It’s rather ironic: a rather nasty condition caused by something with such a pretty sounding name. That’s candida. And to be candid, candidiasis is rather funky, and when you get it, you also feel a deep sense of embarrassment and want to withdraw from social activities until it goes away.
Candida is the group name representing more than 100 species of fungus. When in normal amounts, they live inside the body (mouth, throat esophagus and in the vagina) and do no harm. When some species of candida proliferate, this causes conditions such as vaginal yeast infections or thrush (infection in the mouth and throat).
When candida becomes pathological, it produces a biofilm, which is a habitat in which they reside. Authors of one review explained that, “During early biofilm formation, yeast cells adhere on a surface and initiate germ tube formation, and in the intermediate phase, hyphal elongation occurs, and extracellular matrix (ECM) is abundantly produced. Mature biofilm consists of a yeast base with hyphal elements embedded in ECM, from which newly formed yeast cells grow out and are released, seeding new niches for biofilm formation and/or infection. Thus, cells that exist as part of biofilms are much less susceptible to host defenses.”
Types of Candidiasis
Vaginal candidiasis seems to be quite a common occurrence, as millions of women can attest. In the United States, according to one source, it is the second most common type of vaginal infection after bacterial vaginal infections. According to the CDC, approximately 75% of women will have at least one episode of VVC, and 40%–45% will have two or more episodes. Hospitalizations for candida infections, according to one source, numbered 26,735 patients at a cost of $1.4 billion during 2017.
The infection technically known as vulvovaginal candidiasis (VVC) is caused mostly by an overgrowth of Candida albicans. But VVC cases caused by a sister fungus, Candida glabrata, has been on the rise, according to one study. The authors explain that VVC development is “usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or non-physiological changes.”
Risk factors that alter the vaginal environment, setting the stage for either C. albicans or C. glabrata to proliferate include antibiotic therapy, pregnancy, suppressed immune state, hormone replacement therapy, and use of glucocorticoids. Also some birth control such as IUDs, spermicides, oral contraceptives and even some condoms can spur Candida overgrowth.
Good news, it is not sexually transmitted. Bad news, it tends to occur more frequently during pregnancy.
Thrush, meanwhile, is not as common in healthy women and men. Those who are more vulnerable to developing an overgrowth of C. albicans in the oral cavity are those with diabetes. According to one study of 106 participants, those with diabetes had higher amounts of C. albicans, C. krusei, C. glabrata and C. tropcalis. People who wear dentures, take antibiotics or corticosteroids (such as those inhalants for asthma), and smoke, are also at higher risk.
Both VVC and thrush are not life threatening but will only temporarily make life a bit uncomfortable. Invasive candidiasis, however, can be devastating if not caught and treated immediately. As it depicts, this type of candidiasis invades organs and systems within the body – including the blood, heart, brain eyes, bones and other parts; the most common form is called candidemia, which is Candida overgrowth in the blood. Candidemia is one of the most common causes of bloodstream infections in hospitalized patients, which can lead to death.
According to authors of a published clinical practice guideline for managing Candidiasis, “There are at least 15 distinct Candida species that cause human disease, but more than 90% of invasive disease is caused by the 5 most common pathogens, C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei. Each of these organisms has unique virulence potential, antifungal susceptibility, and epidemiology, but taken as a whole, significant infections due to these organisms are generally referred to as invasive candidiasis.”
And, 2020 would not continue to earn its fearsome reputation without the news that a new, more virulent member of the Candida clan is out there trolling for victims. Its name is Candida auris: “she” is drug resistant and also a “serious global health threat.” This species, according to the CDC, tends to cause outbreaks in hospitals, and of course, with COVID hospitalizations back on the rise at the present time, this is more worrisome.
According to the Council of State and Territorial Epidemiologists, “Candida auris is an emerging fungus that presents a serious global health threat. It can cause invasive infections associated with up to 40% in-hospital mortality. Most strains of C. auris are resistant to at least one antifungal drug, one-third are resistant to two antifungal drug classes, and some strains are resistant to all three major classes of antifungal drugs. C. auris can spread readily between patients in healthcare facilities. It has caused numerous healthcare-associated outbreaks that have been difficult to control.”
Probiotics to the Rescue
Probiotic therapy with specific strains may help reduce symptoms and improve outcomes of VVC, especially when antifungals are also used, according to one review. The authors explain that through their analysis of numerous in vitro studies, probiotics have demonstrated that they reduce the virulence of Candida by inhibiting biofilm formation and may provide additional benefit to antifungals. L. rhamnosus, L. casei, and L. acidophilus significantly reduced levels of Candida albicans biofilms at the initial colonization phase and the later maturation phase of biofilm development.”
One study suggested that Lactobacilli may work to suppress candida overgrowth through competing (and winning) for nutrients as well as producing organic acids, notably lactic acid, that lower/balance the pH in the vagina.
Multiple studies have demonstrated that probiotics may be beneficial to patients with acute VVC treated with standard antifungals by improving vaginal symptoms.
One study compared women with acute VVC receiving only antifungal therapy to women with acute VVC receiving antifungal therapy and vaginal probiotic containing L. acidophilus, L. rhamnosus, Streptococcus thermophilus, and Lactobacillus delbrueckii subsp. bulgaricus and found that the probiotic group had greater improvement in clinical complaints.
Another study of 93 women with recurring VVC looked at the impact of the strain of L. plantarum P17630 or placebo on vaginal colonization of lactic acid bacteria and found that the probiotic significantly improved lactobacilli colonization on the vaginal epithelial cells, which corresponded with better improvements of clinical signs of VVC over placebo.
This strain was tested in another study. Researchers found that women with acute VVC who consumed L. plantarum P17630 after anti-fungal therapy experienced a significant increase in resolution of symptoms including vaginal burning and compared to women using antifungal therapy alone.
Other probiotics also showed promise for VVC. One study used a blend of L. rhamnosus and L. reuteri also following anti-fungal therapy. The women in the probiotic group had better resolution of discharge compared to those who only received anti-fungals alone.
There are many other studies showing the value of consuming probiotics when a candida overgrowth is suspected. Good hygiene and lifestyle habits will also reduce the risk of thrush or VVC. When given an antibiotic, it is a good idea to take probiotics, and if you already are, increase the daily dose. And, be candid with yourself: the soonest you can obtain an anti-fungal when you first feel symptoms, the better!