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Candida
Many species of yeast within the genus "Candida"
make their home in the human body. Anywhere a
moist, warm environment with a favorable pH
factor exists, yeast such as Candida are likely
to be present, usually in a harmless coexistence
with other microflora. However, when stress, an
oversupply of sugar, or prolonged exposure to
heat occur, the Candida yeast tends to
overpopulate and create a spectrum of illnesses
which are uniquely irritating to the body part
they inhabit. Helpful bacteria such as
Lactobacillus appear to play a major role in
maintaining the body's control of Candida at
optimum levels. However, when Candida is
uncontrolled by helpful bacteria, many
infections and complications can occur.
In infants, a yeast imbalance within the mouth
is known as "Thrush." The obstetrics field is
attempting to reduce these occurrences by
identifying prenatal factors that contribute to
this type of yeast overpopulation. It is
believed that infants are exposed to the
mother's indigenous yeast populations in the
birth canal, so prenatal treatment of the mother
may be an effective manner of recapturing the
natural balance of helpful bacteria versus
yeast.
Obstetricians in Poland and Belgium attempted to
identify whether the presence of Candida in the
birth canal was related to age, antibiotic use,
or cigarette smoking. The aim of this 2007 study
was to evaluate the correlation between Candida
isolated from pregnant women and the
environmental factors such as mother's age,
cigarette smoking and antibiotic treatment that
may have an influence on the microfloral balance
of the vagina. Fifty pregnant women were
examined, ages 18-40 years old, after admission
to three different obstetric departments in
Poland. The vaginal samples were tested for
aerobic bacteria, Gardnerella vaginalis,
Lactobacillus and Candida. Candida was found in
21 samples or 43%. A correlation was found
relating to age and the presence of Candida.
Younger pregnant women were more likely to be
colonized by Candida. No influence on bacterial
composition was correlated to tobacco smoking or
antibiotic treatment. This study questions the
assumption that antibiotic use is connected to
an imbalance of Candida, and raises many more
reasons to study Candida and Lactobacillus
patterns as they may affect infants and mothers
during prenatal care.
Yeast imbalances occasionally occur on the skin,
near folded areas that promote a moist
environment. They can create an irritated, red
appearance, but are often treated with
over-the-counter ointments such as Lamisil and
Tinactin, which contain fungicidal agents. In
children, we often call this red prickly skin
eruption a heat rash. In men, this is often
referred to as jock itch, and many topical
sprays are available to reduce the irritation.
A more dangerous form of yeast or Candida
imbalance is known as the systemic yeast
infection, where the entire immune system is
compromised by yeast entering into the
bloodstream, also called Candidemia. The
occurence of these systemic infections was on
the rise in Swedish hospitals when a nationwide
study was launched to explore the causes of
fundicide-resistant Candida in 2006. If
consumers were overusing fluconazole for
over-the-counter self-treatment, they
hypothesized, then highly resistant forms of
Candida might be on the rise.
Earlier surveys of yeasts causing bloodstream
infections in Sweden revealed a relatively high
occurence of Candida species that were resistant
to azole antifungals. Since pharmacies in Sweden
are government-operated, statistics on the
consumption of antifungals can be obtained from
The National Corporation of Swedish Pharmacies.
This information showed a 10-fold increase in
the use of the triazole fluconazole from 1990
through 2005. The government of Sweden took
precautions to catalogue and identify every
strain involved in cases of Candidemia, in
almost 100% of the cases occuring in 2006. In
regions where fluconazole use was high, the
resistant Candida strains appeared to occur more
often, raising future concerns as to how to
control and prevent blood infections of this
type. Candidemia occured in 2006 at the rate of
4.3 episodes per 100,000 population, according
tho this study, and many of the blood cultures
analyzed by the Swedish government's mycology
unit found fundicide-resistant Candida strains
as the cause of this illness. The study calls
into question whether the widespread use of
fluconazole as an over-the-counter symptom
reliever may be shortsighted and damaging to
microfloral balance in the long run.
