Intestinal Candidiasis
Intestinal Candidiasis (IC) refers to an overgrowth of the Candida yeast genus in the small and large intestines. Its presence in the gut is normal, but it can be overabundant in certain populations like premature infants and the immunocompromised. Probiotics and antifungal drugs may prevent IC.
Last Updated:August 16, 2022
Candidiasis is a fungal infection caused by Candida, a genus of yeast that lives on the skin and inside of the mouth, throat, vagina, and GI tract. Intestinal candidiasis refers specifically to an abnormally high level of Candida detected in samples from feces, rectal swabs, or (rarely) the intestinal mucosa (the lining of the stomach or intestinal tract).
IC does not appear to have perceptible symptoms.[1]
Controversial publications from the 1970s and ’80s claimed that intestinal Candida overgrowth lead to a long list of ailments, including fatigue, GI discomfort, recurring yeast infections, arthritis, acne, migraine headache, and heart issues, although most of these claims have been debunked.[1]
IC may lead to diarrhea associated with antibiotics and irritable bowel syndrome with diarrhea (IBS-D), but more research is needed.
Intestinal yeast colonization is estimated from rectal swabs, fecal samples, mucosal samples, or duodenal samples (from the area connecting the stomach and small intestine). Clinical scoring systems, such as the Candida score and Candida index, estimate the risk of developing systemic fungal infections in critically ill patients, and include the extent of Candida colonization at multiple body sites in conjunction with other factors (e.g., length of hospital stay, prior use of antibiotics, prior surgery, and illness severity).
An average fecal sample is expected to contain less than 10^4 colony-forming units (CFU) per milliliter (mL), but there is no consensus on the correct threshold for IC diagnosis.[1][2] Studies generally classify a concentration of 10^3 to 10^5 CFU/mL as IC.
IC doesn’t require treatment in otherwise healthy people. In premature babies and critically ill patients, reducing or limiting intestinal Candida colonization lowers the risk of developing a systemic fungal infection. This is commonly done with antifungal drugs.
Although probiotics aren’t likely to prevent invasive fungal infections, it appears that they can reduce the risk of Candida colonization in premature babies and critically ill children.[3][4]
Vitamin D supplementation may be effective for reducing the prevalence of Candida colonization as well as systemic Candida infection (as measured by blood and urine levels of Candida).
Some studies have also investigated medium-chain triglycerides (MCT) with and without vitamin D. These results are promising, but preliminary.[5][6]
Certain compounds extracted from oregano, pine, cinnamon, and coffee suppress Candida growth in cell culture models and denture stomatitis (mild oral inflammation due to thrush), but these haven't been studied in the human GI tract.[7][8]
Contrary to popular belief, refined carbohydrate intake doesn’t increase the risk of developing IC, and most yeast found in stool is likely derived from food and saliva.[9][10]
Unlike the microbiome, the mycobiome (i.e., the fungal microbiome, which includes Candida) is more closely associated with recent dietary patterns than with long-term habits. Although high-carb diets may produce short-term increases in Candida, they don’t seem to increase risk of IC, and low-carb diets (as well as low-yeast diets) don’t meaningfully affect the risk or severity of IC, either.[9][11][12]
There is little-to-no research on other treatments for IC.
