Management & Treatment of Yeast Infection Problems

What is Yeast Infection?

Yeast infection is a fungus infection of the skin or mucous membranes caused by a group of yeast-like fungi called Candida. Yeasts are organisms that multiply by budding. Candida is one of the normal organisms that live in the body and it frequently colonizes the skin and mucous membranes of the respiratory, intestinal, genital, and urinary tracts without causing harm.

Colonization in the mouth and pharynx is found in 30-55% of healthy young adults, and Candida species may be detected in 40-65% of feces. Infection of Candida is very common, in that three of every 4 women have at least 1 episode of Vulvovaginal Candidiasis (VVC) during their lifetime.

The most common species that affect humans is Candida albicans (C. albicans). About 50-60% of yeast infections are caused by C. albicans. C. glabrata is the second most common species, causing 15-20% of infections; followed by C. parapsilosis (10-20%), C. tropicalis (6-12%) and C. krusei (1-3%).

Causes of Yeast Infection

Candida is normally kept under control by the population of other natural organisms in the body and the body's defense system (T-cells, neutrophils). When there is a change in the organism population (e.g. antibiotic use) or the body's defense system is not working properly (cancer, HIV), Candida may become problematic, causing harm to the body, and resulting in a yeast infection. Causes of Yeast Infection in the body can be attributed to Candida overgrowth.

Recurring Yeast Infection

The body normally has specialized cells that make up the immunity system. Lymphocytes and cell-mediated immunity are important in the prevention of mucosal candidiasis. Therefore, patients with T-cell deficiency, such as human immunodeficiency virus (HIV), have a high risk of developing recurrent and/or persistent Mucocutaneous Candidiasis.

White blood cells called monocytes and polymorphonuclear cells are responsible for killing the hyphae and spores that yeasts produce. Therefore, patients with Neutropenia (low amounts of white blood cells) are at risk for recurring yeast infections or even Systemic Candidiasis.

Complements and immunoglobulins are necessary for intracellular killing of the organisms and patients with deficiencies can have a more prolonged and complicated course of candidal infection.

Symptoms of Yeast Infection

A yeast infection can have several appearances. Candida infection of the mouth (Thrush, or Oral Candidiasis) has an appearance of white flecks on the tongue, upper roof of the mouth, or the pharynx.

Vaginal Candidiasis has a white, thick, curd-like appearance. On the skin, in some cases, a Candida infection appears as itchy, red lesions with pustules and a distinct border with surrounding satellite lesions.

How to Diagnose Yeast Infection

The most common way to diagnose a Mucocutaneous Yeast Infection is to scrape the lesion, revealing a red or bleeding base. A potassium hydroxide test or a methylene blue gram stain, revealing budding yeast or hyphae confirms the diagnosis of a Candida infection. Cultures of the nail bed may distinguish Onychomycosis (candida infection of the nails) versus noninfectious causes.

For cases of Systemic Candida Infections, blood tests can be performed, but they are not relied upon for starting treatment since the results can take days, creating a treatment delay for doctors. Cultures are not routinely performed because of the same reason. Blood cultures are positive in only 50-60% of cases of disseminated disease.

Urinalysis may be helpful, and results may be indicative of either colonization or renal candidiasis. Physicians sometimes obtain cultures of sterile sites. Positive results from these sights indicate the presence of invasive candida and infection. The serum 1-3 D-glucan detection assay has been used and it predicts the presence of candida by measuring levels of beta-glucan (a fungal cell wall component).

Treatment of Yeast Infections

Yeast infections are treated with antifungal medications. Antifungals work by breaking down the cell membrane of yeasts. They are effective in killing most yeast infections, and come in many forms: oral suspensions, creams, ointments, tablets or intravenous (IV). They are:

• Nystatin (oral suspension, cream);


• Fluconazole (Diflucan-tablet, IV);


• Clotrimazole 1% cream (Lotrimin, Mycelex);


• Miconazole 2% cream (Absorbine, Micatin);


• Itraconazole (Sporanox- tablet);


• Ketoconazole (Nizoral-tablet);


• Flucytosine (Ancobon-tablet); and


• Amphotericin B (IV), liposome (AmBisome-IV).