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| | __NOTOC__ |
| | {{Candida vulvovaginitis}} |
| | {{About1|Candida albicans}} |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox_Disease | | | {{CMG}}; {{AE}} {{KS}} {{DN}}{{AKI}} |
| Name = Candidiasis |
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| Image = Candida albicans .jpg |
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| Caption = [[Agar plate]] culture of ''Candida albicans'' |
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| DiseasesDB = 1929 |
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| ICD10 = {{ICD10|B|37||b|35}} |
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| ICD9 = {{ICD9|112}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 001511 |
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| eMedicineSubj = med |
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| eMedicineTopic = 264 |
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| eMedicine_mult = {{eMedicine2|emerg|76}} {{eMedicine2|ped|312}} {{eMedicine2|derm|67}} |
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| MeshID = D002177 |
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| }} | |
| {{SI}} | |
| {{CMG}}
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| ==Overview==
| | {{SK}} Yeast infection, candida vaginitis |
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| '''Candidiasis''', commonly called '''yeast infection''' or '''thrush''', is a [[fungal infection]] (mycosis) of any of the ''[[Candida (genus)|Candida]]'' species, of which ''[[Candida albicans]]'' is the most common.<ref name=Baron>{{cite book | author = Walsh TJ, Dixon DM | chapter=Deep Mycoses |title=Baron's Medical Microbiology |editor=Baron S ''et al'' eds.| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 |isbn=0-9631172-1-1 |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 |format=via NCBI Bookshelf}}</ref><ref name="Medline Plus">{{MedlinePlus|001511|Vaginal yeast infection}}</ref> Candidiasis thereby encompasses infections that range from superficial, such as oral thrush and [[vaginitis]], to [[systemic]] and potentially life-threatening diseases. ''Candida'' infections of the latter category are also referred to as candidemia and are usually confined to severely [[immunocompromised]] persons, such as [[cancer]], [[Organ transplant|transplant]], and [[AIDS]] patients, whereas superficial infections of [[skin]] and [[mucosa]]l membranes by ''Candida'' causing local [[inflammation]] and [[Stress (medicine)|discomfort]] is common in many [[human]] populations.<ref name="Medline Plus"/><ref name="Fidel">{{cite journal|author=Fidel PL|year= 2002|title=Immunity to Candida|journal=Oral Dis.|volume=8|pages=69-75|pmid=12164664}}</ref><ref name="Pappas">{{cite journal |author=Pappas PG |title=Invasive candidiasis |journal=Infect. Dis. Clin. North Am. |volume=20 |issue=3 |pages=485–506 |year=2006 |pmid=16984866 |doi=10.1016/j.idc.2006.07.004}}</ref> While clearly attributable to the presence of the [[opportunistic pathogen]]s of the genus ''Candida'', candidiasis describes a number of different disease syndromes that often differ in their causes and outcomes.<ref name="Medline Plus"/><ref name="Fidel"/>
| | ==[[Candida vulvovaginitis overview|Overview]]== |
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| ==History and taxonomic classification== | | ==[[Candida vulvovaginitis historical perspective|Historical Perspective]]== |
| B. Lagenbeck in 1839 in Germany was the first to demonstrate that a yeast-like fungus existed in the human oral infection "thrush." He also found that a fungus was able to cause thrush.
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| The genera ''Candida'', species ''albicans'' was described by botanist Christine Marie Berkhout. She described the fungus in her doctoral thesis, at the University of Utrecht in 1923. Over the years the classification of the genera and species has evolved. Obsolete names for this genus include ''Mycotorula'' and ''Torulopsis''. The species has also been known in the past as ''Monilia albicans'' and ''Oidium albicans''. The current classification is ''nomen conservandum'', which means the name is authorized for use by the [http://www.bgbm.org/iapt/nomenclature/code/SaintLouis/0000St.Luistitle.htm International Botanical Congress (IBC)].