Most cases of IC (and subsequent invasive infection) are seen in preterm infants and critically ill or immunocompromised individuals. Additionally, certain medications, such as antibiotics and steroids, permeable intestines, invasive surgical procedures, hospitalization, and the use of broad-spectrum antibiotics make premature infants more prone to IC and invasive infections.[3]
People with diabetes may also be more prone to IC, but these findings are complicated by this population’s comparatively high use of antifungals, antibiotics, and steroids (to control inflammation). Intestinal Candida counts can also be elevated as a result of swallowing oral Candida, and oral candidiasis (overgrowth of yeast in the mouth and throat) can occur in people who wear dentures or take the aforementioned medications.[12][13][14]
- ^Michael Lacour, Thomas Zunder, Roman Huber, Anna Sander, Franz Daschner, Uwe FrankThe pathogenetic significance of intestinal Candida colonization--a systematic review from an interdisciplinary and environmental medical point of viewInt J Hyg Environ Health.(2002 May)
- ^C Jacobs, E Coss Adame, A Attaluri, J Valestin, S S C RaoDysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowthAliment Pharmacol Ther.(2013 Jun)
- ^Hua-Jian Hu, Guo-Qiang Zhang, Qiao Zhang, Shristi Shakya, Zhong-Yue LiProbiotics Prevent Candida Colonization and Invasive Fungal Sepsis in Preterm Neonates: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsPediatr Neonatol.(2017 Apr)
- ^Suresh Kumar, Arun Bansal, Arunloke Chakrabarti, Sunit SinghiEvaluation of efficacy of probiotics in prevention of candida colonization in a PICU-a randomized controlled trialCrit Care Med.(2013 Feb)
- ^Amanda B Arsenault, Kearney T W Gunsalus, Sonia S Laforce-Nesbitt, Lynn Przystac, Erik J DeAngelis, Michaela E Hurley, Ethan S Vorel, Richard Tucker, Nirupa R Matthan, Alice H Lichtenstein, Carol A Kumamoto, Joseph M BlissDietary Supplementation With Medium-Chain Triglycerides Reduces Candida Gastrointestinal Colonization in Preterm InfantsPediatr Infect Dis J.(2019 Feb)
- ^J Xie, L Zhu, T Zhu, Y Jian, Y Ding, M Zhou, X FengVitamin D-supplemented yogurt drink reduces Candida infections in a paediatric intensive care unit: a randomised, placebo-controlled clinical trialJ Hum Nutr Diet.(2019 Aug)
- ^Narcisa Mandras, Janira Roana, Daniela Scalas, Simonetta Del Re, Lorenza Cavallo, Valeria Ghisetti, Vivian TullioThe Inhibition of Non- albicans Candida Species and Uncommon Yeast Pathogens by Selected Essential Oils and Their Major CompoundsMolecules.(2021 Aug 15)
- ^Ibrahim Alfarrayeh, Edit Pollák, Árpád Czéh, András Vida, Sourav Das, Gábor PappAntifungal and Anti-Biofilm Effects of Caffeic Acid Phenethyl Ester on Different Candida SpeciesAntibiotics (Basel).(2021 Nov 7)
- ^M Weig, E Werner, M Frosch, H KasperLimited effect of refined carbohydrate dietary supplementation on colonization of the gastrointestinal tract of healthy subjects by Candida albicansAm J Clin Nutr.(1999 Jun)
- ^Christian Hoffmann, Serena Dollive, Stephanie Grunberg, Jun Chen, Hongzhe Li, Gary D Wu, James D Lewis, Frederic D BushmanArchaea and fungi of the human gut microbiome: correlations with diet and bacterial residentsPLoS One.(2013 Jun 17)
- ^R A Hobday, S Thomas, A O'Donovan, M Murphy, A J PinchingDietary intervention in chronic fatigue syndromeJ Hum Nutr Diet.(2008 Apr)
- ^Thomas A Auchtung, Tatiana Y Fofanova, Christopher J Stewart, Andrea K Nash, Matthew C Wong, Jonathan R Gesell, Jennifer M Auchtung, Nadim J Ajami, Joseph F PetrosinoInvestigating Colonization of the Healthy Adult Gastrointestinal Tract by FungimSphere.(2018 Mar 28)
- ^Anthony P Oyom, Emmanuel Okello, Victoria Acam, Christine Aramo, Bashir Mwambi, John C Okiria, Caesar OyetPrevalence and antifungal susceptibility of gastrointestinal candidiasis among diabetic patients: A cross-sectional studyAfr J Lab Med.(2020 Dec 10)
