series (clotrimazole, ketoconazole, fluconazole, itraconazole). Good results in the treatment of vaginal candidiasis are shown by fluconazole, which has a wide spectrum of fungistatic action, without side effects on steroid synthesis and metabolism. The efficacy of a single high dose oral dose offers an advantage over other antimycotics.

With a mild course, local preparations (miconazole, clotrimazole) are shown in the form of a cream, vaginal suppositories and tablets. In chronic infection, systemic antifungal drugs are repeated in certain courses. It is preferable to prescribe low-toxic forms of antimycotics to pregnant women (natamycin, nifuratel intravaginally) and in childhood (nifuratel in applications and intravaginally, oral fluconazole).

Therapy of vaginal candidiasis can be supplemented by the local use of disinfectants and anti-inflammatory agents – solutions of borax in glycerin, potassium permanganate and silver nitrate in the form of baths and douches. With vaginal candidiasis of polymicrobial origin, combinations of antimycotics with metronidazole are prescribed. Immunity is corrected with immunostimulating agents, multivitamins are indicated. Cure from vaginal candidiasis is determined by the disappearance of clinical signs and a negative result of microbiological examination.

Prevention of vaginal candidiasis consists in eliminating the conditions for its development: limiting the use of COCs, antibiotics, cytostatics; medical correction of immunodeficiency, endocrinopathies and other comorbidities, preventive examination of women by a gynecologist.

You can get a consultation from a venereologist and a gynecologist in Volgograd, Volzhsky and Mikhailovka at the DIALINE clinics. We offer a wide range of services, including laboratory tests and examinations on advanced equipment. To make an appointment with a specialist, simply call or leave a request on the website.

Sources

1. org/ginekologiya-volgograd/molochnica-lechenie/
2. 03 IMPORTANT
   Information in this section must not be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Diagnosis and treatment of urogenital candidiasis :: DIFFICULT PATIENT

   А.М. Savicheva
   GU NIIAG im. BEFORE. Otta RAMS, St. Petersburg

   Urogenital candidiasis is a disease of the mucous membranes of the genitals caused by yeast-like fungi of the genus Candida. Candidiasis is common, and about 75% of all women have experienced at least one episode of this disease in their lives. Candidiasis is not an STI, but may indicate changes in immune and/or hormonal status. It should be emphasized that about 20% of healthy women are carriers of yeast-like fungi in the vagina, which does not require treatment.

   Etiology
   Candida yeast-like fungi belong to the Deuteromycetes imperfect fungi family Cryptococcaceae, as they do not have sexual forms of reproduction and sexual spores. Morphologically, they are unicellular organisms, the cells have a round or oval shape, and also form, with a linear arrangement of budding elements, filamentous forms – hyphae and pseudohyphae. Like all eukaryotes, fungi of the genus Candida have a well-shaped nucleus, sometimes several nuclei. The cell is surrounded by a cell wall containing chitin and cellulose. The size of a yeast cell is 3-4 microns, pseudohyphae – 5-10 microns. In addition to pseudohyphae, candida can form true hyphae, which have parallel walls and septa, while pseudohyphae taper at the ends.
   In the study of vaginal discharge, the most commonly isolated species is Candida albicans (about 90%), as well as other species of this genus – C. tropicalis, C. krusei, C. parapsilosis, C. guillermondi and fungi of the genus Torulopsis – Torulopsis glabrata. Currently, T. glabrata is recognized as a normal part of the vaginal biocenosis.
   Yeast-like fungi of the genus Candida are opportunistic, sporeless dimorphic fungi that are facultative anaerobes. They tolerate drying and freezing well. They reproduce by multipolar budding. When tissues are invaded by fungi of the genus Candida, they often transform into thin filamentous forms, forming pseudomycelium, which is formed as a result of incomplete budding of elongated yeast cells. At the same time, the formed daughter cell retains its connection with the mother cell due to the narrow isthmus.
   Fungi of the genus Candida are found in the air, soil, vegetables, fruits, confectionery. They are representatives of the normal intestinal microflora, oral mucosa, external genitalia and areas adjacent to natural openings, which are associated with natural reservoirs of fungi of the genus Candida. Thus, about 50% of clinically healthy individuals are carriers of fungi of the genus Candida on the oral mucosa. A small number of yeast cells in the stool (from 100 to 1000 per 1 g of feces) are found in clinically healthy individuals. In other areas of the skin and in the bronchial tract in healthy individuals, they are rarely sown and in small quantities. Other representatives of the normal microflora are in a competitive relationship with fungi of the genus Candida.

