Understanding Candidiasis: Symptoms, Diagnosis, Nursing Care and Treatment Options

What is Candidiasis?

It is a fungal infection that occurs particularly in moist areas such as the mouth, vagina, skin folds, esophagus and around the fingernails. It is most commonly caused by Candida albicans.Other causative organisms include Candida parapsilosis, Candida tropicalis, Candida krusei, Candida oleophila, Candida glabarata.These organisms are normal flora of the GIT, vagina, mouth, esophagus and skin. Candida may infest wounds, catheter sites, and intravenous sites. Infections may take 6 to 8 weeks to resolve. In immunosuppressed patients, candidiasis can become disseminated by entering the bloodstream and causing serious infections in other organs. Such infections are difficult to eradicate.

Affected Areas

• Vagina – Monoliasis
• Fingernails – Onchomylosis / Paronychia
• Oropharynx – Thrush
• Skin – Intertrigo. This normally occurs under the breast, in the groin, and in the axillae.

Risk factors for Candidiasis

• Prolonged antibiotic use
• Immunosuppressive drugs such as corticosteroids
• HIV/AIDS
• Cancers
• Aging
• Uncontrolled diabetes mellitus
• Use of oral contraceptives
• Urinary catheters
• Tight fitting garments
• Wounds affecting the skin and mucous membrane
• Obesity
• Pregnancy
• Infants of mothers with monoliasis

Signs & Symptoms of Candidiasis

It can occur at any age, but the elderly is more susceptible. It is more common in the genitourinary tract of women than in men. It causes diaper rash in infants, and vaginal infections in females. Ethnicity and race have no known effect on the risk of candidiasis.

• Rashes appear below the breast, between the fingers, at the groin and umbilicus.
• The rashes are scaly and erythematous.

• Nail bed becomes darkened, swollen and red.
• Occasional purulent discharges.
• Separation of the nails from the nail bed.

• Cheesy white coats that look like milk curds on the tongue, mouth, and pharynx
• When rubbed off, they become erythematous and often bleed
• They may be painful and cause burning sensation in the mouth and throat
• Dysphagia

• Fever
• Chills
• Prostration
• Rash

• White or yellowish vaginal discharge. The discharge may be watery or thick but has a white, cottage cheese-like appearance.
• Itching of the vulva area
• Foul smelling of the vaginal discharge
• White or grey raised patches on the vaginal wall with local inflammation
• Painful sexual intercourse (dyspareunia)
• Burning sensation after urination
• Redness of the vagina

• Lungs or pulmonary– cough; hemoptysis; dyspnea; cyanosis
• Eye– blur vision; orbital and periorbital pain
• Brain– headache; seizures, nuchal rigidity
• Kidneys– hematuria; pyuria; cloudy urine; flank pain

Treatment of Candidiasis

The goal of management is to eliminate symptoms.

The first order of treatment is to improve any underlying condition that has triggered the onset of candidiasis. E.g. controlling diabetes; discontinuing antibiotic therapy or catheterization etc.

Antifungal agents such as miconazole, nystatin, clotrimazole, and fluconazole. They may be taken orally, applied on the affected part, inserted into the vagina etc.

Antibiotics such as metronidazole can also be given.

Nursing Care of Candidiasis

The following are the measures to put in place in the care of patient's with ckd

• Monitor and record vital signs.
• Observe the skin for rashes, erythema etc.
• Observe the vagina for discharge, foul smell etc.
• Administer prescribed drugs
• Monitor fluid intake and output.
• Monitor for patient’s level of consciousness.

• Oral toileting (twice daily) should be carried out on patients with oral thrush
• Carry out bed bath or assisted bed bath for patients depending on their condition
• Encourage females to take good care of their genitalia and perineum
• Gentle skin care should be carried out on patients with intertrigo
• Ensure patients put on dry, clean loose-fitting panties and braziers to improve circulation to the genitalia and breasts.
• Change soiled or dirty bed linen.

• In patients with oral thrush, serve light diet to prevent irritation of the mouth.
• Avoid spicy, hot, or acidic foods that might exacerbate lesions.
• Patients with severe dysphagia should be served light diet.
• Patients with mild dysphagia should be encouraged to chew a bit longer before swallowing
• Encourage patient to take in a lot of fluids unless there is renal impairment
• Food must be served in bits and frequently and must be rich in calories.
• Serve food attractively
• Ensure mouth care before and after meals
• Advise the patient to avoid mouthwashes with alcohol and to lubricate the lips.

• Wash panties frequently and dry in the sun
• Wear airy and loose underwear’s to reduce moisture at the genital area
• Teach the patient to keep her or his skin dry, use a clean towel and wear neat clothes daily.
• Full compliance to medications
• Clean toilet bowls and seats with disinfectants.
• Educate patient to wash his or her hands thoroughly after touching infected areas to prevent the infection from spreading.
• Educate the patient with a vaginal infection to avoid contamination with faeces from the GI tract by wiping from front to back after defecation.
• If the patient is diabetic, provide guidelines on how to maintain good control of blood sugar levels to decrease susceptibility to candidiasis.

Preventions of Candidiasis

• Proper and effective treatment of infected persons and their sexual partners
• Urge abstinence from sexual intercourse when not married
• Practice safer sex by using condoms for casual sex
• Having one sexual partner
• Treatment of infected pregnant women before they deliver to prevent infecting the babies in the process of childbearing
• Bath tubs should be scrubbed with disinfectants
• Avoid the use of baths, towels and underwear of infected persons
• Ensure peri-anal cleanliness and proper personal hygiene
• Avoid washing of the vagina with things which will change the vaginal flora and aid infection
• Careful use of antibiotics since they change the vaginal flora