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What Causes Candida Parapisilosis Infection?
Question: Hello,
I am being treated for an overgrowth of Candida Parapisilosis(no visable signs, but culture proven) in my mouth (burning tongue, metallic taste, and itching under tongue), throat/naso pharyex area (burning and itching), nasal passages (pressure, pain, itching) This is all due to long term use (5 years) of broad spectrum antibiotics for acne. I have had this for about a year and have been treating this with compounded topical Amphitericin B mostly successfully. 8 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea, pressure in my esophagus area and a gnawing feeling in my upper stomach. I stayed on this drug for 14 days and finally had to stop due to these side effects-the prescription was initially for 3 months. I fully expected my symptoms to subside but I am still having the same nausea and pressure in my esophagus and upper stomach pain 9 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No visable sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. No visual signs of fungi. A quick stain for esophageal fungal was also negative- however, each time I have tested positive (mouth, urinary tract, and vaginal-managed by boric acid suppositories) for this type of candida there have been no visual signs but a 4 week culture was positive. Unfortunately there was a miscommunication with the pathology dept and they didn't have an extra sample to do a culture. I am so miserable....only able to stomach rice noodles and small amounts of liquid and my symptoms never let up. I am 26 yrs old, very healthy and have never had any gastro issues in the past. My symptoms are not affected by any foods. My symptoms do not fluctuate. My diet for years has been eating 100% organic, no meat, dairy, eggs, or gluten. I eat preservative-free, and take a high quality probiotic daily. I have never had any gastro issues until taking Voraconazole. My GI doctor is baffled and has basically told me to get another opinion. I am hoping that you have had experience with Voriconazole and can help me. Can my current symptoms be a result of a candida overgrowth in my esophagus? Thanks!
Here are my lab results:
ALT-27
AST-19
Albumin Level-.3
Alk Phos-51
Bili Direct <0.10
Bili Total-0.20
Total Protein- 7.7
Tissue Tran Iga-1
IgA Total-106
Vitamin B-1309
Folate Serum-13.50
Waiting on Vit D but expect score to be within range as I supplement with this
I am being treated for an overgrowth of Candida Parapisilosis(no visable signs, but culture proven) in my mouth (burning tongue, metallic taste, and itching under tongue), throat/naso pharyex area (burning and itching), nasal passages (pressure, pain, itching) This is all due to long term use (5 years) of broad spectrum antibiotics for acne. I have had this for about a year and have been treating this with compounded topical Amphitericin B mostly successfully. 8 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea, pressure in my esophagus area and a gnawing feeling in my upper stomach. I stayed on this drug for 14 days and finally had to stop due to these side effects-the prescription was initially for 3 months. I fully expected my symptoms to subside but I am still having the same nausea and pressure in my esophagus and upper stomach pain 9 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No visable sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. No visual signs of fungi. A quick stain for esophageal fungal was also negative- however, each time I have tested positive (mouth, urinary tract, and vaginal-managed by boric acid suppositories) for this type of candida there have been no visual signs but a 4 week culture was positive. Unfortunately there was a miscommunication with the pathology dept and they didn't have an extra sample to do a culture. I am so miserable....only able to stomach rice noodles and small amounts of liquid and my symptoms never let up. I am 26 yrs old, very healthy and have never had any gastro issues in the past. My symptoms are not affected by any foods. My symptoms do not fluctuate. My diet for years has been eating 100% organic, no meat, dairy, eggs, or gluten. I eat preservative-free, and take a high quality probiotic daily. I have never had any gastro issues until taking Voraconazole. My GI doctor is baffled and has basically told me to get another opinion. I am hoping that you have had experience with Voriconazole and can help me. Can my current symptoms be a result of a candida overgrowth in my esophagus? Thanks!
Here are my lab results:
ALT-27
AST-19
Albumin Level-.3
Alk Phos-51
Bili Direct <0.10
Bili Total-0.20
Total Protein- 7.7
Tissue Tran Iga-1
IgA Total-106
Vitamin B-1309
Folate Serum-13.50
Waiting on Vit D but expect score to be within range as I supplement with this
Brief Answer:
Anti acidity, lactic acid bacillus spore can help cure the symptoms..
Detailed Answer:
Hello XXXX,
Thank you for asking direct query.
I read understand and answering your query.
The antifungal medication that you have taken previously e.g. amphotericin B and voriconazole have some side effects which includes gastrointestinal disturbances, nausea, vomiting, diarrhea etc.
With this much Drugs candida infection is usually washed out. If you receive to consecutive samples saying that is candida infection than we can think that you are having candida infection.
Some candida species can also be found as a commensal flora of mucus membrane. So isolation of this species cant confirm that it is pathogenic.
In my advice you can take the proton pump inhibitor like Pantoprazole along with the Levosulpride. This combination will decreases acidity and fastens stomach clearance and gives you good sleep.
