Editing Candidiasis (section)

== Signs and symptoms ==
[[File:Derm-57.jpg|thumb|Skin candidiasis]]
[[File:Yeast Infection.png|thumb|[[Vaginal yeast infection]]]]
[[File:Toefungus.jpg|thumb|Nail candidiasis ([[onychomycosis]])]]
Signs and symptoms of candidiasis vary depending on the area affected.<ref name="ID10" /> Most candidal infections result in minimal complications such as redness, itching, and discomfort, though complications may be severe or even fatal if left untreated in certain populations. In healthy ([[immunocompetence|immunocompetent]]) persons, candidiasis is usually a localized infection of the skin, fingernails or toenails (onychomycosis), or mucosal membranes, including the [[Human mouth|oral cavity]] and [[pharynx]] ([[oral thrush|thrush]]), [[esophagus]], and the sex organs ([[vagina]], [[Human penis|penis]], etc.);<ref name="Medscape clinical" /><ref name="Baron">{{cite book |vauthors=Walsh TJ, Dixon DM |chapter=Deep Mycoses |title=Baron's Medical Microbiology |editor=Baron S |edition=4th |publisher=Univ of Texas Medical Branch |year=1996 |pmid=21413276 |isbn=978-0-9631172-1-2 |chapter-url=https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 |display-editors=etal |url-status=live |archive-url=https://web.archive.org/web/20081201115047/http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 |archive-date=2008-12-01 }}</ref><ref name="Thrush - 2015 review">{{cite journal | vauthors = Patil S, Rao RS, Majumdar B, Anil S | title = Clinical Appearance of Oral Candida Infection and Therapeutic Strategies | journal = Frontiers in Microbiology | volume = 6 | pages = 1391 | date = December 2015 | pmid = 26733948 | pmc = 4681845 | doi = 10.3389/fmicb.2015.01391 | doi-access = free }}</ref> less commonly in healthy individuals, the [[Human gastrointestinal tract|gastrointestinal tract]],<ref name="pmid24789109">{{cite journal | vauthors = Martins N, Ferreira IC, Barros L, Silva S, Henriques M | title = Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment | journal = Mycopathologia | volume = 177 | issue = 5–6 | pages = 223–40 | date = June 2014 | pmid = 24789109 | doi = 10.1007/s11046-014-9749-1 | quote = Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients but also related to nosocomial infections and even in healthy individuals. There is a wide variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. | hdl = 10198/10147 | s2cid = 795450 | url = http://repositorium.sdum.uminho.pt/bitstream/1822/31482/1/document_17753_1.pdf | hdl-access = free | access-date = 2019-09-24 | archive-date = 2017-08-17 | archive-url = https://web.archive.org/web/20170817171547/http://repositorium.sdum.uminho.pt/bitstream/1822/31482/1/document_17753_1.pdf | url-status = live }}</ref><ref name="pmid24612332">{{cite journal | vauthors = Wang ZK, Yang YS, Stefka AT, Sun G, Peng LH | title = Review article: fungal microbiota and digestive diseases | journal = Alimentary Pharmacology & Therapeutics | volume = 39 | issue = 8 | pages = 751–66 | date = April 2014 | pmid = 24612332 | doi = 10.1111/apt.12665 | s2cid = 22101484 | quote = In addition, GI fungal infection is reported even among those patients with normal immune status. Digestive system-related fungal infections may be induced by both commensal opportunistic fungi and exogenous pathogenic fungi. The IFI in different GI sites have their special clinical features, which are often accompanied by various severe diseases. Although IFI associated with digestive diseases are less common, they can induce fatal outcomes due to less specificity of related symptoms, signs, endoscopic and imaging manifestations, and the poor treatment options.&nbsp;... Candida sp. is also the most frequently identified species among patients with gastric IFI.&nbsp;...  Gastric IFI is often characterised by the abdominal pain and vomiting and with the endoscopic characteristics including gastric giant and multiple ulcers, stenosis, perforation, and fistula. For example, gastric ulcers combined with entogastric fungal infection, characterised by deep, large and intractable ulcers,[118] were reported as early as the 1930s.&nbsp;... The overgrowth and colonisation of fungi in intestine can lead to diarrhoea. | doi-access = free }}</ref><ref name="SIFO">{{cite journal | vauthors = Erdogan A, Rao SS | title = Small intestinal fungal overgrowth | journal = Current Gastroenterology Reports | volume = 17 | issue = 4 | pages = 16 | date = April 2015 | pmid = 25786900 | doi = 10.1007/s11894-015-0436-2 | s2cid = 3098136 | quote = Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms.&nbsp;... For routine SIFO in an immunocompetent host, a 2–3 week oral course of fluconazole 100–200 mg will suffice. }}</ref> [[urinary tract]],<ref name="pmid24789109" /> and [[respiratory tract]]<ref name="pmid24789109" /> are sites of candida infection.

