A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome

Article Abstract:

Candida albicans is a species of yeast which is present as a part of the normal intestinal flora. Under some conditions, this yeast can colonize the vagina, resulting in candida vaginitis. There has been much discussion of a syndrome which is believed to result from the development of hypersensitivity to C. albicans. The syndrome is thought to result when the use of oral contraceptives, the overuse of antibiotics, or other factors result in overgrowth of the yeast on mucosal surfaces. Those who believe this syndrome exists claim that this results in an allergic or toxic generalized response which can cause a variety of symptoms, including severe premenstrual tension, menstrual irregularity, bloating, heartburn, constipation, anxiety, depression, difficulty concentrating, and memory deficits. Since the drug nystatin is effective against Candida albicans, a study was undertaken to determine if nystatin ameliorates the symptoms of the supposed candidiasis hypersensitivity syndrome. Forty-two women received the following four treatments for eight weeks each: oral and vaginal nystatin; oral nystatin and vaginal placebo; oral placebo and vaginal nystatin; and oral placebo and vaginal placebo. As expected, the three treatment conditions containing nystatin were more effective than the all-placebo regimen for the reduction of symptoms of vaginal candidiasis. However, the symptoms of the candidiasis hypersensitivity syndrome were reduced by about the same amount by all the treatments. An average of 25 percent symptom reduction was seen in the three treatments that included nystatin in some form, and a reduction in symptoms of 23 percent was seen in the all-placebo treatment. All four treatments were also equally effective in reducing psychological symptoms and feelings of global distress. Thus the recommendation that nystatin be used for women with presumed candidiasis hypersensitivity syndrome appears to be unwarranted, because it had no greater effect than placebo. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Searching for the yeast connection

Article Abstract:

Chronic candidiasis syndrome has been the focus of much animosity between the medical community and people who believe they have this syndrome but feel that clinicians are not paying adequate attention to their complaints. Some believe that the overgrowth of a yeast, Candida albicans, can result in depression, lethargy, bloating, premenstrual pain and a host of other symptoms. But others within the medical community are unconvinced that such a syndrome even exists. This opinion is treated with disdain by support groups which have organized for the patients who assert that they have the syndrome. In the December 20, 1990 issue of The New England Journal of Medicine, investigators report the results of a careful study to determine if treatment with nystatin, and antifungal drug, reduces the symptoms reported for chronic candidiasis. They found that although the drug is effective against vaginal yeast infection (a much more specific condition than the broader chronic candidiasis syndrome), there was no significant difference between patients taking nystatin and those taking an inactive placebo in the symptoms of the syndrome. Thus a placebo had the same effect on reported symptoms as a drug that kills yeast; both led to a 25 percent reduction in the symptoms of chronic candidiasis. This study is not likely to alter the controversy, however, since most of the believers insist that dietary control is important, as is avoiding moldy places; the researchers failed to control such factors in their study. Further scientific research is necessary to determine if the chronic candidiasis syndrome actually exists, but meanwhile, the support groups will continue to meet and popular books on the subject, such as The Yeast Connection, will continue to sell. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Echinocandins for candidemia in adults without neutropenia

Article Abstract:

A case study of a 62-year-old man who has a bloodstream infection with a candida species other than Candida albicans is presented. The pathophysiology and clinical evidence of the therapy are provided, the treatment of such case of candidemia in adults without neutropenia with the echinocandin caspofungin is analyzed, along with reviewing the potential adverse effects, and treatment options and relevant formal guidelines for treatment are presented.

New England States, Health aspects, Care and treatment, Case studies, Echinocandins

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