| | ==[[Candida vulvovaginitis classification|Classification]]== |
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| The full current taxonomic classification is available at ''[[Candida albicans]]''.
| | ==[[Candida vulvovaginitis pathophysiology|Pathophysiology]]== |
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| The genus ''Candida'' includes about 150 different species. However, only a few of those are known to cause human infections. ''C. albicans'' is the most significant pathogenic (=disease-causing) species. Other ''Candida'' species causing diseases in humans include ''C. tropicalis'', ''C. glabrata'', ''C. krusei'', ''C. parapsilosis'', ''C. dubliniensis'', and ''C. lusitaniae''.
| | ==[[Candida vulvovaginitis causes|Causes]]== |
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| == Manifestation == | | ==[[Candida vulvovaginitis differential diagnosis|Differentiating Candidiasis from other Diseases]]== |
| In [[immunocompetent]] people, candidiasis can usually only be found in exposed and moist parts of the body<ref name=Baron/>, such as:
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| * the [[oral cavity]] (oral thrush)
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| * the [[vagina]] and/or [[vulva]] (vaginal candidiasis or thrush)
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| * folds of skin in the [[diaper]] area ([[diaper rash]])
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| * the nipples while breastfeeding
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| * the [[penis]] or [[foreskin]]
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| * the [[armpit]]
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| * the ear
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| * the skin around the [[nostrils]] or in the nostrils
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| Candidiasis is the second most common cause of [[vagina]]l irritation, or [[vaginitis]], and can also occur on the male genitals. In [[immunocompromised]] patients, the ''Candida'' infection can involve the [[esophageal candidiasis|esophagus]] and can become [[systemic]], causing a much more serious condition: [[fungemia]]. <ref name="Pappas"/><ref name="Fidel"/>
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| Children, mostly between the ages of 3 and 9 years, can be affected by chronic mouth yeast infections, normally seen around the mouth as white patches. However, this is not a common condition.
| | ==[[Candida vulvovaginitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| == Causes == | | ==[[Candida vulvovaginitis risk factors|Risk Factors]]== |
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| ''Candida'' yeasts are usually present in most people, but uncontrolled multiplication resulting in disease symptoms is kept in check by other naturally occurring [[microorganism]]s, e.g., bacteria co-existing with the yeasts in the same locations, and by the human [[immune system]].
| | ==[[Candida vulvovaginitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| In a study of 1009 women in New Zealand, the fungus, ''Candida albicans'', was isolated from the vaginas of 19% of apparently healthy women. Carriers experienced few or no symptoms. However, external use of irritants (such as some detergents or [[douche]]s) or internal disturbances (hormonal or physiological) can perturb the normal [[vaginal flora|flora]], constituting [[lactic acid bacteria]], such as [[lactobacilli]], and an overgrowth of yeast can result in noticeable symptoms. Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex, and using lubricants containing glycerin have been found to be causally related to yeast infections. [[Diabetes mellitus]] and the use of [[antibiotics]] are also linked to an increased incidence of yeast infections. Candidiasis can be sexually transmitted from men to women, but not from a woman to a man. Diet has been found to be the cause in some animals. [[Hormone Replacement Therapy]] and infertility treatments may also be predisposing factors.
| | ==Diagnosis== |
| | [[Candida vulvovaginitis history and symptoms|History and Symptoms]] | [[Candida vulvovaginitis physical examination|Physical Examination]] | [[Candida vulvovaginitis laboratory findings|Laboratory Findings]] | [[Candida vulvovaginitis x ray| X Ray]] | [[Candida vulvovaginitis CT| CT]] | [[Candida vulvovaginitis other imaging findings| Other Imaging Findings]] | [[Candida vulvovaginitis other diagnostic studies|Other Diagnostic Studies]] |
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| == Symptoms == | | ==Treatment== |
| Symptoms include severe [[itching]], burning, and soreness, irritation of the [[vagina]] and/or [[vulva]], and a whitish or whitish-gray discharge, often with a curd-like appearance.
