Mucocutaneous candidiasis is an opportunistic infection caused by the fungus Candida albicans that can affect the mouth (oral candidiasis, oral thrush), esophagus (esophageal candidiasis) or vagina (vulvovaginal candidiasis, yeast infections). Opportunistic infections occur in individuals who are immunocompromised (weakened immune systems), such as patients infected with the human immunodeficiency virus (HIV).
HIV primarily destroys CD4 T-cells, which are a type of lymphocyte (white blood cell that helps coordinate the immune system's response to infection and disease). The patient's CD4 cell count is used as a marker to determine how far the disease has progressed. Individuals with a CD4 cell count lower than 200 cells per microliter of blood have progressed to AIDS. Since the virus weakens the immune system, HIV patients are more vulnerable than the general population to developing diseases and infections, including mucocutaneous candidiasis.
The Candida albicans fungus, which is responsible for the development of candidiasis, is found almost everywhere in the environment. Most people have small amounts of Candida albicans present in their mouths and/or vagina at any given time, but healthy individuals are able to prevent the fungus from multiplying and causing an infection. Candidiasis does not usually affect individuals with healthy immune systems, but when it does, symptoms are usually minor. In contrast, immunocompromised patients, such as HIV patients, often suffer from severe symptoms, including painful lesions in the mouth that make it difficult to eat.
Oral candidiasis, commonly known as oral thrush, usually develops in HIV patients once their CD4 cell count drops below 350. While oral thrush is the least serious of the fungal infections associated with HIV, it may indicate that a patient's HIV condition is worsening. The oral infection can progress to esophageal candidiasis, which occurs when thrush spreads to the esophagus. Esophageal candidiasis typically occurs when the HIV patient's CD4 cell counts are 200 or less. Esophageal candidiasis is the only type of candidiasis that is considered an AIDS-defining illness. This means that when HIV-infected patients develop esophageal candidiasis, their condition has progressed to AIDS.
Vaginal candidiasis (yeast infection) is common in both immunocompetent and immunocompromised individuals. Researchers estimate that about 75% of all women are likely to have at least one vaginal Candida infection during their lifetime, and up to 45% experience two or more. Individuals who become pregnant, take high-estrogen oral contraceptives (like birth control pills), have uncontrolled diabetes mellitus, wear tight-fitting clothes, receive antibiotic therapy and individuals who have sexually transmitted diseases have an increased risk of developing yeast infections.
Candidiasis infections are treatable. HIV patients who have candidiasis infections usually receive treatment with antifungals to clear the infection. Some of these medications may cause liver damage. Therefore, blood tests should be performed regularly during treatment to monitor liver function. Treatment generally lasts about 10 to 14 days.
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