Candidiasis (Candidiasis, Thrush)

A group of diseases caused by yeast-like fungi of the genus Candida. Fungi of the genus Candida are found on fruits, vegetables, lactic acid products, bath waters, etc.; they are also frequent inhabitants (saprophytes) of the mucous membranes of the oral cavity, digestive tract, respiratory tract, vagina, and skin of healthy people. Exogenous transmission of fungi occurs by contact, possibly also by airborne droplets, when eating foods containing yeast-like fungi. The occurrence of candidiasis is facilitated by violations of the body's defenses (severe debilitating diseases, tumors, diabetes mellitus, vitamin deficiencies, etc.), as well as long-term uncontrolled use of broad-spectrum antibiotics that suppress the normal microflora of the mucous membranes and skin, and antagonists of fungi of the genus Candida. There are skin candidiasis, isolated candidiasis of internal organs, digestive system, lungs, genitourinary system, vagina, and candidiasis sepsis.

Candidiasis of the digestive system most often manifests itself in damage to the mucous membrane of the mouth and pharynx; characterized by the appearance of small red spots, later dotted white plaques on the mucous membrane of the tongue, cheeks, larynx, which can merge, forming clearly defined lesions covered with milky-white films, upon removal of which eroded surfaces are revealed. In this case, patients note a burning sensation in the mouth, soreness of the mucous membranes, difficulty (due to pain) in chewing and swallowing.

Damage to the esophagus is most often localized in its middle third, characterized by swelling and hyperemia of its mucous membrane, ulcerations covered with a whitish film, and painful dysphagia.

Candidiasis of the stomach and intestines is rare and occurs in the form of catarrhal or erosive gastritis, enteritis, and enterocolitis. Severe forms of candida ulcers of the gastrointestinal tract can be complicated by gastrointestinal bleeding, perforation and the development of peritonitis.

Candidal sepsis is a generalized form of candidiasis, characterized by a severe general condition of the patient, hectic fever, the formation of abscesses in various organs (kidneys, liver, pancreas, brain, muscles, etc.), often accompanied by purulent meningitis, wart-ulcerative endocarditis.

The prognosis in many cases is unfavorable.

The diagnosis of candidiasis of the digestive tract is established in the presence of a characteristic lesion of the oral mucosa with thrush in combination with symptoms of damage to other organs of the digestive system. Damage to the esophagus, stomach, and colon can be determined by endoscopic examination (in this case, discharge from the ulcerative lesion and films are taken for laboratory testing; a biopsy is performed from the affected areas).

A reliable diagnosis of candidiasis is the laboratory isolation of yeast-like fungi (discharge from ulcerative lesions of the mucous membranes, pus, bile is examined, and in case of candidal sepsis - blood), as well as the detection of fungi in histological preparations obtained through targeted biopsy. Positive reactions with a Candida fungal vaccine at a dilution of the test serum of 1:200 or higher, with a polysaccharide antigen in the complement fixation reaction (at a serum dilution of 1:20 or higher) have diagnostic value.

Treatment is inpatient. Nystatin is prescribed at 500,000 units 4 times a day (for generalized candidal sepsis, the daily dose is increased to 4-6 million units). For rectal candidiasis, suppositories with nystatin (containing 250-500 thousand units of the drug) are used. For esophageal candidiasis, ketoconazole is used at a dose of 200 mg per day or fluconazole 50-100 mg per day; if treatment is ineffective, treat with amphotericin B.

Prevention. Eliminating the possibility of infection from patients with candidiasis; sanitary control, mechanization and automation of labor, use