Systemic candidiasis

January 2005     View PDF     En español

Cause

The fungus called Candida causes candidiasis. This fungus is normally found in small amounts in the mouth, vagina, digestive tract and skin. In a healthy person, other bacteria and the immune system keep it from becoming a problem.

However, a weak immune system makes it easier for Candida to grow and cause infection. In HIV disease, the most serious Candida outbreaks occur when CD4+ cell counts are very low (below 100). In people with weak immune systems, candidiasis can recur and be difficult to treat.

Factors including diabetes, pregnancy, iron, folate, and vitamin B12 or zinc deficiency, and use of antihistamines can increase the risk of Candida infections. Things that may weaken the immune system—from chemotherapy to stress and depression—can also cause or worsen candidiasis.

Infection in the vagina
Vaginal candidiasis, called yeast infection or vaginitis, is an infection of the vulva and/or vagina. It causes a smelly, thick, white-yellow discharge that might occur with itching, burning and swelling. A bad case can make walking, peeing or sex very painful.

Infection in the mouth
Oral candidiasis, called thrush, involves the mouth and sometimes the throat. It can also occur without symptoms. The most common symptoms usually include discomfort of the mouth and throat, burning and an altered sense of taste (often described as “bad”). Creamy white or yellowish coatings or spots on the mouth and throat are also common. Thrush is rare if a person’s CD4+ cell count is above 500, but outbreaks are more common as it drops to 100.

Infection in the throat
Candidiasis of the throat and windpipe, called esophageal infection, is a serious condition. It is on the list of AIDS-defining illnesses, affecting up to 1 in 5 people with AIDS. It often occurs together with thrush. Symptoms include chest pain, nausea and pain when swallowing. The esophagus may become partly blocked by coatings and spots that build up. In rare cases, bad ulcers can rupture the esophagus. Esophageal candidiasis can spread, or disseminate, into the stomach and intestines. Because esophageal candidiasis can make swallowing painful, people may not eat enough and lose weight if it’s not treated promptly.

Infection of the skin
Candida can infect skin in the armpits, groin (including the scrotum and tip of the penis in men) and under the breasts. This is called cutaneous candidiasis. Infection can also occur around burns, cuts or catheters. It causes a bright red uneven eruption in the folds of skin. This may be coated by a white, wrinkled layer of tissue. Other symptoms include a mild burning. Fingernails and toenails can also be infected, which can be a special problem for people whose hands are often in water, like bartenders or dishwashers.

Infection throughout the body
Systemic candidiasis is when Candida spreads throughout the body, and it can be life-threatening. Infection might include the brain, heart, kidneys, eyes, liver, genital tract and joints. This form occurs most often in people with low white blood cell counts (neutropenia). This type of infection is also called disseminated candidiasis.