The occurence of yeast-based vaginitis is far
more widespread than blood infections. In fact,
in women from the ages of 18 through 78, they
are a commonplace irritant. Throughout a woman's
lifetime, she has a 70% chance of experiencing
at least one vaginal yeast infection, or
Candidiasis. This illness affects an
overwhelming majority of females at some point
in their life, and is caused by an imbalance of
the microflora in the genital tract.
In a recent 2008 study conducted at the Kinki
University of Japan, the microbial flora of the
lower genital tract in adult females were
examined. The study observed that the female
genital tract has a very complex microbial
flora, constantly changing under the influence
of monthly hormone cycles and sugar levels. The
Japanese study revealed that the presence of a
type of sugar known as glycogen within the
vaginal mucosa was partly controlled by the
secretion of estrogen and progesteron, with
helpful bacteria as a contributing factor. In
addition, a large population of Lactobacilli
helps to maintain the pH of the vagina and
external cervical ostium. The optimum pH appears
to occur between 4.4 and 4.6, but E coli is
inhibited from growth at a pH of less than 5.
Because Lactobacilli are known to be helpful in
generating an appropriate acidic level to
inhibit harmful bacteria, the presence of
certain bacteria in the vagina appears to be
critical in maintaining a healthy pH level.
Lactobacilli may also play a role in helping the
genital area to adapt to changes in sugar
levels. A total of 238 women were examined in
this study, and the most frequently detected
microflora were Lactobacilli, Corynebacterium,
and Staphylococcus epidermidis.
The Japanese study found that vaginal microbial
flora was influenced by inflammation, malignant
lesions, and by the age of the subject. Age was
the most important factor in predicting which
microflora would be present. Lactobacillus and
Candida albicans were detected more frequently
in younger women. However, Pseudomonas
aeruginosa and Bacillus were frequent among the
older women who participated in the study
(subjects greater than 50 years old). The
Japanese study concluded that microflora adjusts
to its environment when the ovaries are active,
and likewise readjust when the ovaries become
less active after the childbearing years are
over. To draw an inference from these study
results, a future challenge for the probiotic
industry may be to offer products that are
specifically aimed at particular age groups of
women, who may experience vaginitis from
different species of microflora in each decade
of their lifelong reproductive stages.
The Australian medical team of Marie Pirotta and
Suzanne Garland has produced studies of
Candidiasis which are wide-ranging in terms of
large sample populations. In order to confirm
scientifically whether antibiotics do indeed
have a negative affect on the microflora of the
female genital tract, they sampled over 200
women just before taking antibiotics, then again
after the course of antibiotics was complete.
This Australian study was conducted in 2006.
Study participants were required to have no
vaginal symptoms prior to entering the
population sample, and be taking antibiotics for
a non-genital condition.
In the Australian study, the proneness to
Candida-related vaginitis was significantly
raised after the 200+ women in the sample took a
prescribed dose of antibiotics. Candida was
present in 21% of the women before they took
antibiotics, and increased to 37% afterwards.
The species of microflora found after antibiotic
treatment varied significantly among the
subjects: Candida albicans was the most
prevalent before and after treatment, rising to
over 70% of vaginitis-infected subjects in the
after-antibiotic samples, but Candida glabrata
was also detected in around 20% of the
post-antibiotic cases of vaginitis. The study
concluded by encouraging physicians to test for
definitive microbial evidence before assuming
Candida albicans is the cause of vaginitis,
especially for patients with a tendency towards
recurrent symptoms. The study recommended that
when physicians prescribe antibiotics, the
history of vaginitis should be discussed so that
the least aggressive therapy can be recommended
for those patients. The Australian team in this
study stopped short of recommending probiotics,
but their contribution is significant with
regard to causes and effects related to Candida
colonization.
