Yeast infections

These infections are common (Crawford and Hollis, 2007) and generally caused by commensal organisms; organisms which normally live on the skin (particularly of the oral cavity and genital tracts) in symbiosis with their human hosts. This non-parasitic relationship becomes pathogenic when opportunistic situations which favour its multiplication arise. This is common while patients are taking oral antibiotics or oral contraceptives or in patients who are immunosuppressed.

Candida albicans is a commensal of the mouth and gastrointestinal tract which can result in opportunistic infection (Gawkrodger, 2003). There are predisposing factors which good nursing advice may help patients to address:

1. Moist and opposing skin folds: advise patients to dry the skin well after washing especially in skin folds with the use of individual towels;
2. Obesity patients require advice about weight reduction strategies;
3. Immunosuppressed patients require education about such opportunistic infections in order to recognise them and seek advice early;
4. Pregnancy
5. Poor hygiene: patients need advice about good skin hygiene and careful drying;
6. Humid environments: patients should be advised to avoid skin occlusion in order to aid healing and prevent recurrence;
7. Wet work occupations: offer advice about careful hand drying and hand protection during wet work, e.g. gloves;
8. Use of broad-spectrum antibiotics should be avoided unless necessary.
   
   

Presentation
Yeast infections may present in a number of different ways.

Genital thrush commonly presents as an itchy, sore vulvovaginitis. Mucous membranes are inflamed and white plaques adhere to these. There may be a white vaginal discharge or penile discharge. Thrush can be spread by sexual intercourse.

Intertrigo
There is a moist macerated appearance to this super-infection with Candida albicans in the sub mammary, axillary or inguinal folds and in the interdigital clefts. Red macerated skin with satellite lesions just ahead of the advancing edge is very distinctive of candida.

Oral
White plaques stick to the buccal mucosa (Figure 12.10). Unlike leukoplakia (white plaques on the mucous membranes), these can be scraped off and leave small bleeding points underneath. Broad-spectrum antibiotics, false teeth, poor oral hygiene and poorly sterilised feeding equipment in babies can predispose to this.

Systemic
Systemic candidiasis can occur in immunosuppressed patients. Red nodules or pustules are seen in the skin.

Management

1. There is little evidence on the optimal treatment of candidal skin infections.
2. It is generally agreed that general measures such as good hygiene and careful drying should be improved and other predisposing factors addressed.
3. Topical imidazoles, for example clotrimazole, ketaconazole, are recommended for first-line treatment.
4. Oral treatment is required for people with severe or extensive disease or when topical treatment has failed.
5. Oral Fluconazole is recommended as the first-line treatment if systemic treatment is needed.
6. In children under the age of 12 years specialist advice should be sought.