Antifungal resistance to candidiasis occurs when infections caused by one of the Candida fungi become resistant to treatment by antifungal medications that are usually effective at treating candidiasis.
A fungus called Candida causes candidiasis, a fungal infection. Candida lives on the skin and inside the mouth, vagina, and elsewhere on the body. Certain changes in environmental conditions can encourage the growth of the fungus, causing a fungal infection. There are several different fungi in the Candida group.
The most common type of candidiasis is vaginal candidiasis, also known as a yeast infection.
When the conditions inside the vagina change, which can be due to a pH imbalance, medications, or large hormonal changes, an overgrowth of Candida is more likely. Vaginal candidiasis causes itching, redness, foul-smelling discharge, and pain when urinating.
Candida infections can also affect the mouth and throat. When candidiasis occurs in these areas, it’s commonly known as thrush. Candidiasis can also occur in the oesophagus, the tube that connects the throat and stomach.
Symptoms of thrush include redness, soreness, white patches in the mouth and throat, pain while swallowing, and cracks around the mouth. If candidiasis is in the oesophagus, you may experience difficulty swallowing.
The most dangerous type of candidiasis, invasive candidiasis occurs when the Candida infection spreads to multiple parts of the body via the bloodstream. This is also known as candidemia. It’s more common in patients that have been hospitalised for long amounts of time. Invasive candidiasis can affect the brain, bones, eyes, heart, and blood cells.
Although Candida albicans is the most common cause of Candida infections, other strains of the Candida fungus are usually resistant to treatment. Antifungal resistance can occur naturally in some fungi due to its’ genetic makeup, which explains why some species of the Candida fungus are more resistant to treatment than others. However, antifungal resistance is also learned.
When a fungi is exposed to antifungal drugs over time, it adapts to be resistant to treatment by those medications. This makes fungal infections by Candida harder to treat.
There are two main medications used to treat Candida infections: a class of antifungals called echinocandins and fluconazole. Patients resistant to one can be treated by the other. However, patients with a Candida infection that is resistant to both do not have a lot of treatment options. This part of why antifungal resistance poses a big public health risk.
The main treatment option for Candida infections resistant to echinocandins and fluconazole is amphotericin B. This drug can be very harmful to patients that are already sick, limiting how useful it can be for certain people. For example, patients with invasive candida that is resistant to echinocandins and fluconazole may not have as strong of a chance of surviving treatment with amphotericin B.
Because invasive candidiasis, particularly, spreads in hospital settings, it’s important to know what we can do to prevent it as patients and from the standpoint of healthcare workers.
If you work in a health setting, you can offset antifungal resistance by:
As a hospital patient, you can:
We’re each responsible for our small part in preventing antifungal resistance. As a community member, practising good hygiene every day goes a long way.