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Probiotics and Candida Infections Introduction The yeast Candida albicans is present on or in most humans as a harmless commensal organism. Thousands of yeast cells can be present in an individual, mostly in the gastrointestinal tract, without any ill effect. However Candida albicans is also the major fungal pathogen of humans. Infections can be localised, occurring in areas such as the vagina or the mouth, both of which cause a considerable degree of discomfort. Candida albicans can spread from a local infection to one affecting almost any organ system. Candidiasis can be associated with or a predisposing factor for, a number of conditions including; chronic fatigue syndrome, arthritis, irritable bowel syndrome and allergies. Microflora During the natural birthing process, the babies gut becomes colonized by many bacteria common to that of their mother, as the bacteria are initially ingested from the vagina during delivery. In turn the vaginal microflora is typically colonised with normal fecal flora. Pathogens also colonise the vagina by ascending from the rectum and can then move to the bladder. This process is mediated by bacterial adherence but is not a hygiene issue. Indeed, the fact that the normal vaginal microflora also colonises from an intestinal origin, means that microbial ascension per se is a natural process that can actually help protect the host. Probiotic bacteria which are taken orally will colonise the vagina in the same way. A trial using Lactobacillus rhamnosus and Lactobacillus fermentum were recovered from the vaginas of women given the probiotic strains in a milk drink.(10) Candida Infections The vagina creates its own environment and maintains a balance among the normal bacteria found there and the hormonal changes in a woman’s body. Infections can occur when the vaginal ecosystem has been changed by certain medications such as antibiotics, hormones, oral contraceptives, spermicides, douches, vaginal medication and also by sexual intercourse, sexually transmitted diseases, stress and change in sexual partners. A study showed that the normal gut flora have a natural resistance to Candida albicans but this may be reduced when antibiotics are taken.(1) Many women suffer from recurrent yeast infections indicating that there must be a reservoir of Candida albicans. A trial concluded that the endometrium is not a common reservoir for Candida albicans.(3) However, there is a significant association shown between the presence of yeasts in the rectum and in the vagina.(5) A study discovered a correlation between the occurrence of Candida albicans in the gut and in the vagina, by swabbing both the rectum, and vaginas of healthy women. The rectum is therefore Protexin Health Care – Technical Notes Probiotics and Candida Infections June 2005 - This document supersedes all previous document Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE www.protexin.com 1 thought to be the reservoir for Candida infections and the cause of re-infection of the vagina.(8) Further work showed that the presence of yeast is higher in the lower bowel of women during a Candida infection than in those who do not have any symptoms.(4) Treatment of Candidiasis The most common treatment for vaginal yeast infections is an antifungal cream or pessary, which is applied directly to the area of infection. However although this may be effective in relieving symptoms and reducing the local infection, it will not affect the rate of relapse of Candida infections.(6) Results of a trial suggested that there is value in eliminating any intestinal reservoir of Candida when treating patients with vaginal Candidiasis.(7) A review of the literature concluded that due to the recurrent nature of Candida vaginitis a complete treatment would not be possible without removing Candida albicans from the gut.(9) Prevention by Probiotics Probiotic microbes not only suppress the growth of Candida in the alimentary tract and vagina, but they also inhibit the adherence of Candida to epithelial surfaces. The ability of probiotic bacteria to stimulate innate and acquired immune systems in the host and activate phagocytic cells is also thought to play a role in the inhibition of Candida. A study found that high doses of bifidobacterium have a value in increasing the patient resistance to infection by Candida albicans. (2) The inhibition of Candida by probiotic bacteria, in the alimentary and vaginal tracts, represents a key, first-line defense against mucosal and systemic candidiasis. Lactobacillus acidophilus is known to decrease both Candidal colonisation and infection, threefold in patients consuming this species.