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 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
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
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.
- 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
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
More serious infections can occur with Candida as well. These
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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PLEASE NOTE: As with all of this Web site, I try to give
general answers to common questions my patients and their parents ask me
in my (real) office. If you have specific questions about your
child you must ask your child's regular doctor. No doctor can give
completely accurate advice about a particular child without knowing and
examining that child. I will be happy to try and answer
about children's health, but unless your child is a regular patient of
mine I cannot give you specific advice.
Copyright © 2007
Vinay N. Reddy, M.D. All rights reserved.
Written 05/02/07; last revised 05/09/07