In immunocompromised individuals, ''Candida'' infections in the [[esophageal candidiasis|esophagus]] occur more frequently than in healthy individuals and have a higher potential of becoming [[systemic disease|systemic]], causing a much more serious condition, a [[fungemia]] called candidemia.<ref name="Medscape clinical" /><ref name="Fidel">{{cite journal | vauthors = Fidel PL | title = Immunity to Candida | journal = Oral Diseases | volume = 8 | pages = 69–75 | year = 2002 | issue = Suppl 2 | pmid = 12164664 | doi = 10.1034/j.1601-0825.2002.00015.x }}</ref><ref name="Pappas">{{cite journal | vauthors = Pappas PG | title = Invasive candidiasis | journal = Infectious Disease Clinics of North America | volume = 20 | issue = 3 | pages = 485–506 | date = September 2006 | pmid = 16984866 | doi = 10.1016/j.idc.2006.07.004 }}</ref> Symptoms of esophageal candidiasis include [[dysphagia|difficulty swallowing]], [[odynophagia|painful swallowing]], abdominal pain, nausea, and vomiting.<ref name="Medscape clinical" /><ref name="Yamada 2009" />

=== Mouth ===
Infection in the mouth is characterized by white discolorations in the tongue, around the mouth, and in the throat. Irritation may also occur, causing discomfort when swallowing.<ref>{{Cite web|url=https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html|title=Candida infections of the mouth, throat, and esophagus {{!}} Fungal Diseases {{!}} CDC|date=2019-04-17|website=www.cdc.gov|access-date=2019-08-01|archive-date=2019-01-09|archive-url=https://web.archive.org/web/20190109142756/https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html|url-status=live}}</ref>

Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a few weeks.<ref>{{cite web|title = Thrush|url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001650/|year = 2011|access-date = 2011-04-08|url-status = live|archive-url = https://web.archive.org/web/20110210121452/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001650|archive-date = 2011-02-10}}</ref>

=== Genitals ===
Infection of the vagina or [[Human vulva|vulva]] may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray [[cottage cheese]]-like discharge.  Symptoms of infection of the male genitalia (balanitis thrush) include red skin around the head of the penis, swelling, irritation, itchiness and soreness of the head of the penis, thick, lumpy discharge under the foreskin, unpleasant odour, difficulty retracting the foreskin ([[phimosis]]), and pain when passing urine or during sex.<ref>[http://www.nhs.uk/Conditions/Thrush-men/Pages/Symptoms.aspx NHS: Symptoms of thrush in men (balanitis thrush)] {{webarchive|url=https://web.archive.org/web/20131101202229/http://www.nhs.uk/Conditions/Thrush-men/Pages/Symptoms.aspx |date=2013-11-01 }}</ref>

=== Skin ===
Signs and symptoms of candidiasis in the skin include itching, irritation, and chafing or broken skin.<ref name="medlineplus.gov">{{Cite web|url=https://medlineplus.gov/ency/article/000880.htm|title=Candida infection of the skin: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2019-08-06|archive-date=2019-08-06|archive-url=https://web.archive.org/web/20190806175019/https://medlineplus.gov/ency/article/000880.htm|url-status=live}}</ref>

=== Invasive infection ===
Common symptoms of gastrointestinal candidiasis in healthy individuals are [[pruritus ani|anal itching]], belching, bloating, indigestion, nausea, diarrhea, gas, intestinal cramps, vomiting, and [[gastric ulcer]]s.<ref name="pmid24789109" /><ref name="pmid24612332" /><ref name="SIFO" /> Perianal candidiasis can cause anal itching; the lesion can be [[erythematous|red]], papular, or ulcerative in appearance, and it is not considered to be a [[sexually transmitted infection]].<ref>{{cite book|editor-first = Bruce G. | editor-last = Wolff |display-editors=etal |title=The ASCRS textbook of colon and rectal surgery|year=2007|publisher=Springer|location=New York|isbn=978-0-387-24846-2|pages=241, 242, 245}}</ref> Abnormal proliferation of the candida in the gut may lead to [[dysbiosis]].<ref name="ReferenceA">{{cite journal | vauthors = Mukherjee PK, Sendid B, Hoarau G, Colombel JF, Poulain D, Ghannoum MA | title = Mycobiota in gastrointestinal diseases | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 2 | pages = 77–87 | date = February 2015 | pmid = 25385227 | doi = 10.1038/nrgastro.2014.188 | s2cid = 5370536 }}</ref> While it is not yet clear, this alteration may be the source of symptoms generally described as the [[irritable bowel syndrome]],<ref>{{cite journal | vauthors = Santelmann H, Howard JM | title = Yeast metabolic products, yeast antigens and yeasts as possible triggers for irritable bowel syndrome | journal = European Journal of Gastroenterology & Hepatology | volume = 17 | issue = 1 | pages = 21–6 | date = January 2005 | pmid = 15647635 | doi = 10.1097/00042737-200501000-00005 | url = http://www.jptwellnesscircle.com/teleseminars/DrSantelmannCandida.pdf | citeseerx = 10.1.1.567.6030 | s2cid = 35882838 | access-date = 2017-10-24 | archive-date = 2019-12-05 | archive-url = https://web.archive.org/web/20191205034202/http://www.jptwellnesscircle.com/teleseminars/DrSantelmannCandida.pdf | url-status = dead }}</ref><ref>{{cite journal | vauthors = Collins SM | title = A role for the gut microbiota in IBS | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 11 | issue = 8 | pages = 497–505 | date = August 2014 | pmid = 24751910 | doi = 10.1038/nrgastro.2014.40 | s2cid = 10676400 }}</ref> and other gastrointestinal diseases.<ref name="pmid24612332" /><ref>{{cite journal | vauthors = Gouba N, Drancourt M | title = Digestive tract mycobiota: a source of infection | journal = Médecine et Maladies Infectieuses | volume = 45 | issue = 1–2 | pages = 9–16 | date = 2015 | pmid = 25684583 | doi = 10.1016/j.medmal.2015.01.007 | doi-access = free }}</ref>

=== Neurological symptoms ===
Systemic candidiasis can affect the central nervous system causing a variety of neurological symptoms, with a presentation similar to meningitis.