Marco For Micro - Candida Albicans

Microbe Candida albicans

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Dimorphic fungi but only presents as hyphae in the body Normal part of flora in the oral cavity, GIT, rectum and vagina It helps to keep balanced flora ecology and only disease only occurs when the body immune system is compromised ex. HIV/AIDS, traumas, broad spectrum Abs, dietary imbalances (simple carbohydrates, vitamin deficiencies), endocrine changes and pH changes because these can disrupt the normal bacterial ecology in the body Also associated with defective T cell immunity Not contagious

Lab. Tests

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Microscopy: tissue scrapings treated with 10% KOH, allows to see budding yeast cells, septate hyphae Culture: ex. Stool, to confirm positive microscopy and grown on a sobourad agar to show opaque and cream coloured colonies Germ Tube Test: this test is unique to the Candida spp. And they will form blastospores when suspended in serum and incubated at 37C for 2-3 hrs. Serology: a high titre of fungal glycoprotein Abs in recent or active infection or Candida specific mannas

Disease Vulvovaginitis- an opportunistic infection  Common female disease  Due to a change in vaginal flora or an STD  Much less common in men Oral Candida Infection  Opportunistic infection more common in immunocompromised individuals, diabetics, overuse of antibiotics. This infection is a RED FLAG for AIDS if the patient is not on corticosteroids or broadspectrum antibiotic use. Chronic mucocuntaneous candidiasis (CMC)  Heterogenous group of treatment resistant superficial Candida infection of the skin, nails and oropharynx  Organs are not involvement  Underlying T cell impairment may play a role Disseminated candidiasis:  Fairly rare  Candida that has spread to many other organs, such as the eye, heart (endocarditis), and kidney.  Must be immunocompromised

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S’s & Sx’s of disease Vulvovaginitis  Erythema  Inflammation of the vagina and vulva  Thick white or curd like discharge (Often described as cottage cheese like)  Intense pruritis  Vaginal irritation  There may be vaginal burning  Dysuria  Dyspaerunia Oral Candida Infection  Focal white patches on oral mucosa, palate and tongue  Bleed when scraped off  Can spread to esophagus Chronic mucocuntaneous candidiasis (CMC)  Symptoms are similar to oral candidiasis and candidal onychomycosis.  Hyperkeratosis and cuntaneous horn formation that usually affects both hands.  Endocrine dysfunctions can manifest any time during the life (Doctor Fungus. (2007). Chronic Mucocutaneous Candidiasis. Retrieved on February 14th, 2007 from the World Wide Web: www.doctorfungus.org) Disseminated candidiasis:  Severe neutropenia

Virulence Factors Because it is an opportunistic infection there are no specific virulence factors for causing disease. Usually the fungus lives commensally in our body and it is only when the immune state is compromised and there is a change in the vaginal flora does this organism over grow and cause disease.

 VULVOVAGINITIS Naturopathic Intervention modality

Support for/Mechanism of Action

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Lots of conjuctivitis

Reference

Nutrition

Supplements 1. Digestive Enzymes 2. Origanum vulgare (Oregano oil) Dietary Modifications 1. Candida Diet 2. Labtobacillus acidophilus

Supplements 1. Digestive Enzymes Increasing digestive secretions such as gastric hydrochloric acid, bile and pancreatic enzymes may help to stop the overgrowth of candida, and stop its passage into the small intestine. Therefore, supplementation with digestive enzymes may help to prevent the overgrowth of candida, by decreasing candida growth in the body. This helps prevent chronic systemic candidiasis and also local overgrowth, such as in the vagina and mouth (Murray & Pizzorno, 1998).

Hilton, E., Isenberg, H.D., Alperstein, P., France, K., Borenstein, M.T. (1992). Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Annual of Internal Medicine, 116(5): pp. 353-357.

2. Origanum vulgare (Oregano oil)

Murray, M., & Pizzorno, J. (1998). Encyclopedia of Natural Medicine, 2nd ed. Prima Publishing: Rocklin, CA.

