Candidiasis is a fungal infection and among the most common conditions seen in people with HIV. While candidiasis is a rather common condition in general, it's often the first illness and sign that HIV disease is progressing to a more severe stage. Candidiasis outbreaks can be frequent, can cause great discomfort and can add to the decline of health in HIV disease.
Systemic candidiasis is when Candida spreads throughout the body, and it can be life-threatening.
The most common symptoms usually include discomfort of the mouth and throat, burning and an altered sense of taste (often described as "bad"). Creamy white or yellowish coatings or spots on the mouth and throat are also common. Thrush is rare if a person's CD4+ cell count is above 500, but outbreaks are more common as it drops to 100.
Infection in the vagina causes a smelly, thick, white-yellow discharge that might occur with itching, burning and swelling. A bad case can make walking, peeing or sex very painful.
Infection iin the throat causes chest pain, nausea and pain when swallowing. The esophagus may become partly blocked by coatings and spots that build up. In rare cases, bad ulcers can rupture the esophagus.
Candida can infect skin in the armpits, groin (including the scrotum and tip of the penis in men) and under the breasts. This is called cutaneous candidiasis. Infection can also occur around burns, cuts or catheters. It causes a bright red uneven eruption in the folds of skin. This may be coated by a white, wrinkled layer of tissue. Other symptoms include a mild burning. Fingernails and toenails can also be infected, which can be a special problem for people whose hands are often in water, like bartenders or dishwashers.
Infection might include the brain, heart, kidneys, eyes, liver, genital tract and joints. This form occurs most often in people with low white blood cell counts (neutropenia). This type of infection is also called disseminated candidiasis.
The fungus called Candida causes candidiasis. This fungus is normally found in small amounts in the mouth, vagina, digestive tract and skin. In a healthy person, other bacteria and the immune system keep it from becoming a problem.
However, a weak immune system makes it easier for Candida to grow and cause infection. In HIV disease, the most serious Candida outbreaks occur when CD4+ cell counts are very low (below 100). In people with weak immune systems, candidiasis can recur and be difficult to treat.
Factors including diabetes, pregnancy, iron, folate, and vitamin B12 or zinc deficiency, and use of antihistamines can increase the risk of Candida infections. Things that may weaken the immune system -- from chemotherapy to stress and depression -- can also cause or worsen candidiasis.
Most nutritionists agree that sugar, yeast, dairy, wheat, caffeine, nicotine and alcohol are the main culprits because they help yeast to grow. To prevent this, they recommend eating as little as possible of these types of foods. Another approach is to eat larger amounts of foods that may keep yeast from growing. For example, some nutritionists believe garlic has natural antifungal properties that may help prevent candidiasis. Fresh garlic is considered best, although commercial garlic "pills" help reduce the odors.
Another factor that can contribute to uncontrolled yeast growth is using antibiotics. "Friendly" bacteria are found naturally in the body and establish a healthy balance while eliminating unfriendly yeasts. Many common antibiotics, like tetracycline and penicillin, kill these bacteria which then allow yeast to grow, especially in the vagina. It is not unusual, even for people with healthy immune systems, to experience a fungal infection after using antibiotics.
Overall, the best way to naturally prevent fungal infections is to eat healthfully and regularly, avoid excessive sugar intake and avoid or decrease alcohol and cigarettes.
Oral, vaginal and skin infections are usually diagnosed by appearance and symptoms. Lab tests are usually performed if the infection does not clear up after treatment.
If a person with thrush has problems swallowing (food "gets stuck") and/or has bad chest pain, he or she may also have esophageal infection. If symptoms do not improve with treatment, or if someone has problems swallowing but does not have thrush, an endoscopy is usually performed. This is when a doctor uses a small tube to look into the esophagus.
Systemic candidiasis is very difficult to diagnose. Candida in the blood may come from a local infection (like the mouth or site of a catheter) as well as from infection of internal organs. Candida may only briefly be present in the blood when an internal organ is infected, therefore a blood test result is not always reliable.