Candidiasis

Candidiasis (candidosis) is a disease of the skin, nails and mucous membranes, sometimes internal organs, caused by yeast-like fungi of the genus Sandida.

The most significant value in human pathology is Candida albicans fungus. Much less often pathological changes can cause other fungi of this genus (Candida tropicalis, Candida krtisei, etc.).

[1], [2], [3]

The cause of candidiasis

Yeast-like fungi of the genus Candida are conditionally pathogenic, asymmetric fungi, which are facultative anaerobes. They tolerate drying and freezing well. In the yeast phase of development, characteristic for saprophytic existence, it is a single-celled, oval-shaped microorganism, ranging from 1.5 μm (young cells up to 14 μm {mature cells). They multiply multipolar budding. When invading tissues, the fungi of the genus Candida are often transformed into thin filamentous forms, forming pseudomycelia as a result of incomplete budding of elongated yeast cells. In this case, the formed daughter cell remains connected with the mother cell due to a narrow isthmus.

Fungi of the genus Candida are found in air, soil, vegetables, fruits, confectionery. They are representatives of the normal intestinal microflora, the mucous membrane of the mouth, the external genitalia and the zone adjacent to the natural openings, which are associated with the natural reservoirs of the fungi of the genus Candida. Thus, the carriage of fungi of the genus Candida on the mucosa of the mouth has about 50% of clinically healthy individuals. A small number of yeast cells in the stool (from 100 to 1000 per 1 g of stool) are found in clinically healthy individuals. On the remaining parts of the skin and in the bronchial tract in healthy individuals, they are rarely sown and in small quantities. Other representatives of normal microflora are found with fungi of the genus Candida in competitive relationships.

Pathogenesis of candidiasis

Colonization with the yeast-like fungi of the Candida mucosa and skin, like the manifest candidiasis, is a manifestation of the weakening of the protection of the "host" It has long been known that the youngest (infants), very old or very sick, are most susceptible to this disease, conditioned by a conditionally pathogenic yeast-like fungus people. Candidiasis, first of all, is a "sickness of the sick". Endocrine factors predisposing to this mycosis include endocrine diseases (hypercortisy, diabetes, obesity, hypothyroidism and hypoparathyroidism), severe general diseases (lymphoma, leukemia, HIV infection, etc.), a pathological pregnancy. Currently, the most commonly used for the development of candidiasis is the use of antibiotics with a broad spectrum of antibacterial action, glucocorticosteroids, cytostatics, hormonal contraception. A number of exogenous factors also contribute to the development of candidiasis. These include elevated temperature and excessive humidity, leading to maceration of the skin, microtrauma, skin damage by chemicals, etc. The impact of several predisposing factors (endogenous and exogenous) significantly increases the risk of candidiasis. Infection usually occurs in the birth canal, along with the possibility of a transplacental pathway of infection (congenital candidiasis) is also proved. The emergence of candidiasis in adults most often occurs as a result of autogenous superinfection, although exogenous superinfection (genital, perigenital areas) may occur. Dysbacteriosis and violation of the protective system of the surface of the mucous membrane and skin facilitate the attachment (adhesion) of the fungus to the epithelial cells and its penetration through the epithelial barrier.

Symptoms of candidiasis

There are the following varieties of candidiasis:

1. Superficial candidiasis (mouth, genitalia, skin, nail ridges and nails).
2. Chronic generalized (granulomatous) candidiasis of children and adolescents (chronic cutaneous mucous candidiasis).
3. Visceral candidiasis (involvement of various internal organs and systems): candidiasis of the pharynx, esophagus and intestine, candidiasis of the bronchi and lungs, candida septicemia, etc.

Doctors-dermatovenereologists and dermatocosmetologists in daily practice are more often encountered with manifestations of superficial candidiasis. Localization of lesions is distinguished:

1. Candidiasis of the mucous membranes and skin: candidiasis stomatitis, candidosis glossitis, candidiasis of the corners of the mouth (yeast junction), candidal cheilitis, vulvovaginal candidiasis, candida balanoposthitis.
2. Candidiasis of skin and nails: candidiasis of large folds, candidiasis of small folds, candidiasis paronychia and onychia (onychomycosis).

Candida stomatitis is the most frequent form of superficial candidiasis of mucous membranes. The most common clinical form of acute candidal stomatitis is "thrush", or pseudomembranous candidosis. It often occurs in newborns in the first 2-3 weeks of life and in adults with the predisposing factors listed above. Foci of lesion are usually located on the mucous membrane of cheeks, palate, gums. In these areas there are whitish-cream crumbly raids. Sometimes they resemble coagulated milk and can drain a considerable distance into solid whitish shiny areas. Under them it is often possible to find a hyperemic, less often eroded surface. With long-existing candidiasis stomatitis acquires a brownish-brown or cream color and is more firmly retained on the affected mucosa.