As you are on long time broad spectrum antibiotics, you literally washed out the normal commensal flora of the intestine. You can take the lactic acid bacillus spore capsules. This can be helpful in replenishing the normal flora of intestine and help relieving gastrointestinal problem.
Please take all the medication under your doctors guidance.
Avoid spicy and foods that can cause acidity.
Small frequent diet would be preferable. Avoid single heavy food. This will complicate the digestion of the food. Walking for 15 to 20 minutes after a diet can be helpful in this gastrointestinal problem.
Though we haven't found any lesion in endoscopy which support this symptoms, it is presumably the very sub visual lesion that can causing it.
You can ask me for further clarification here.
Thank you,
Dr Arun Tank
Infectious Disease Specialist.
Anti acidity, lactic acid bacillus spore can help cure the symptoms..
Detailed Answer:
Hello XXXX,
Thank you for asking direct query.
I read understand and answering your query.
The antifungal medication that you have taken previously e.g. amphotericin B and voriconazole have some side effects which includes gastrointestinal disturbances, nausea, vomiting, diarrhea etc.
With this much Drugs candida infection is usually washed out. If you receive to consecutive samples saying that is candida infection than we can think that you are having candida infection.
Some candida species can also be found as a commensal flora of mucus membrane. So isolation of this species cant confirm that it is pathogenic.
In my advice you can take the proton pump inhibitor like Pantoprazole along with the Levosulpride. This combination will decreases acidity and fastens stomach clearance and gives you good sleep.
As you are on long time broad spectrum antibiotics, you literally washed out the normal commensal flora of the intestine. You can take the lactic acid bacillus spore capsules. This can be helpful in replenishing the normal flora of intestine and help relieving gastrointestinal problem.
Please take all the medication under your doctors guidance.
Avoid spicy and foods that can cause acidity.
Small frequent diet would be preferable. Avoid single heavy food. This will complicate the digestion of the food. Walking for 15 to 20 minutes after a diet can be helpful in this gastrointestinal problem.
Though we haven't found any lesion in endoscopy which support this symptoms, it is presumably the very sub visual lesion that can causing it.
You can ask me for further clarification here.
Thank you,
Dr Arun Tank
Infectious Disease Specialist.
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thank you very much for your thoughtful and thorough answer.
Regarding candida infection: I have had a positive culture on 3 occassions.
Urinary- treated successfully with diflucan
Vaginally- treated with difulcan unsuccessfully, then boric acid suppositories successfully, but will return on occasion but will relieve with the suppositories
Oral - treated with Amphotericin B troches and nasal spray which will get rid of all symptoms, but will return if I stop the treatment.
Is it possible that now I am having symptomatic candida in my esophagus causing nausea and chest discomfort? Could 2 weeks of the Voriconazole been a catalyst to this? I have been off of this drug for 8 weeks and still having this problem. My symptoms remain constant, never fluctuating and are not affected by foods in any way. I have now been given a liquid suspension of the Amphotericin B in hopes of treating my esophagus and stomach. Is this a reasonable approach and if so, how long should it take to expect to feel results?
If it is a non visual sub lesion, can this happen with such a short time, only 2 weeks, on Vorconizole?
I am very concerned about taking a PPI as I have never had any gastro problems and again, my symptoms don't fluctuate as I would think an acid problem may respond. Am I correct in this thinking? Up until this point I have concerns that I s
may have side effects that will create more problems. Since prescriptions medications have caused these problems, I was wondering if you have suggestions of a more natural approach to relieving and curing my esophageal pressure and nausea?
If I do have a sub visual lesion, will this go away over time with a bland diet and probiotics? I am on week 9 of this approach and am very discourages, but willing to continue if relief may be in sight and if I can avoid more drugs. I do not eat spicy or acidic foods even before this happened.
With regard to the candida, I feel like I am on a viscious cycle that I can't get under control. Since I started treating my sinus symptoms last December, I have developed eye symptoms that are relieved with a boric acid wash 3 x a day. All of these symptoms in my mouth, throat, nasal passages and eyes are all the same...itching and burning... and are all relieved to the point of completely going away with anti fungal treatment only to return when I am off of the treatment. I even have this itching in my esophagus area. If I can't take a systemic medication I feel like I will never get over this and I even though I am hesitant to take Voriconazole again my infectious disease specialist will not prescribe it now since I have had the gastro problem even though it was his original recommendation. He is willing to continue the Amphotericin B but nothing else. I live in an area of very limited choices for out of the ordinary health care.
Thank you very much for your time and advice.
Regarding candida infection: I have had a positive culture on 3 occassions.
Urinary- treated successfully with diflucan
Vaginally- treated with difulcan unsuccessfully, then boric acid suppositories successfully, but will return on occasion but will relieve with the suppositories
Oral - treated with Amphotericin B troches and nasal spray which will get rid of all symptoms, but will return if I stop the treatment.
