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Candidiasis.

Candidiasis is a general term for diseases produced by Candida species and encompasses colonization, superficial infection (e.g., thrush, vaginitis, cystitis, and intertrigo), deep local invasion (e.g., esophagitis), and hematogenous dissemination (e.g., to the eyes, skin, kidneys, and brain). The species that most commonly cause candidiasis are C. albicans (yeasts, pseudomycelia, and mycelia), C. tropicalis (yeasts and pseudomycelia), and Torulopsis glabrata (yeasts only). Disseminated infection occurs in both sexes and at all ages as a function of immunologic impairment. Chronic mucocutaneous candidiasis (CMCC) shows a familial tendency in about 20% of cases with associated endocrinopathy (e.g., hypoparathyroidism, hypoadrenalism, hypothyroidism, or diabetes mellitus).

Candida Albicans

Among the many species of Candida, C. albicans is a major common pathogen for human beings and causes invasive yeast infection. C. albicans is generally controlled by the immune system and normally grows in harmless quantities in the intestinal tract and vagina. It is one of the many organisms that make up the flora of a healthy intestinal tract. When it outgrows the other friendly organisms in the intestinal tract, it disrupts the intestinal balance. This immune and gut permeability imbalance is caused by a number of factors, such as excess stress, allergies, use of antibiotics, steroids, birth control pills, hormonal drugs, heavy metal poisoning, and viral infections. Certain foods also have the potential to create an environment where yeast can flourish. These foods include refined carbohydrates, alcohols (beer and wine are sources of yeasts and molds), artificial preservatives and additives, and yeast containing breads and pastry goods. Vaginal colonization is increased by diabetes mellitus, pregnancy, and the use of oral contraceptive agents.

Symptoms

Once the yeast is allowed to grow unchecked, it releases large amounts of toxins and allergens into the bloodstream and tissues which cause a wide variety of problems, such as fatigue, headache, abdominal bloating, asthma, bladder infection, skin disruption, premenstrual syndrome, and phobias. It can affect anyone, but generally women are affected the most, and the symptoms vary, such as skin rashes, lethargy, menstrual problems, weight gains migraines, poor concentration, and depression. Candidiasis affects all nine bodily systems: digestive, central nervous, cardiovascular, lymphatic, respiratory, reproductive, urinary, endocrinal and musculoskeletal. Children affected by yeast are sometimes called "Candida kids" and occasionally suffer from learning disabilities, dyslexia, inability to concentrate, and hyperactivity. Candida overgrowth has been reported in the autistic population. There also may be inflammatory reactions due to hypersensitivity of the immune system to the Candida antigens.

ELISA Tests

Agglutination, fluorescent antibody, and cross immunoelectrophoresis tests have all been used for diagnosing candidiasis. The double gel diffusion precipitin (Ouchterlony) test has been used for quite some time. The rationale for any of these procedures is that infection will stimulate Candida antibody production, which can then be detected and, in some instances, quantified.

The recent development of ELISA tests to determine antigen, antibody, and immune complex level of Candida has provided essential quantitative information on the distribution of antigen and antibody in normal and abnormal situations and therefore offers not merely a means of serological diagnosis but a simple technique to study the interplay between host and organism during normal colonization, over-colonization, and infection states. For thoroughness, these authors highly suggest using three related tests when attempting to diagnose candidiasis: Candida albicans antibody tests for IgG, IgA and IgM; Candida Immune Complex; and Candida antigen test.

Interpretation

To date many physicians have clinically evaluated IgG, IgA and IgM antibodies to Candida as indices to severity and chronicity of Candida colonization and sensitivity either treating the patients with a yeast-free diet and/or anti-fungal therapy. The yeast-free diet plays a major role in curtailing the yeast growth. We have observed a significant drop in antibodies (IgG, IgA and IgM) and immune complex levels in subjects on a yeast-free diet plan.

Immunoglobulin IgA protects the body's surface against foreign antigens. It resides on all the body's mucosal membranes and surfaces. High IgA levels may indicate that the infection's source is an external allergen or irritant. IgM is usually considered to be the first antibody to respond to an immunological challenge. Clinically, in patients with a long-standing history of candidiasis, usually all three antibodies (IgG, IgA and IgM) are markedly elevated. In early colonization with systemic symptoms, one sees an elevated IgM, and with recurrent local candidiasis infection IgA is elevated. Persistent high levels of IgG suggest chronic systemic candidiasis. A consistently high level or a rising level of antigens correlates with dissemination early in the course of disease. One has to remember that Candida IgG antibodies are present in all normal people and in children as early as three years of age. It is evident that there is some overlap in the levels of antibody found in healthy, colonized, and infected adults. Because of this, no single level of IgG, IgA and/or IgM antibody can be used in the diagnosis of candidiasis.

Candida immune complex is a non-covalent binding of Candida antigen, IgG antibody and the fragments of complement. Immune Complexes are generally present in proportion to the Candida load and elevated levels indicate an abnormally increased load of Candida. The levels of Candida immune complex fall when the Candida load is reduced with the yeast-free diet plan and/or anti-fungal therapy. Increase in Candida-specific IgM, IgG and/or IgA along with the increase in Candida immune complex indicates chronic or continued over colonization by C. albicans.

During acute infection period, elevated Candida antigen test tends to be positive followed by an increase in IgM antibodies. However, if this acute infection phase is missed, then there is an increasing level of IgG antibodies along with the increased levels of immune complex. A negative antigen reaction does not exclude the possibility of systemic Candida infection.

We believe that clinical observation together with a thorough Candida profile test will identify those patients with candidiasis. Additional testing may be required to evaluate patient status during treatment.

V.S. Jathar, PhD has over 20 years of experience in the field of laboratory medicine. He has published and presented his research work in national and international journals and conferences. Since 1995, he is a Technical Director at Alletess Medical Laboratory. The C. albicans specific immune complex test is a unique test, which he developed to determine the status of C. albicans infection.

Meera V. Jathar, MD is a board certified physician in Physical Medicine & Rehabilitation. She is a staff physician at Youville Hospital & Rehabilitation Center, Cambridge, Massachusetts. She is a Medical Consultant at Massachusetts Peer Review Organization and Alletess Medical Laboratory.

REFERENCES

(1.) Basic & Clinical Immunology: 8th edition, a LANGE medical book edited by Stites, D.P., Terr, A.I., Parslow, T.G., in Fungal Diseases, Drutz, D.J. 649-665, 1994.

(2.) Jones JM. "Laboratory diagnosis of invasive candidiasis." Clin Microbiol Rev, 3,32-45,1990.

(3.) Lew MA. "Diagnosis of systemic Candida infection." Ann Rev Med, 40,87-97,1989.

(4.) De Repentigny L, Reiss E. "Current trends in immunodiagnosis of candidiasis and aspergillosis." Rev Infect Dis, 6,301-12,1984.

(5.) Bennett JE. "Rapid diagnosis of candidiasis and aspergillosis." Rev Infect Dis, 9,398-402,1987.
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Author:Jathar, V. S.; Jathar, Meera V.
Publication:Original Internist
Geographic Code:1USA
Date:Mar 1, 2001
Words:1177
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