500 mg bid of oregano oil has potent antifungal effects and is a very important part of treatment for women with chronic vaginitis due to candida (Stengler & Balch, 2004). Dietary Modifications 1. Candida Diet This diet involves the complete elimination of sugar from the diet, because yeast thrives on sugar, and sugar also depresses the immune system. Therefore, by eliminating sugar, the yeast cannot grow and the immune system is strengthened. This includes all forms of sugar from the highly processed granular and brown sugars to more natural sugars such a pure honey or maple syrup. In addition, foods that contain naturally high amounts of sugar should also be excluded (ex. Fruit, all alcohol, products containing fermented yeast). Moreover, mold and yeast containing foods should also be avoided. Some of these include: vinegar made from yeast culture, mushrooms, peanuts, cheese, pickled or smoked meats, and fermented drinks such as cider, root beer, coffee, and black tea (including decaffeinated drinks) (Rollins, 2007; Stengler & Balch, 2004; Murray & Pizzorno, 1998). Milk may also be a food sensitivity that leads to candida overgrowth, has a high lactose content and should be removed from the diet to determine its role in the development of vulvovaginitis (Stengler & Balch, 2001). Also, milk contains trace amount of antibiotics, which disrupt the vaginal flora further and

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Hudson, T. (1999). Women’s Encyclopedia of Natural Medicine. Keats Publishing: Los Angeles, CA.

Rollins, Gray. (2007). The Candida Yeast Diet. Retrieved on February 18, 2007 from the World Wide Web: http://www.changingshape.com/resourc es/articles/candida-diet.as Stengler, M, & Balch, J. (2001). The Natural Physicians Healing Therapies. Prentice Hall Press: Paramus, NJ. Stengler, M, & Balch, J. (2004). Prescription for Natural Cures. John Wiley & Sons: Hoboken, NJ.

allow for the overgrowth of yeast (Murray & Pizzorno, 1998). 1. Lactobacillus acidophilus There are many strains of Lactobacillus that help to slow the development of Candida albicans, a major cause of vulvovaginitis. Research has shown that ingestion of yogurt containing active Lactobacillus helps clear up current vulvovaginitis and helps prevent future infections from occurring. The normal urogenital microflora is mainly dominated by Lactobacillus. It helps to prevent the development of pathogenic bacteria, by maintaining an acidic environment and by releasing hydrogen peroxide. Furthermore, L. acidophilus has been shown to help prevent bacterial adherence in the vagina. A yearlong crossover trial compared yogurt eating to non-yogurt eating patients and found a threefold decrease in vulvovaginitis in patients who consumed yogurt containing active L. acidophilus (Hilton et al., 1992; Hudson, 1999). It plays an important role in maintaining a strong local immune system in the vagina, by preventing the growth of opportunistic pathogens and yeast. Women should eat a cup (8 ounces) of unsweetened live yogurt containing L. acidophilus and other beneficial bacteria (Stengler & Balch, 2004). Botanical Medicine

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Allium sativum (Garlic)

1. Allicin Allicin, a disulfide-containing constituent present in Allium sativum, exhibits antimycotic properties by oxidizing thiol groups of essential enzymes such as: alcohol dehydrogenase (nutrient digestion), cysteine proteinase (tissue invasion), thioredoxin reductase, and RNA polymerase. Specifically, Allicin inhibits succinate dehydrogenase activity in Candida albicans, thereby reducing the microorganism’s oxygen uptake by 70%, resulting in subsequent inhibition of microbial growth and respiration. Allium sativum impairs biosynthesis of proteins and nucleic acids, and completely inhibits lipid biosynthesis by chemically reacting with sulfhydryl compounds, such as glutathione. Thus, depleted stores of glutathione promote peroxidation of cellular lipids. This affects the

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Adetumbi et al. (1986) Allium sativum (Garlic) Inhibits Lipid Synthesis by Candida albicans. Antimicrobial Agents and Chemotherapy 30(3):499-501. Ghannoum, M.A. (1988) Studies on the anticandidal mode of action of Allium sativum (Garlic). J Gen Microbiol. 134(11): 2917-2924. Koch, H.P. and Lawson, L.D. (1996) Garlic: The Science and Therapeutic Application of Allium sativum L. and Related Species. Williams & Wilkins: Baltimore, USA. p. 168-172.

permeability and adherence of the membrane and consequently undermines the viability of the cell. 2.

