Candidiasis is primarily caused by Candida albicans. It mainly affects the epidermis and mucous membranes but can also lead to visceral or systemic infections, making it the most common type of fungal disease.

bubble_chart Clinical Manifestations

Due to the different sites of invasion, the clinical manifestations vary.

1. Cutaneous candidiasis is more common in newborns and younger infants. The lesions primarily occur in diaper-covered areas, such as the buttocks, vulva, perianal region, and groin; followed by the armpits, anterior neck, and chin. Initially, the skin appears red and eroded, with scattered flat papules the size of rice grains, which easily erode to form clearly demarcated, moist, and bright red lesions accompanied by gray-white scaling. Surrounding areas may develop vesicles or pustules, which gradually merge to form new erosions. The affected area is both painful and itchy, causing infants to cry and become restless.
2. Thrush initially presents as white coatings attached to the oral mucosa, which are not easily wiped off. These may merge into large white patches spread throughout the oral cavity, appearing relatively soft. Upon removal, a red and rough mucosal surface is revealed.
3. Candida esophagitis primarily manifests as vomiting and difficulty swallowing. Older children may complain of a burning sensation in the esophagus during meals.
4. Candida enteritis often occurs after oral administration of broad-spectrum antibiotics due to intestinal dysbiosis. Diarrhea occurs 3 to over 20 times a day, presenting as foamy or watery stools, sometimes with mucus and a fermentation odor. In severe cases, ulcers may form, leading to bloody stools or even intestinal perforation and peritonitis.
5. Candida pneumonia shares symptoms with bronchopneumonia, such as fever, cough, panting, and cyanosis. Lung auscultation reveals dullness and medium or fine crackles. The onset is slow, and the course is prolonged. If diagnosis is delayed or antibiotics are continued, the condition may worsen. Often, discontinuation of antibiotics leads to spontaneous recovery.
6. Disseminated candidiasis usually spreads hematogenously, progressing through a stage of fungal septicemia before causing lesions in one or more organs. It often leads to damage to the heart, kidneys, or brain. The condition is severe.

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bubble_chart Auxiliary Examination

1. Pathogen Examination: Place skin scrapings, sputum, feces, etc., on a glass slide, add a drop of 10% potassium hydroxide or distilled water, gently heat, or directly drop urine onto the slide. Under the microscope, slender hyphae and clusters of spores can be observed.
2. Pathogen Culture: Inoculate specimens such as skin scrapings, sputum, or feces onto Sabouraud's medium (glucose peptone agar medium) and culture at 37°C. Within 1–4 days, white or yellowish-brown creamy yeast-like colonies can be observed.
3. X-ray Examination: This has no specific diagnostic value. If esophageal candidiasis is suspected, a barium meal contrast study can be performed. If pulmonary candidiasis is suspected, a chest X-ray can be taken.

bubble_chart Treatment Measures

﹝Treatment﹞

(1) Thrush: Rinse the mouth with 1% sodium bicarbonate, then apply 1% Chinese Gentian Violet. Alternatively, crush nystatin (100,000 U/tablet) and mix with 1–2 ml of water, then scrub and apply to the affected area of the mouth, 3–4 times daily. (2) Cutaneous candidiasis: In addition to frequent diaper changes to maintain local cleanliness and dryness, apply nystatin cream (100,000 U/g), 2–4 times daily. (3) Treatment of visceral candidiasis: 1. Amphotericin B: The initial dose is 0.1 mg/(kg·d), gradually increasing daily to 1–1.5 mg/(kg·d). Dilute to 0.1 mg/ml in 10% glucose and administer by slow intravenous drip, preferably over 6 hours or slightly longer. When the dose reaches 1–1.5 mg/(kg·d), the frequency can be reduced from daily to every other day. The total treatment course is 1–3 months. Drug reactions such as fever, shivering, headache, nausea, and vomiting may occur during infusion, which can be managed symptomatically without discontinuing the medication. For severe reactions, the dose may be reduced, and hydrocortisone or dexamethasone can be added to the intravenous drip. Amphotericin B has certain toxicity to the kidneys, liver, and hematopoietic system. Blood and urine tests, as well as blood urea nitrogen, should be checked every 3–7 days during treatment, and liver function should be monitored weekly. Grade I renal impairment usually resolves after stopping the drug for 3–7 days. If significant damage to liver, kidney, or hematopoietic function occurs, discontinue the drug for 2–5 weeks and restart at a low dose after recovery. 2. Imidazoles: (1) Miconazole: Exhibits broad-spectrum antifungal and antibacterial activity. The dose is 20–40 mg/(kg·d), divided into 3 doses, diluted in 5% glucose for intravenous drip. The treatment course is 3–12 weeks. For intrathecal injection, administer 10–20 mg each time for 3–7 days. (2) Ketoconazole: Well absorbed in the gastrointestinal tract but does not penetrate the cerebrospinal fluid. The dose is 4–8 mg/(kg·d), administered orally, with a treatment course of 1–2 months. (3) Fluconazole: Widely distributed in various body fluids, well absorbed, and excreted in urine. The oral dose is 200–400 mg/d. 3. Allitridin: The adult dose is 60–120 mg (0.15% allitridin injection 40–80 ml) added to 500 ml of 5–10% glucose solution for intravenous drip once daily, starting at a low dose. The dose for children should be adjusted accordingly.