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Candida Infections (Thrush, Diaper Rash, and Vaginitis)

Candida albicans is a fungus very similar to yeast which is found everywhere, including on plants, in open water (both lakes and oceans), in most animals and their wastes, and in people. Everybody has Candida in their mouths and throats and throughout their digestive tracts, and all girls and women have Candida in their vaginas. In most people this is not a problem, since there are lots of other microorganisms, mostly bacteria, in these areas which help keep Candida under control and since your immune system also keeps the Candida population down.

Active Candida infections usually happen in small babies whose immune systems aren't yet fully working, in adults and children who have been on antibiotics (which affect the bacteria that normally keep Candida in check), in patients who take steroids regularly, and in people with immune-system problems. The most common Candida infections are:

Thrush

Thrush is a Candida infection of mucous membranes in the mouth. It usually occurs in very young babies, but it has also been seen in older children and adults who take inhaled steroids for asthma. When we examine a baby with thrush we usually see white patches ("plaques") on the mucous membranes inside the cheeks, (slightly less often) on the tongue and the palate (the roof of the mouth), and (even less often) in the throat. These plaques look like residue from breast milk or formula; the difference between thrush and milk residue is (1) that the plaques hurt (some babies with thrush won't eat well because of the pain) and (2) that the plaques cannot be scraped off easily with a tongue depressor. This can be treated with liquid nystatin or other antifungal antibiotics, which I usually ask parents to "paint" on the plaques with a Q-tip. When I treat a baby with thrush, I also tell the parents to boil all pacifiers and (for bottle-fed babies) bottle nipples so that any Candida left on them is killed. For a breast-fed baby with thrush, I give liquid nystatin to the baby and nystatin cream to his mother to apply to her nipples during the time he is receiving nystatin; this helps prevent reinfection with Candida from mom's skin. People taking inhaled steroids can reduce the chances of thrush by rinsing their mouths with water after each dose of steroids.

Diaper Rash

The most common causes of diaper rash are chemical (urine and stool normally contain lots of things that irritate the skin). However, Candida also frequently causes rashes in the diaper area; these are fairly common in babies, but can also happen in older children who still wear diapers and who have been on antibiotics for ear infections or other infections. Candidal diaper rash is usually red, and typically has smaller red "satellite" spots on the edges of the main rash. We treat Candidal diaper rash initially with nystatin cream.

Vulvovaginitis

Irritation of the vagina and the vulva (the external gentalia) can also be caused by Candida overgrowth. This is more likely to happen with changes in hormone levels, like those seen in pregnancy or while taking estrogens (whether for birth control or for other reasons). It can also be seen with antibiotic therapy, steroid treatment, diabetes (like yeast, Candida grows very well with extra sugar around), foreign bodies in the vagina or cervix such as intrauterine contraceptive devices (IUDs) or diaphragms, use of diapers, and in HIV infection (HIV specifically attackes the part of the immune system that normally protects against Candida). Candida vaginitis is not a sexually-transmitted disease (remember: everyone has Candida somewhere). It is usually treated with oral antifungal antibiotics.

More serious infections can occur with Candida as well. These include meningitis and sepsis. However, disasters like this usually happen only in people whose immune systems aren't working properly, whether from disease such as HIV or from treatment for other diseases that affect immune responses, such as cancer chemotherapy or to prevent rejection after organ transplant.

Since we all have Candida in our bodies from the time we are born, it's hard to prevent a Candida infection if you are susceptible. Most older children and adults with working immune systems, however, will keep their Candida under control without difficulty.

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Copyright © 2007 Vinay N. Reddy, M.D. All rights reserved.
Written 05/02/07; last revised 05/09/07