   Pathogenesis
   Colonization of the mucous membranes of the genitals by yeast-like fungi of the genus Candida, as well as manifest candidiasis, is a manifestation of the weakening of the “host” defense. It has long been known that the most susceptible to this disease, caused by an opportunistic yeast-like fungus, are very young (infants), very old or very sick people. Candidiasis, first of all, is a “disease of the sick.” Endogenous factors predisposing to this mycosis include endocrine diseases (hypercorticism, diabetes mellitus, obesity, hypothyroidism and hypoparathyroidism), severe general diseases (lymphoma, leukemia, HIV infection, etc.), pathological pregnancy. Currently, the use of antibiotics with a wide spectrum of antibacterial action, glucocorticosteroids, cytostatics, and hormonal contraception most often contributes to the development of candidiasis. A number of exogenous factors also contribute to the development of candidiasis. These include high temperature and excessive humidity, leading to maceration of the skin and mucous membranes, microtrauma, damage to the skin and mucous membranes by chemicals, etc. Exposure to several predisposing factors (endogenous and exogenous) at the same time significantly increases the risk of developing candidiasis.
   Infection of the fetus and newborn child usually occurs intranatally when passing through the infected birth canal of the mother, along with this, the possibility of a transplacental and ascending route of infection (congenital candidiasis) has also been proven. It is also possible the development of postnatal candidiasis in newborns. Infection of the fetus and newborn child is facilitated by the presence of vulvovaginal candidiasis in the mother, especially in the third trimester of pregnancy, the presence of concomitant diseases, especially diabetes.
   The occurrence of candidiasis in adults most often occurs as a result of autogenous superinfection, although exogenous superinfection (genital, perigenital areas) can also occur. Dysbacteriosis and violation of the protective system of the surface of the mucous membrane and skin facilitates the attachment (adhesion) of the fungus to epitheliocytes and its penetration through the epithelial barrier.

   Clinical picture
   Vulvovaginal candidiasis is characterized by the formation of a whitish coating on the hyperemic mucous membrane of the vulva and vagina (as with thrush). Characteristic crumbly “curdled” white discharge appears. Patients are disturbed by excruciating itching and burning. Perhaps burning of the vulva during urination and pain during sexual contact. The defeat of the vulva and vagina with yeast-like fungi is characterized by great persistence and a tendency to relapse. In a chronically relapsing disease, an exacerbation is often observed before the onset of menstruation.
   Yeast vulvovaginitis usually develops with persistent treatment with antibacterial drugs, in patients with decompensated diabetes mellitus and pregnant women, as well as with prolonged use of hormonal contraceptives. It is possible to transmit the disease from a wife to her husband, who develops yeast balanoposthitis. Candidiasis urethritis is rare.
   In newborns, clinical manifestations of the disease develop immediately after birth (with congenital candidiasis) or later in the form of local skin lesions and mucous or severe visceral lesions up to sepsis. However, most often in the presence of vulvovaginal candidiasis in the mother, the child develops candidiasis.