(11) In another study a probiotic containing Lactobacillus rhamnosus was found to be safe for daily use in healthy women, reducing colonisation of the vagina by potential pathogenic bacteria and yeast. (12) It is thought that although probiotics may not be able to cure yeast vaginitis, they are useful in addition to anti-fungal drugs and to reduce the risk of recurrence. The use of probiotics can help fortify natural resistance of the gut microflora to Candida albicans, particularly if antibiotics are used.(1) Protexin Health Care – Technical Notes Probiotics and Candida Infections June 2005 - This document supersedes all previous document Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE www.protexin.com 2 Conclusion In a normal healthy individual, overgrowth of Candida albicans is prevented by the commensal bacteria, found in the usual microflora. However, antibiotics have the ability to disrupt the bacterial populations within the gut. This can then lead to the overgrowth of undesirable microorganisms like Candida albicans. If probiotics are used in this situation then, although Candida albicans will not be completely eliminated, yeast counts will be reduced. Probiotics help to prevent and reduce candida infections of the vagina by: Increasing the number of probiotic and indigenous lactobacilli moving from the rectal skin to the vagina. Reducing the number of pathogens moving from the rectal skin to the vagina. Enhancing the intestinal mucosal immunity which, in turn affects vaginal immunity making the environment less receptive to pathogenic organisms. Reducing the pH of the vaginal tract, making it an unfavourable environment for yeast growth. Decreasing the number of yeast organisms within the gut, this acts as a reservoir for re-infection. It is thought that although probiotics may not be able to cure yeast vaginitis, they are useful in addition to anti-fungal drugs for the treatment of Candida infections. As a preventive they are safe for daily use and effective at decreasing yeast levels within the gut, reducing the risk of recurrence. Probiotics can therefore, help to maintain vaginal health, prevent candida infections and also reduce the risk bacterial vaginosis. Protexin Health Care – Technical Notes Probiotics and Candida Infections June 2005 - This document supersedes all previous document Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE www.protexin.com 3 References 1. Payne S, Gibson G, Wynne A, Hudspith B, Brostoff J, Tuohy K (2003). In vitro studies on colonization resistance of the human gut microbiota to Candida albicans and the effects of tetracycline and Lactobacillus plantarum LPK. Curr Issues Intest Microbiol. 4(1):1-8. 2. Lykova EA, Vorob'ev AA, Bokovoi AG, Pobedinskaia IN, Gevondian VS, Gevondian NM, Mitrokhin SD, Minaev VI, Dzis NB, Makkaveeva LF, Kovalev IV, Murashova AO, Bondarenko VM (2000). [Disruption of microbiocenosis of the large intestine and the immune and interferon status in children with bacterial complications of acute viral infections of the respiratory tract and their correction by high doses of bifidumbacterin forte] Antibiot Khimioter. 45(10):22-7. 3. Tasdemir M, Tasdemir I, Tasdemir S, Tavukcuoglu S (1997). Endometrium is not a reservoir for recurrent vaginal candidiasis. Clin Exp Obstet Gynecol. 24(2):112-3. 4. Fong IW. The rectal carriage of yeast in patients with vaginal candidiasis (1994). Clin Invest Med. 17(5):426-31. 5. Peer AK, Hoosen AA, Seedat MA, van den Ende J, Omar MA (1993). Vaginal yeast infections in diabetic women. S Afr Med J. 83(10):727-9. 6. Spinillo A, Carratta L, Pizzoli G, Lombardi G, Cavanna C, Michelone G, Guaschino S (1992). Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal reservoir. J Reprod Med. 37(4):343-7. 7. Nystatin Multicenter Study Group (1986). Therapy of candidal vaginitis: the effect of eliminating intestinal Candida. Am J Obstet Gynecol. 155(3):651-5. 8. Leegaard M (1984). The incidence of Candida albicans in the vagina of "healthy young women". How often do they have symptoms? Possible etiological factors. Acta Obstet Gynecol Scand. 63(1):85-9. 9. Miles MR, Olsen L, Rogers A (1977). Recurrent vaginal candidiasis. Importance of an intestinal reservoir. JAMA. 238(17):1836-7. 10. Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B (2001). Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol. 30(1):49-52. 11. Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT (1992). Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 116(5):353-7. 12. Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, Bruce AW (2003). Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol. 35(2):131-4. 13. Alderberth I (1999). Establishment of a normal intestinal microflora in the newborn infant. In: Hanson LA, ed. Probiotics, Other Nutritional Factors, and Intestinal Microflora . Philadelphia, PA: Lippincott-Raven; 63-78 Protexin Health Care – Technical Notes Probiotics and Candida Infections June 2005 - This document supersedes all previous document Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE www.protexin.com 4