Is it possible that now I am having symptomatic candida in my esophagus causing nausea and chest discomfort? Could 2 weeks of the Voriconazole been a catalyst to this? I have been off of this drug for 8 weeks and still having this problem. My symptoms remain constant, never fluctuating and are not affected by foods in any way. I have now been given a liquid suspension of the Amphotericin B in hopes of treating my esophagus and stomach. Is this a reasonable approach and if so, how long should it take to expect to feel results?
If it is a non visual sub lesion, can this happen with such a short time, only 2 weeks, on Vorconizole?
I am very concerned about taking a PPI as I have never had any gastro problems and again, my symptoms don't fluctuate as I would think an acid problem may respond. Am I correct in this thinking? Up until this point I have concerns that I s
may have side effects that will create more problems. Since prescriptions medications have caused these problems, I was wondering if you have suggestions of a more natural approach to relieving and curing my esophageal pressure and nausea?
If I do have a sub visual lesion, will this go away over time with a bland diet and probiotics? I am on week 9 of this approach and am very discourages, but willing to continue if relief may be in sight and if I can avoid more drugs. I do not eat spicy or acidic foods even before this happened.
With regard to the candida, I feel like I am on a viscious cycle that I can't get under control. Since I started treating my sinus symptoms last December, I have developed eye symptoms that are relieved with a boric acid wash 3 x a day. All of these symptoms in my mouth, throat, nasal passages and eyes are all the same...itching and burning... and are all relieved to the point of completely going away with anti fungal treatment only to return when I am off of the treatment. I even have this itching in my esophagus area. If I can't take a systemic medication I feel like I will never get over this and I even though I am hesitant to take Voriconazole again my infectious disease specialist will not prescribe it now since I have had the gastro problem even though it was his original recommendation. He is willing to continue the Amphotericin B but nothing else. I live in an area of very limited choices for out of the ordinary health care.
Thank you very much for your time and advice.
Brief Answer:
specific answers are below
Detailed Answer:
Hello dear thank you for asking query.
Please find your answer below in point wise manner.
1. From the above description it is clear that you have recurrent candida infection. Such infection can only occurs in immunocompromise state, HIV, diabetes or prolong broad spectrum antibiotics. You mentioned that you have taken the prolong antibiotics for the sinus infections so this infection may arise from this treatment.
2. Yes it is possible that you have esophagus infection by candida and causing you a chest discomfort. Voriconazole is the antifungal agent and can be used to cure the infection so it will not catalyse the fungal infection.
3. Swab from the respiratory tract via endoscopy can be helpful to diagnose fungal infection. If this swab says it as a candida infection than liquid amphotericin can be helpful. Amphotericin B drug is itself very toxic drug and can cause many of the side effects including some you have mentioned.
4. PPI can help relieve your gastro problem so you should take it under your doctors guidance. Washed out normal flora can be replenished by probiotics. This also helps cure fungal infections.
5. Yes you can naturally relieve the problem with small frequent diet, bland and non spicy food, avoidance of bulky food and walking for a while after meal, eating curd can help cure your problem.
6. Drug induced lesion will not go on with conservative therapy, you need both conservative and drug therapy to cure this problem. Combine approach can only cure this problem rapidly.
8. Both the drug voriconazole and amphotericin B have some side effects. Each should be used according to the patient profile. So you can take it as per the doctors guidance.
9. You can do sensitivity testing from the sample, once the treatment started according to the report it will be cured soon.
You can ask me for further clarification.
Thank you
Dr Arun Tank
Infectious disease specialist.
specific answers are below
Detailed Answer:
Hello dear thank you for asking query.
Please find your answer below in point wise manner.
1. From the above description it is clear that you have recurrent candida infection. Such infection can only occurs in immunocompromise state, HIV, diabetes or prolong broad spectrum antibiotics. You mentioned that you have taken the prolong antibiotics for the sinus infections so this infection may arise from this treatment.
2. Yes it is possible that you have esophagus infection by candida and causing you a chest discomfort. Voriconazole is the antifungal agent and can be used to cure the infection so it will not catalyse the fungal infection.
3. Swab from the respiratory tract via endoscopy can be helpful to diagnose fungal infection. If this swab says it as a candida infection than liquid amphotericin can be helpful. Amphotericin B drug is itself very toxic drug and can cause many of the side effects including some you have mentioned.
4. PPI can help relieve your gastro problem so you should take it under your doctors guidance. Washed out normal flora can be replenished by probiotics. This also helps cure fungal infections.
5. Yes you can naturally relieve the problem with small frequent diet, bland and non spicy food, avoidance of bulky food and walking for a while after meal, eating curd can help cure your problem.
6. Drug induced lesion will not go on with conservative therapy, you need both conservative and drug therapy to cure this problem. Combine approach can only cure this problem rapidly.
8. Both the drug voriconazole and amphotericin B have some side effects. Each should be used according to the patient profile. So you can take it as per the doctors guidance.
9. You can do sensitivity testing from the sample, once the treatment started according to the report it will be cured soon.
You can ask me for further clarification.
Thank you
Dr Arun Tank
Infectious disease specialist.
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Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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