From a review of these studies and several
others, it appears that the widespread reliance
on fluconazole has generated some risks of
inaccurate self-diagnosis. Consumers may assume
they have one form of Candida, when sometimes
another species is the cause. Sometimes the
symptoms of a yeast infection mask other medical
problems like Chlamydia, which is not cured by
anti-fungal agents. Unless a species-specific
microbial diagnosis is conducted by medical
personnel, it is possible that another condition
can go undiagnosed and untreated. The widespread
use of antibiotics also appears to harm the
balance of helpful bacteria, especially with
regard to female genito-urinary health. When
broad-spectrum antibiotics are prescribed to
patients with recurrent cases of yeast-based
vaginitis, a cycle of detrimental yeast
imbalance is likely to be the result. Better
diagnostic tools and improved therapies are
needed for the challenge of Candida
overpopulation.
A preferred method of restoring the yeast
microfloral balance may be offered by
probiotics, especially as a preventative or
prophylactic approach. Just as yogurt is often
recommended during and after taking antibiotics,
in order to help restore the bacteria that
controls yeast infections, probiotic supplements
may also be helpful. Sugar levels and pH balance
also contribute to the conditions that encourage
overpopulation of Candida. Lactobacillus appears
to benefit pH levels in the digestive tract and
in the genital tract, to the detriment of
Candida, but the exact mechanism by which this
occurs in the genital tract is not yet
understood fully. Additional study of probiotics
in humans is likely to reveal new therapies for
yeast-based vaginitis and other illnesses caused
mainly by the imbalance of Candida. Unlike
fungicides and antibiotics, probiotics display
the advantages of having no major side effects,
and not contributing to the development of
super-resistant Candida strains. Due to the
relative mildness of probiotics compared to
these other therapies, their use as a balancing
mechanism shows a great deal of potential.
SOURCES:
"Candidemia in Sweden 2005-2006." Victor
Fernandez, Kristina Lindberg, Eva Jakobson, Erja
Chryssanthou, Lena Klingspor, Erik Svensson, Jan
Sjölin, and Per Hagblom. Department of Clinical
Bacteriology, Sahlgrenska University Hospital,
Göteborg. Department of Clinical Microbiology,
Karolinska University Laboratory, Stockholm.
Department of Laboratory Medicine, Division of
Clinical Bacteriology, Karolinska University
Hospital Huddinge, Stockholm. Department of
Parasitology, Mycology and Environmental
Microbiology, Swedish Institute for Infectious
Disease Control, Solna. Section of Infectious
Diseases, Department of Medical Sciences,
Uppsala University, Uppsala, Sweden.
"Yeast bloodstream infections in Sweden 2003."
Jakobson E, Skoog G, Hagblom P, and Fernandez V.
The Swedish Reference Group for Antifungal
Agents. Platform presentation at the 4th meeting
of the Nordic Society for Medical Mycology.
2005. Copenhagen, Denmark.
"Candida in vagina of pregnant women." Iwona
Gabriel, and Krystyna Stencel-Gabriel, and
Eugeniusz Gabriel, and Anita Olejek, and Andrzej
Wiczkowski (2007). [In Polish]. Medical Mycology
, 14 .
"Microbial Flora of Female Lower Genital Tract
and Its Influencing Factors." [in Japanese]
Department of Clinical Pathology, Central
Laboratory, and Department of Obstetrics, Kinki
University School of Medicine and University
Hospital. Huruta Tadasu, Sakata Yasuhiro,
Teshima Kensaku, Ichiro Noda, Tanaka Mitio,
Atsumi Ohnishi, and Agou Tamie. Medical Journal
of Kinki University 1 (3) pp.213-219.
"Genital Candida Species Detected in Samples
from Women in Melbourne, Australia, before and
after Treatment with Antibiotics." Marie V.
Pirotta and Suzanne M. Garland. Department of
General Practice, Department of Obstetrics and
Gynaecology, University of Melbourne, Carlton,
Department of Microbiology and Infectious
Diseases, Royal Women's Hospital, Melbourne,
Victoria, Australia. Journal of Clinical
Microbiology, September 2006, p. 3213-3217, Vol.
44, No. 9.
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