This is an automatically translated article.
The article was written by Specialist Doctor I Le Thi Thu Hang - Dermatologist, Department of Medical Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.
Candida can cause disease at different ages and in both sexes. It often occurs in people with risk factors such as diabetes, dry mouth, increased sweating, use of corticosteroids and broad-spectrum antibiotics, or immunocompromise, including HIV/AIDS infection.
1. Causes and pathogenesis
Mainly caused by Candida albicans . This is an oval, 2-6 x 3-9 μm yeast that can produce budding, pseudofilamentous or true mycelium. In addition to C. Albicans, Candida includes more than 100 other strains, most of which do not grow and cause disease in humans. Other strains of Candida such as C. tropicalis, C. Dubliniensis, C. Parapsilosis, C. Guilliermondii.. are the cause of disease in humans, especially in disseminated infections.
Nấm Candida có thể xuất hiện ở nhiều bộ phần trên cơ thể
2. Clinical and subclinical symptoms of candida mucositis
2.1 Clinical
Stomatitis (thrush): the most common, appearing at any age, but the disease is often severe in young children, lactating women and the elderly. Favorable factors are the use of antibiotics, corticosteroids, the use of dentures, cancer, radiation therapy, HIV/AIDS. Pseudomembranous glossitis: manifestations can be acute and chronic. Acute is common in lactating women and the elderly with white-white pseudomembranous spots, red mucous membranes, edema in the tongue, palate, cheeks, and pharynx. Symptoms are mild burning and burning. In the chronic form, the lesion is less red and edematous but is widespread, possibly down to the esophagus. Atrophic inflammation: thin oral epithelium, burning sensation, gloss, edema. There may be atrophy, redness and ulceration of the tongue mucosa. This form is common in denture users. Leukoplakia: is a spot, slightly white in color with irregular margins, difficult to remove.
Trẻ em dễ bị tưa miệng do nấm candida
Corneringitis: cracks in the skin of the corner of the mouth, white scales, pain when chewing and lesions may spread around the mouth. Favorable factors are malnutrition, increased salivation. Vulvar/vaginitis : chronic progression. Lesions are red patches with white, itchy pseudomembranous membranes, possibly with pustules in the area around the lesion, which may extend to the perineum. Common in women who are pregnant, have an IUD, use oral contraceptives. Other predisposing factors are diabetes, obesity or corticosteroid treatment. Balanitis: common in uncircumcised men. Location on the glans and foreskin. Lesions are red papules, pustules, increased secretions, sensations of irritation, pain. The disease is recurrent.
2.2 Subclinical
Fresh examination in KOH solution or in gram-stained specimens shows the image of yeast spores with pseudofilaments. Cultured in Sabouraud's medium grow white or cream-yellow colonies, with a smooth, glossy surface. Sugar fermentation cultures to isolate different Candida species. PCR test: helps to classify Candida species, however, can be difficult when more than one Candida species is present in the specimen.
Xét nghiệm PCR cho phép xác định các loài candida
3. Treatment
3.1 Principles of treatment
Identification and elimination of risk factors is important in the treatment of candida mucositis. Use antifungal antibiotics.
3.2 Specific treatment
Stomatitis: Nystatin solution, gargle 2-3 times/day. In severe cases, oral antifungal antibiotics can be used. Vulvar/vaginitis: topical or topical azole antifungals include butoconazole, clotrimazol, econazole, ketoconazole, fenticonazole, miconazole, omoconazole, oxiconazole, and terconazole. Topical drugs: miconazole or clotrimazol 200mg, vaginal single dose, econazole 150mg, vaginal 1 time/night for 2 days. It is possible to use the drug Fluconazole 150mg, take a single dose, Itraconazole 100mg twice a day for 3 days. Balanitis: apply imidazole drugs (clotrimazol, ketoconazole, miconazole), terbinafin 2 times a day until the lesions are gone. + Severe cases can be combined with oral drugs:
Ketoconazole 200mg/day, for 7 days;
Fluconazole 150mg/week, for 4 weeks,
Itraconazole 200mg x 2 times/day, for 4 weeks;
Posaconazole 800mg/day, for 3 weeks...
Điều trị bằng thuốc là phương pháp điều trị hiệu quả bệnh do nấm candida gây ra
Chronic mucosal candidiasis: + Systemic drugs: Itraconazole 200mg/day for 3 months, or 200mg/12 hours for 1 week/month and repeat for the next 2 months, or Fluconazole 150-300mg/week for 4-6 week, or Terbinafin 250mg/day for 3 months.
+ In case of poor response or resistance to antifungal drugs, treat amphotericin B intravenously 1 time, 3 days apart, the initial dose is 0.1mg/kg (for focal lesions) and 0.7mg/kg (for localized lesions). extensive and progressive lesions). When lesions respond, switch to drugs such as Itraconazole 200mg/12 hours for 4 weeks; or Fluconazole 150-300 mg/week for 4 weeks; or voriconazole 4mg/kg/12 hours IV; Posaconazole 800 mg/day. If Candida is resistant, the first dose of 70 mg/day can be used, followed by 50 mg/day for 30 days.
Oral antifungal antibiotics have many side effects, especially for the liver and kidneys, so it is necessary to test before treatment to have the right indication.
Thận có thể bị ảnh hưởng khi người bệnh uống quá nhiều thuốc kháng sinh
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