- ^Tomasz Gosiewski, Dominika Salamon, Magdalena Szopa, Agnieszka Sroka, Maciej T Malecki, Malgorzata BulandaQuantitative evaluation of fungi of the genus Candida in the feces of adult patients with type 1 and 2 diabetes - a pilot studyGut Pathog.(2014 Oct 15)
- ^Andrea K Nash, Thomas A Auchtung, Matthew C Wong, Daniel P Smith, Jonathan R Gesell, Matthew C Ross, Christopher J Stewart, Ginger A Metcalf, Donna M Muzny, Richard A Gibbs, Nadim J Ajami, Joseph F PetrosinoThe gut mycobiome of the Human Microbiome Project healthy cohortMicrobiome.(2017 Nov 25)
- ^Lynne V McFarland, Charlesnika T Evans, Ellie J C GoldsteinStrain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-AnalysisFront Med (Lausanne).(2018 May 7)
- ^Qiurong Li, Chenyang Wang, Chun Tang, Qin He, Ning Li, Jieshou LiDysbiosis of gut fungal microbiota is associated with mucosal inflammation in Crohn's diseaseJ Clin Gastroenterol.(2014 Jul)
- ^George A Stamatiades, Petros Ioannou, George Petrikkos, Constantinos TsioutisFungal infections in patients with inflammatory bowel disease: A systematic reviewMycoses.(2018 Jun)
- ^M G Romeo, D M Romeo, L Trovato, S Oliveri, F Palermo, F Cota, P BettaRole of probiotics in the prevention of the enteric colonization by Candida in preterm newborns: incidence of late-onset sepsis and neurological outcomeJ Perinatol.(2011 Jan)
- ^Mehmet Yekta Oncel, Sema Arayici, Fatma Nur Sari, Gulsum Kadioglu Simsek, Sadik Yurttutan, Omer Erdeve, Sibel Saygan, Nurdan Uras, Serife Suna Oguz, Ugur DilmenComparison of Lactobacillus reuteri and nystatin prophylaxis on Candida colonization and infection in very low birth weight infantsJ Matern Fetal Neonatal Med.(2015)
- ^P L Danna, C Urban, E Bellin, J J RahalRole of candida in pathogenesis of antibiotic-associated diarrhoea in elderly inpatientsLancet.(1991 Mar 2)
- ^Animesh A Mishra, Andrew Y KohAdaptation of Candida albicans during gastrointestinal tract colonizationCurr Clin Microbiol Rep.(2018 Sep)
- ^A C Mawle, R Nisenbaum, J G Dobbins, H E Gary Jr, J A Stewart, M Reyes, L Steele, D S Schmid, W C ReevesSeroepidemiology of chronic fatigue syndrome: a case-control studyClin Infect Dis.(1995 Dec)
- ^Candidiasis hypersensitivity syndrome. Executive Committee of the American Academy of Allergy and Immunology.J Allergy Clin Immunol.(1986-Aug)
- ^Hoarau G, Mukherjee PK, Gower-Rousseau C, Hager C, Chandra J, Retuerto MA, Neut C, Vermeire S, Clemente J, Colombel JF, Fujioka H, Poulain D, Sendid B, Ghannoum MABacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn's Disease.mBio.(2016-09-20)
- ^Christel Chehoud, Lindsey G Albenberg, Colleen Judge, Christian Hoffmann, Stephanie Grunberg, Kyle Bittinger, Robert N Baldassano, James D Lewis, Frederic D Bushman, Gary D WuFungal Signature in the Gut Microbiota of Pediatric Patients With Inflammatory Bowel DiseaseInflamm Bowel Dis.(2015 Aug)
- ^M Zwolińska-Wcisło, T Brzozowski, T Mach, A Budak, D Trojanowska, P C Konturek, R Pajdo, D Drozdowicz, S KwiecieńAre probiotics effective in the treatment of fungal colonization of the gastrointestinal tract? Experimental and clinical studiesJ Physiol Pharmacol.(2006 Nov)
- ^A Das, E O'Herlihy, F Shanahan, P W O'Toole, I B JefferyThe fecal mycobiome in patients with Irritable Bowel SyndromeSci Rep.(2021 Jan 8)
- ^Piero Sciavilla, Francesco Strati, Monica Di Paola, Monica Modesto, Francesco Vitali, Duccio Cavalieri, Gian Maria Prati, Maura Di Vito, Giovanni Aragona, Carlotta De Filippo, Paola MattarelliGut microbiota profiles and characterization of cultivable fungal isolates in IBS patientsAppl Microbiol Biotechnol.(2021 Apr)
- ^Gaichao Hong, Ying Li, Min Yang, Gangping Li, Wei Qian, Hanhua Xiong, Tao Bai, Jun Song, Lei Zhang, Xiaohua HouGut fungal dysbiosis and altered bacterial-fungal interaction in patients with diarrhea-predominant irritable bowel syndrome: An explorative studyNeurogastroenterol Motil.(2020 Nov)