Homeopathy

Melaleuca alternifolia (Tea Tree)

Borax  Leukorrhea that looks like the white of eggs and has the sensation of warm water flowing down.  Used specifically for oral thrush – this is apparently one of the biggest remedies used for thrush in children.  Used for white fungus like growth. (Murphy, 2000) Calcarea carbonica (Calc carb)  Burning vaginal itching with a thick yellow or white discharge due to a yeast infection.  Symptoms better in the morning and when slightly constipated.  Symptoms worse before and after menstruation, from applying heat to the vulva, during pregnancy, in cold damp and windy weather, and from physical or mental exertion. (Lockie, 2000)  Indicated in itching and burning of the genitals.  Used for thick, milky and gushing or yellow leukorrhea that is worse during urination.  Leukorrhea with itching and burning. (Murphy, 2000) Sulfur

2. Melaleuca alternifolia Specific constituents of Melaleuca alternifolia, terpinen-4-ol, 1,8-cineole, α-terpinene, and terpinolene induce alterations in the cell permeability of Candida albicans by inserting between the fatty acyl chains that make up the membrane lipid bilayer, disrupting lipid packaging, and impairing ATPase functioning. Such alterations increase membrane permeability and fluidity, and impair cell homeostasis. Rubrics 1. Female Genitalia/Sex – Leukorrhea – cream-like. 2. Female Genitalia/Sex – Leukorrhea – itching. 3. Mouth – thrush (Borx). 4. Skin – Eruptions – discharging (=moist) – white. 5. Female – Genitalia/sex – Leukorrhea – white. 6. Generals – Food and drinks – sugar – desires. 7. Female Genitalia/Sex – Leukorrhea – offensive – yeast-like. (von Fimmelsberg & Kunzli, 1987; Schroyens, 2004) There are not any rubrics that are specific for a vaginal yeast infection, and oral thrush is the closet thing in the repertory specific to a candida albicans infection. Other remedies that have been indicated for vaginal discharge that resembles a vaginal yeast infection: Sepia, Mercurius solubilis, Pulsatilla (Lockie, 2000 & Murphy, 2000).

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Lemar et al. (2005) Allyl alcohol and garlic (Allium sativum) extract produce oxidative stress in Candida albicans. Microbiology 151:3257-3265. Hammer et al. (2004) Antifungal effects of Melaleuca alternifolia (tea tree) oil and its components on Candida albicans, Candida glabrata and Saccharomyces cerevisiae. Journal of Antimicrobial Chemotherapy 53:1081-1085. Lockie, Andrew. Natural Health: Encyclopedia of Homeopathy (2000). Dorling Kindersley Limited, New York, NY. (P.85, 200, 260-261.) Murphy, Robin. (2000). Homeopathic Remedy Guide. H.A.N.A. Press, Virginia. Von Fimmelsberg, Jost Kunzli (1987). Kent’s Repertorium General. B Jain Publishers (P) Ltd. New Delhi, India. Schroyens, Frederik (ed.). (2004). Synthesis: Repertorium Homeopathicum Syntheticum Edition 9.1. Homeopathic Book Publishers. London, England.

Itching in the rectum and around the anus.  Offensive-smelling yellow or white vaginal discharge caused by candida.  Symptoms better in fresh air, with dry warmth, from walking.  Symptoms worse from prolonged standing, from wearing too much clothing, in cold and damp, from washing, from being too warm in bed. (Lockie, 2000)  Indicated for leukorrhea that is yellow and mucous like with burning and excoriating. (Murphy, 2000) To eliminate damp and strengthen Spleen Liver 8  Resolves Damp Heat from the Lower Burner  Benefits the genitals  Nourishes blood and Yin Treatment for: vaginitis, dysuria, genital itching, genital pain 

TAM

Damp heat in the lower burner. Spleen Qi deficiency White discharge, large amount, and thick, sticky, no odor. Kidney yin deficiency Vagina may be pink-red with white and thick discharge, and dry burning around vagina.