Persistently flowing candidiasis stomatitis and glossitis should sstorah. To live a doctor, as they can be one of the first manifestations of acquired immunodeficiency (in HIV-infected people).

In patients with a lesion of the mucous membrane of the mouth, mycosis often spreads to the corners of the mouth - the candidiasis of the corners of the mouth develops (yeast, or candidosis, zaeda). It can also arise in isolation and usually takes a long time. In the corners of the mouth appear limited erosion - cracks on a slightly infiltrated base, surrounded by the fringe of a slightly raised white thawed epidermis. The emergence of yeast zaeda promotes maceration of the corners of the mouth, which occurs with an incorrect bite. Clinical manifestations of candidiasis and streptoderma of the corners of the mouth are similar.

Candidiasis cheilitis - inflammation of the red border of the lips. With it there is a moderate swelling and cyanosis of the red border of the lips, thin grayish lamellar scales with raised edges, thinning of the skin of the lips, radial grooves, cracks. Subjectively worried about dryness, slight burning, sometimes soreness. With macroclavite, the lips thicken considerably, thick crusts and bleeding cracks appear on their surface. Similar clinical manifestations occur with atopic cheilitis and streptococcal lesions of the red border of the lips.

Candidiasis vulvovaginitis is characterized by the formation on the hyperemic mucosa of the vulva and vagina whitish plaque (as with thrush). Appear characteristic crumbly white discharge. Patients are troubled by painful itching and burning. The lesion is difficult to treat and is prone to relapse. Yeast vulvovaginitis usually develops with persistent treatment with antibacterial antibiotics, in patients with decompensated diabetes mellitus and pregnant women, with "hidden" infections, and with long-term use of hormonal contraceptives. Possible transmission of the disease from his wife to her husband, who develops a yeast balanoposthitis. Rarely does candidal urethritis occur.

Candidiasis balanoposthitis occurs more often on the background of obesity, decompensation of diabetes mellitus, in men with chronic gonorrhea and non-gonorrheal urethritis and in persons with narrow foreskin. On the head and inner leaf of the prepuce against the background of hyperemia appear numerous small pustules, transforming in erosion of different sizes with whitish deposits. These manifestations are accompanied by itching and burning. In the absence of adequate therapy, they can lead to inflammatory phimosis, there is a risk of attaching candida to urethritis.

Candidiasis of large folds (skin under the mammary glands, axillary cavities, pahovobedrennyh folds, intervaginal folds and folds of the abdomen) develops usually in obese, in people with diabetes and receiving glucocorticosteroid hormones. When candidiasis of small folds (the skin of interdigital folds of feet and brushes) on the hands, more often between the III-IV fingers, as a result of prolonged maceration, interdigital yeast erosion occurs. In large and small folds on hyperemic skin thin-walled, often merging pustules appear. Further, dark-cherry-colored erosions with a shiny, "lacquer" surface are formed. The edges of erosions are poly-cyclic, with a fringe of exfoliating white epidermis, elevated along the periphery in the form of a "collar". Around the hearth there are small pustules (pustules-satellites) and erosion. It is characterized by pronounced itching and burning. Differentiation of the disease with streptococcal intertrigo is often difficult.

In persons with endocrine disorders (more often with the action of several predisposing factors), a widespread superficial candidiasis of the skin and mucous membranes may occur.

In the presence of the main focus of candidiasis, allergic rashes - levurids (from French levures - yeast) can occur. They are manifested by itching limited or widespread vesicles, papular or erythematous-squamous eruptions.

Diagnosis of candidiasis

The presence of yeast-like fungi in patients in the foci is determined by microscopic and cultural studies. When microscopy of native or stained with aniline dye preparations in candidiasis, a large number of budding cells, pseudomycelia or true mycelium are found. It must, however, be remembered that the single finding of single yeast cells in the test preparation or the production of Candida fungi in single colonies is not proof of the candida nature of the disease. Of great importance are the corresponding clinical manifestations, the quantitative registration of colonies and an increase in their number with progressing diseases.

[4], [5], [6]

Treatment of candidiasis

To assign a rational treatment to a patient, 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 mucous membrane of the mouth, genitals and perigenital area, it is necessary to determine the degree of seeding of yeast of the genus Candida of the gastrointestinal tract. With massive colonization of the gastrointestinal tract with fungi of the genus Candida, it is advisable to prescribe drugs to suppress their growth (for example, natamycin - Pimafucin).

With local lesions of the skin and mucous membranes, candidiasis is usually limited to the use of externally anticancerous drugs in rational forms.