| | [[Candida vulvovaginitis medical therapy|Medical Therapy]] | [[Candida vulvovaginitis surgery|Surgery]] | [[Candida vulvovaginitis primary prevention|Primary Prevention]] | [[Candida vulvovaginitis secondary prevention|Secondary Prevention]] | [[Candida vulvovaginitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Candida vulvovaginitis future or investigational therapies|Future or Investigational Therapies]] |
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| Many women mistake the symptoms of the more common [[bacterial vaginosis]] for a yeast infection. In a 2002 study published in the ''Journal of Obstetrics and Gynecology'', only 33 percent of women who were self treating for a yeast infection actually had a yeast infection. Instead they had either bacterial vaginosis or a mixed-type infection.
| | ==Case Studies== |
| | [[Candida vulvovaginitis case study one|Case #1]] |
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| In men, symptoms include red patchy sores near the head of the penis or on the foreskin. The sores may feel irritated and itchy, and sometimes they will burn as well.
| | ==External Links== |
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| ==Pathological Findings==
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| ===Gross Images===
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Oralcandi.JPG|Oral candidiasis on the [[tongue]] and soft [[palate]].
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| Image:Oral candidiasis.jpg|Oral manifestations of HIV infection and AIDS. Chronic oral candidiasis in patient with AIDS. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Oral candidiasis 2.jpg|Soft palate showing extensive oral candidiasis in patient with AIDS. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| Image:Candidiasis 4.jpg|Oral candidiasis <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Candidiasis 5.jpg|Eczema secondary to candidiasis. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| Image:Candidiasis 6.jpg|Candidiasis; skinfold. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Erythematous candidiasis.jpg|Erythematous candidiasis. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| Image:Genital candidiasis.jpg|Genital candidiasis. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Candidiasis_Paronychia.jpg|Paronychia: Another manifestation of candidiasis. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| Image:Interdigital candidiasis.jpg|Interdigital candidiasis. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Candidiasis umblical cord.jpg|Candidiasis of umblical cord. White spots of colonies are present. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| Image:Lung_candidiasis.jpg|Lung: Candidiasis. Postmortem findings. <small>Image courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| </gallery>
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| </div>
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| ===Histopathology===
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| ====Candidiasis of Esophagus & Colon ====
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| <youtube v=-E-HwjCm2h8/>
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| == Diagnosis ==
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| Medical professionals use two primary methods to diagnose yeast infections: microscopic examination, and culturing.
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| For the microscope method, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% [[potassium hydroxide]] (KOH) solution is then also placed on the slide. The KOH dissolves the skin cells but leaves the ''Candida'' untouched, so that when the slide is viewed under a microscope, the hyphae and pseudo spores of ''Candida'' are visible. Their presence in large numbers strongly suggests a yeast infection.
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| For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then rubbed across a culture medium. The medium is incubated for several days, during which time colonies of yeast and/or bacteria develop. The characteristics of the colonies provide a presumptive diagnosis of the organism causing symptoms.
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| == Treatment ==
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| It is important to consider that ''Candida'' species are frequently part of the human body's normal oral and intestinal flora. Candidiasis is occasionally misdiagnosed by medical personnel as bacterial in nature, and treated with [[antibiotic]]s against bacteria. This can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition.
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| In clinical settings, candidiasis is commonly treated with antimycotics - the [[antifungal drug]]s commonly used to treat candidiasis are topical [[clotrimazole]], topical [[nystatin]], [[fluconazole]], and topical [[ketoconazole]]. In severe infections (generally in hospitalized patients), [[amphotericin B]], [[caspofungin]], or [[voriconazole]] may be used. Local treatment may include vaginal [[suppository|suppositories]] or medicated [[douche]]s. [[Gentian violet]] can be used for breastfeeding thrush, but pediatrician recommends using it sparingly, since in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals. <ref>[http://extoxnet.orst.edu/newsletters/n115_91.htm extoxnet.orst.edu]</ref>
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| One of the most potent nondrug or natural yeast-fighting substances is caprylic acid, a medium-chain fatty acid derived from coconut oil. Caprylic acid in capsule form is commonly sold as a dietary supplement in health food stores. It is very effective against Candida and other forms of fungi. It is even effective mixed with a little coconut oil or vitamin E oil as a topical application for fungal skin infections. Some cases of fungal infections that have lasted for months clear up in a matter of days using caprylic acid and a little coconut oil. It works just as effectively inside the body, killing fungi without the least bit of harm.