Spleen 6  Regulates the Spleen and Stomach  Drains Damp  Regulates the Lower Burner  Benefits the Genitals  Tonifies the Kidneys Treatment for: dysuria, genital pain, leukorrhea, reproductive system disorders, and urinary dysfunction.

AcuXO. Liver, Spleen, Conception Vessel. Retrieved from the world wide web on February 17, 2007 from http://www.acuxo.com/index.asp Dai Xia Bing – Vaginal Discharge (leukorrhea). Retrieved from the world wide web on February 17, 2007 from http://tcm.healthinfo.org/gynecology/gynecologyleukorrhea.htm Ross. Jeremy. (1995) Acupuncture point combinations: the key to clinical success. New York. Pg. 406.

Conception Vessel 3  Resolves damp heat  Regulates the lower burner  Stops leukorrhea  Transforms stagnation  Tonifies the kidneys Treatment for: vaginal pain, vaginitis, genital itching, leukorrhea, dysuria

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Hydrotherapy or Counseling or Physical Medicine

Douching Keep the bag below the pelvis and exert only slight pressure because strong pressure can drive to solution through the cervix and into the uterus and this can extend the infection. (Do-it-yourself remedies, 2004; Christina’s Body and Fitness, 2007). Suppositories This is the insertion of something up the vaginal wall, which can help to kill any pathogenic organisms found there.

Douches 1. H2O2 is a natural product produced by the bacteria in vagina and kills yeast, and can be therefore be used as a douche. Mix 1tsp of ordinary 3% H2O2 with once cup of water. Douche once a day until the symptoms have cleared (Do-it-yourself remedies, 2004). 2. To restore the natural pH of the vagina use an acidic douche. Use 2 tbsp of cider vinegar or juice from ½ a lemon and 1 tsp vitamin C in a quart of water. This will acidify the vaginal environment and yeast cannot be sustained (Do-it-yourself remedies, 2004; Christina’s Body and Fitness, 2007).

Christina’s Body and Fitness. (2007). Health Journal: Fighting Yeast Infections. Retrieved from the world wide web on February 16, 2007 from http://www.bodyandfitness.com/Inform ation/Womenhealth/yeast.htm.

Suppositories 1. Garlic has many anti-microbial effects and can be used as a suppository. Carefully peel a clove of garlic, wrap it in gauze and insert it into the vagina where it can be left of up to 12hrs. This can be repeated as necessary (Feminist Women’s Health Center, 2007) 2. Yogurt suppository. Dip a tampon in unpasteurized plain yogurt and insert it into the vagina 1-2x a day until the symptoms are cleared. A moist tampon can also be covered with acidophilus and inserted into the vagina (Home remedies, 2007; Feminist Women’s Health Center, 2007).

Home Remedies (2007). Yeast Infections. Retrieved from the world wide web on February 16, 2007 from http://www.home-remedies-foryou.com/remedy/Yeast-Infection.html.

Feminist Women’s Health Center. (2007). Infections and Insurrections: Women Treating Yeast Infections. Retreived from the world wide web on February 16, 2007 from http://www.fwhc.org/health/yeast.htm

Do-it-yourself remedies. (2004). The Yeast Infection Homepage. Retrieved from the world wide wed on February 16. 2007 from http://www.msu.edu/~eisthen/yeast/you rself.html

References for the Candida Chart. Doctor Fungus. (2007). Chronic Mucocutaneous Candidiasis. Retrieved on February 14th, 2007 from the World Wide Web: www.doctorfungus.org)

Lescheid, D. (2007). Candida Albicans. CCNM Microbiology Class. Toronto, Ontario.

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