CANDIDIASIS - FORMS OF CANDIDIASIS

Clinical symptoms and syndromes

The spectrum of infections caused by microorganisms of the genus Candida includes localized diseases of the skin and nails; diseases affecting the mucous surfaces of the mouth, vagina, esophagus and bronchial tree; in addition, infections that spread involving many organs. In all cases, the diagnosis must be supported by microscopic observation of the fungi in the material coming directly from the lesions and must be confirmed by culture of the microorganism.

Candidiasis of the skin and nails

Candidiasis infection can cause itchy lesions of the skin folds (intertiginous lesions). On the nails, pus can form at the level of the nail edge (perionysis) or a real infection of the nail (onyxis), which becomes dull and yellowish. A severe form is chronic mucocutaneous candidiasis (CMC), consisting of a heterogeneous group of clinical syndromes characterized by superficial, chronic and therapy-resistant Candida infections, affecting the skin, nails and oral cavity. Despite "extensive skin involvement, there is no" tendency to disseminated visceral candidiasis in CMC. CMC is observed almost exclusively in immunocompromised subjects, in subjects suffering from diseases of the endocrine system, autoimmune diseases with the presence of circulating autoantibodies and, in adults, in the presence of a thymoma (thymus tumor). It is clinically characterized by granulomatous lesions. (granulomas), hyperkeratotic (increased thickness of the skin) and verrucous (warts) on the skin and mucous membranes of the mouth, larynx and esophagus.

Candidiasis of the digestive system

The most common manifestation is thrush, frequent in infants, characterized by a reddening of the oral cavity and the appearance of a crumbly whitish patina on the inside of the cheeks, tongue and palate. In HIV-positive subjects at an early stage, oral candidiasis is present in 20-30% of cases and can have a certain significance as an index of the evolution of the disease; it is almost constant in full blown AIDS.
Candidiasis of the esophagus is generally, but not always, associated with oral candidiasis and causes painful swallowing (odynophagia), difficulty swallowing (dysphagia), retrosternal burning, but can also be asymptomatic. It is one of the most frequent infections that allow diagnosis. The assessment is based on the execution of an endoscopy, which reveals the presence of whitish membranes on the mucous membrane of the esophagus, from which a sample is taken which, then placed in culture, will show the growth of the Candida colonies.
More rare, and less well specified, are Candida enteritis and colitis which, in any case, can only be diagnosed on a histological basis (by taking intestinal tissue and analyzing it under a microscope), because the finding of Candide in the stool is not it has no pathological significance.

Candidiasis of the uro-genital system

Vulvo-vaginitis due to Candida very frequent, especially during pregnancy and during estrogen-progestin or antibiotic treatments. They are characterized by redness of the vaginal mucosa, the presence of whitish plaques, vaginal secretions, itching and burning. In men there may be an erythema of the balano-preputial sulcus with itching and burning. Urinary tract infections are rarer, which can manifest themselves with the presence of white-yellowish plaques on the vesicle wall.

Sepsis and endocarditis

Sepsis (infections spread throughout the body) from candida, as well as in subjects with severe immune system deficiencies, are observed in catheter wearers and in the course of total parenteral nutrition (drip feeding). Endocarditis (infectious process of the endocardium, which is formed by the heart valves and the innermost lining of the heart) implants itself on already damaged valves and can be secondary to cardiac surgery. The candida vegetations that are deposited on the valves can sometimes fragment, and from them can detaching of the fragments (emboli) that can go to the vessels, even of medium caliber, of the pulmonary or systemic circulation (periphery), occluding them, with consequent death of the tissues supplied by the same vessels that have been occluded.

Disseminated candidiasis

Generally spread through the blood (bloodstream), it involves many organs. Severe neutropenia (deficiency of neutrophil granulocytes, important immune response cells) is considered the most important predisposing factor for life-threatening infections. The incidence of this form of candidiasis is growing rapidly as more and more patients with severe leukemia are treated aggressively with potent immunosuppressive drugs and as more and more patients undergo bone marrow or other organ transplants.