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| Polynesian women who eat their traditional coconut-based diet rarely, if ever, get yeast infections. Only in more temperate climates where processed vegetable oils are the main source of dietary fat are yeast infections, skin fungus, acne, and other skin infections big problems. Lauric acid, found in coconut oil, kills lipid-coated bacteria but does not appear to harm the friendly intestinal bacteria. Medium-Chain Fatty Acids (MCFA)s also have antifungal properties, so not only will they kill disease-causing bacteria and leave good bacteria alone but also they will kill Candida and other fungi in the intestinal tract, further supporting a healthy intestinal environment. Eating coconut oil on a regular basis, as the Polynesians do, helps to keep Candida and other harmful microorganisms at bay.
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| Some home remedies for candidiasis include the consumption or direct application of [[Yoghurt|yogurt]] (which contains [[lactobacillus]]), [[probiotics]], [[acidophilus]] tablets or salves, Pau d'arco tea, and even lightly crushed cloves of [[garlic]], which yield [[allicin]], an antifungal agent. [[Boric acid]] has also been used to treat yeast infections (by inserting gelcaps filled with boric acid powder into the vagina at bedtime for three to four consecutive nights). Eating a diet consisting primarily of green, fresh, raw vegetables also may give relief. Other alternative treatments consist in consuming a fermented beverage called [[Kefir]].
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| While home remedies may offer relief in minor cases of infection (although a peer-reviewed study in Australia found yogurt ineffective as treatment for ''Candida albicans''), seeking medical attention may be necessary, especially if the extent of the infection cannot be judged accurately by the patient. For instance, oral thrush is visible only at the upper digestive tract, but it may be that the lower digestive tract is likewise colonized by ''Candida'' species.
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| Treating candidiasis solely with medication may not give desired results, and other underlying causes require consideration. As an example, oral candidiasis is often linked to the use of inhaled [[corticosteroids]] in [[asthma medication]]. Patients on long-term inhaled corticosteroids should rinse their mouths after each dose of steroids to counteract this effect. Oral candidiasis can also be the sign of a more serious condition, such as [[HIV]] infection, or other immunodeficiency diseases. Following the health tips at [[vulvovaginal health]] can help prevent vaginal candidiasis.
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| Babies with diaper rash should have their diaper areas kept clean, dry, and exposed to air as much as possible. [[Sugar]]s assist the overgrowth of yeast, possibly explaining the increased prevalence of yeast infections in patients with [[diabetes mellitus]], as noted above. As many ''Candida spp.'' reside in the digestive tract, dietary changes may be effective for preventing or during a ''Candida'' infection. Due to its requirement for readily fermentable carbon sources, such as mono- or dimeric sugars (e.g., [[sucrose]], [[glucose]], [[lactose]]) and starch, avoiding foods that contain these nutrients in high abundance may help to prevent excessive ''Candida'' growth. [[Breast milk]] is a suitable growth substrate for yeasts, and both nursing mother and baby need to be treated (even if both are not symptomatic) to prevent thrush from being passed between mother and child. <ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=123132 PubMed Central Article]</ref>
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| ==Case Example: Renal Candidiasis==
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| ===Clinical Summary===
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| A 73-year-old black male was in good health until about three months before his death when he noticed enlarged lymph nodes first in both inguinal regions and later elsewhere. Antileukemic therapy was begun. About two weeks prior to his death the patient presented to the emergency room with uncontrollable epistaxis. On physical examination, the liver was palpable but the spleen was not. The white blood count was below normal and consisted mainly of lymphocytes with many atypical cells. The patient's bone marrow was also found to be heavily loaded with lymphocytes. Platelets were extremely low and remained so despite platelet transfusions. Subsequently, the patient developed pneumonia which progressed until death. Antemortem cultures yielded Candida tropicalis and Pseudomonas aeruginosa.