   Diagnosis
   For the diagnosis of urogenital candida infection, microscopic methods, cultural methods with the isolation of yeast-like fungi, identification of candida species, a test to determine the sensitivity of candida to antimycotic drugs, molecular biological methods (PCR) for the detection of Candida albicans are used.
   The material for the study is the discharge of the vagina, cervical canal, urethra, as well as urine. It is necessary to remember the possibility of rapid reproduction of the fungus and start the study as soon as possible after aseptic sampling. To take the material with a vaginal swab or inoculation loop in 10 µl, the discharge is taken from the vaginal fornix and the side wall of the vagina. For microscopic examination, the material is placed on two glass slides, for cultural diagnostics – in a special transport medium.
   The microscopic method is preferred for laboratory diagnosis of vulvovaginal candidiasis, since 20% of healthy women have candida in the vagina, which will also grow when cultured, which will give rise to an unreasonable diagnosis of vaginal candidiasis. The cultural method is useful in the chronic relapsing course of the disease, in the study of the action of drugs, in the atypical course of the disease, when other possible pathogens are excluded.
   For microscopic examination, the doctor sends to the laboratory a smear preparation from the vaginal discharge and a test tube with a cotton swab, which was used to take the material from the lateral or posterior fornix of the vagina. The middle portion of freely released urine is also sent, taken into a sterile test tube.
   For microscopy, unstained preparations are used, as well as preparations treated with KOH, stained according to Gram, Romanovsky-Giemsa, methylene blue.
   The diagnosis is based on the detection of elements of the fungus: single budding cells, pseudomycelium, other morphological structures (blastoconidia, pseudohyphae).
   Candida grows well on simple nutrient media, including blood agar, wort agar, potato agar, Sabouraud’s medium with glucose or maltose. Candida colonies are moist, cream-colored, raised, shiny or opaque. Candida species are distinguished by the assimilation of carbohydrates as the sole source of nutrition and by the fermentation of carbohydrates with the formation of acid and, in some cases, acid and gas. In table. 1 shows the ability of different types of candida to ferment carbohydrates.
   The clinician decides on the significance of the detected yeast-like fungi.
   For cultural diagnostics, the clinical material is inoculated on 2-3 media (blood agar, wort agar, liquid and solid Sabouraud media, Vagicult media from Orion Diagnostica (Finland). Incubated at +37 ∞C, as unlike fungi pathogenic to humans, this mode is unfavorable for saprophytes
   Assess semi-quantitative growth on agar media and weave pure cultures for subsequent identification. coverslip, leave the culture for 18-48 hours at room temperature, after which they are microscoped in a phase contrast microscope or with the condenser lowered.The shape of the pseudohyphae and the location of the pseudohyphae along the pseudohyphae are assessed.0005 For a quick detection of C. albicans, capillary culture is performed on medium with horse or fetal calf serum. Already after two hours of incubation, this type of candida (the most frequent) gives rise to pseudohyphae.
   If further precise identification is required, use carbohydrate kits to check their utilization and fermentation. Currently, diagnostic kits are being produced for both computer and visual recording of the results of carbohydrate fermentation.
   It should be emphasized that PCR for the diagnosis of urogenital candidiasis should be used with caution. A positive test result for the presence of C. albicans, obtained by PCR, may only indicate the colonization of the vagina by these fungi and is not evidence of the presence of candidiasis.

   Treatment
   To prescribe a rational treatment, it is necessary to take into account the clinical form of candidiasis, its prevalence and identified predisposing factors (general and local). With superficial candidiasis of the genitals and the perigenital area, the degree of contamination with yeast of the genus Candida of the gastrointestinal tract should be determined. With massive colonization of the gastrointestinal tract by fungi of the genus Candida, it is advisable to prescribe drugs to suppress their growth (natamycin, levorin, nystatin, etc.).
   In acute vulvovaginal candidiasis, lotions and douches with a 0.05% solution of chlorhexidine bigluconate or a 0.01% solution of miramistin have a quick therapeutic effect. Antifungal azole derivatives (isoconazole, econazole, etc.) and polyene antibiotics (natamycin) are also used externally in appropriate forms: suppositories, vaginal balls, vaginal tablets and cream with a special applicator.
   With simultaneous damage to the skin folds, external therapy is carried out depending on the severity of inflammation. First, lotions are prescribed (0.05% solution of chlorhexidine bigluconate, or 0.01% solution of miramistin, or 0.04% solution of zinc sulfate), and then lubrication of the foci with 1-2% aqueous or alcoholic solution of aniline dye or 1-2% other anti-candidiasis drug in the form of a paste, gel or hydrophilic cream.
   General anti-candidiasis therapy is prescribed for patients with recurrent vulvovaginal candidiasis, as well as for candidiasis that occurs during treatment with antibacterial drugs, glucocorticoids and cytostatics, decompensated diabetes mellitus, cancer, blood diseases, HIV infection, etc. Azole derivatives are recommended, which are well absorbed from the intestine to the systemic circulation. Fluconazole (Mikoflucan) is prescribed 50 mg daily or 150 mg once a week for 2-4 weeks; itraconazole – 100 mg once a day for 15 days; ketoconazole – 200 mg (one tablet) once a day for 2-3 weeks. Known antifungal antibiotics of the polyene series (nystatin, natamycin, levorin) are practically insoluble in water, therefore they are poorly absorbed from the intestine.
   In case of recurrent vulvovaginal candidiasis, in addition to identifying contributing factors (diabetes mellitus, abnormal pregnancy, obesity, hormonal contraception, “hidden” infection, etc.), fluconazole (Micoflucan) is prescribed at a dose of 150 mg once a month, and with frequent relapses – itraconazole 200 mg once a day for three days or 200 mg twice a day for one day; Ketoconazole 400 mg once daily for 5 days may also be prescribed. In table. 2 shows the treatment regimen for vulvovaginal candidiasis.

   Prevention
   It is important to prevent candidiasis in persons with a combination of several predisposing factors: immunodeficiency, blood disease, neoplasm, condition after major operations, as well as after massive treatment with antibiotics, glucocorticoid hormones, cytostatics, who received ionizing radiation.