Candida species can be cultured from the stool of many patients, but usually it is present at low levels. Following antibiotic therapy it may become a dominant organism. One theory is that it is mere overgrowth of an innocent bystander, while another is that its overgrowth is pathogenic.
Several Candida species have been implicated: albicans, krusei, tropicalis and others.
Clinical and laboratory features:
(1) The patient develops diarrhea, abdominal pain and cramping in association with antibiotic therapy.
(2) Examination of the stool shows overgrowth of a Candida species with large numbers of yeast forms in the Gram stain and/or a pure growth on culture.
(3) No other cause for the diarrhea is identified.
(4) Clinical improvement is associated with declining levels of Candida in the stool.
Additional findings supporting the diagnosis:
(1) The patient is immunosuppressed or immunodeficient.
(2) Certain populations (children, elderly, other) may be at increased risk.
(3) Therapy with antifungal agents and/or recolonization of the fecal flora controls the diarrhea.
Many patients with overgrowth of Candida in the stool following antibiotic therapy will improve following discontinuation of antibiotic therapy.