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| ===Autopsy Findings===
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| At autopsy, there was evidence of disseminated candidiasis.
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| ===Histopathological Findings===
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| [http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| [[Image:Renal candidiasis 001.jpg|left|thumb|350px|This autopsy photograph of the kidneys demonstrates the multifocal punctate lesions visible on the serosal surface (arrows). Don't confuse these small yellow punctate lesions with the fat that is adherent to the renal capsule. ]]
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| [[Image:Renal candidiasis 002.jpeg|left|thumb|350px|This photograph of the cut surface of these kidneys shows that these multifocal punctate lesions are primarily in the cortex (arrows).]]
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| [[Image:Renal candidiasis 003.jpeg|left|thumb|350px|This is a low-power photomicrograph of lymph node with three prominent areas of Candida colonies (arrows). Even at this low magnification, the purple-staining yeast and pseudohyphae can be easily seen. This section was stained with Periodic Acid-Schiff Hematoxylin (PASH), which stains the cell wall of fungi to make them more easily visible.]]
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| [[Image:Renal candidiasis 004.jpeg|left|thumb|350px|This is a low-power photomicrograph of one of the Candida colonies from this lymph node. The chains of yeast which are termed "pseudohyphae" are apparent at this magnification. ]]
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| [[Image:Renal candidiasis 005.jpeg|left|thumb|350px|This higher-power photomicrograph shows the yeasts and pseudohyphae in this focus of Candida organisms. ]]
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| [[Image:Renal candidiasis 006.jpeg|left|thumb|350px|This high-power photomicrograph shows the yeasts (1) and pseudohyphae (2). ]]
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| [[Image:Renal candidiasis 007.jpeg|left|thumb|350px|This is a low-power photomicrograph of the kidney from this same case. Note the Candida colonies (arrows). The pseudohyphae are evident around the periphery of these colonies even at this low magnification. ]]
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| [[Image:Renal candidiasis 008.jpeg|left|thumb|350px|This is a higher-power photomicrograph of a Candida colony in the kidney. Note the pseudohyphae of the Candida organisms. ]]
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| ==References==
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| {{Reflist}}
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| ==External links== | |
| * {{cite web |title=Vaginitis |url=http://www3.niaid.nih.gov/healthscience/healthtopics/vaginitis/ |author=National Institute of Allergies and Infections |date=June 27, 2007 |accessdate=2008-02-21}} - fact sheet on vaginitis/vaginal infections | | * {{cite web |title=Vaginitis |url=http://www3.niaid.nih.gov/healthscience/healthtopics/vaginitis/ |author=National Institute of Allergies and Infections |date=June 27, 2007 |accessdate=2008-02-21}} - fact sheet on vaginitis/vaginal infections |
| * [http://www.mayoclinic.com/health/oral-thrush/DS00408 Oral Thrush] Mayo Clinic
| | {{WikiDoc Help Menu}} |
| * [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=85 DermAtlas candidiasis images]
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| * [http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/31092.html#treat InteliHealth page on candidiasis] Presented by InteliHealth reviewed by [[Harvard Medical School]]
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| * [http://www.lib.uiowa.edu/hardin/md/yeastinfection.html Links to pictures of Yeast Infection (Hardin MD/Univ of Iowa)]
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| * {{cite web |title=Yeast Infections |url=http://www.vaginapagina.com/index.php?title=Yeast_Infection |publisher=VaginaPagina}} - info on treatments
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| ==See Also==
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| * [[Candida albicans]]
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| * [[Oral candidiasis]]
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