WEBVTT - Ep 188 Candida yeast: Here, there, and everywhere 0:00:00.120 --> 0:00:02.560 Let me take you back to when I was a weird, 0:00:02.800 --> 0:00:06.760 nerdy fourteen year old. I'd recently started menstruating and was 0:00:06.840 --> 0:00:11.080 incredibly self conscious about managing my periods At school. The 0:00:11.119 --> 0:00:14.040 popular girls would congregate in the school bathroom, so they'd 0:00:14.040 --> 0:00:16.480 hear the unzipping of my bag and the crinkle as 0:00:16.520 --> 0:00:20.520 they unwrapped sanitary products from their packaging. I was terrified 0:00:20.560 --> 0:00:22.800 about what gossip would be sped around school if people 0:00:22.880 --> 0:00:26.200 found out that time was on my period. I made 0:00:26.280 --> 0:00:30.040 the decision to avoid changing my sanitary products at school. 0:00:30.640 --> 0:00:35.360 This created a lovely, warm, moist environment for yeast, so 0:00:35.440 --> 0:00:38.320 it's no surprise that I got a yeast infection or thresh. 0:00:39.080 --> 0:00:41.279 If you have not had the pleasure, it's like an 0:00:41.280 --> 0:00:46.040 infected horsefly bite. It's an incessant itch that is constantly 0:00:46.159 --> 0:00:50.480 screaming for attention. I couldn't sleep, It hurt to pee, 0:00:50.760 --> 0:00:53.680 I couldn't concentrate on anything except for the pain of 0:00:53.720 --> 0:00:58.440 the itch. This coped with being a teenager with hormones 0:00:58.560 --> 0:01:02.560 coursing through my body. The shame and self loathing of 0:01:02.600 --> 0:01:08.040 my poor decision made this a really distressing time. To 0:01:08.080 --> 0:01:10.880 add to my humiliation, I had to tell my GP 0:01:11.120 --> 0:01:14.560 about my symptoms, but I lacked the polite vernacular to 0:01:14.600 --> 0:01:17.839 do so. I eventually stammered that I had an itch 0:01:17.959 --> 0:01:21.000 at the front of my bum, and the GP took 0:01:21.040 --> 0:01:23.560 pity on me and my mum was able to take 0:01:23.600 --> 0:01:27.720 over the consultation. I was asked no further questions and 0:01:27.760 --> 0:01:31.360 no invasive tests were performed. I was given a prescription 0:01:31.520 --> 0:01:34.280 for Caniston, and this was the first time I had 0:01:34.280 --> 0:01:37.240 ever used a pessary and had no idea whether I 0:01:37.280 --> 0:01:41.080 was in certy in correctly. However, I recovered and became 0:01:41.200 --> 0:01:44.959 scrupulous about my vaginal health and changed my sensory products 0:01:45.000 --> 0:01:50.040 at least every four hours, as recommended. Fast forward abound 0:01:50.120 --> 0:01:52.880 ten years. I'm in a sexual relationship and I get 0:01:53.200 --> 0:01:57.520 the itch. I assume it's thrush and get Caniston over 0:01:57.520 --> 0:02:00.720 the counter at the pharmacy and carry. 0:02:00.440 --> 0:02:02.000 On with my day. 0:02:02.120 --> 0:02:04.520 The thrush clears up for a while, but then it 0:02:04.560 --> 0:02:07.600 comes back, so I called the GP and they tell 0:02:07.640 --> 0:02:10.200 me to go to the sexual health clinic. To do this, 0:02:10.440 --> 0:02:13.080 I have to take annual leave to travel there in 0:02:13.120 --> 0:02:17.200 the opening hours. Even then, the only accommodated walkins, so 0:02:17.400 --> 0:02:20.080 I may not have been seen. If these barriers were 0:02:20.120 --> 0:02:23.560 not enough. I was also extremely embarrassed with dou whole 0:02:23.639 --> 0:02:27.000 idea of going to a sexual health clinic. Eventually, I 0:02:27.000 --> 0:02:29.200 saw a GP who gave me a swap and confirmed 0:02:29.240 --> 0:02:32.800 I did have recurrent thrush. My partner at the time 0:02:33.400 --> 0:02:36.240 laughed and told me that thrush was no big deal, 0:02:36.680 --> 0:02:38.880 which is probably because he. 0:02:38.800 --> 0:02:39.600 Couldn't catch it. 0:02:40.880 --> 0:02:43.720 Because my thrush was recurrent, the GP gave me a 0:02:43.720 --> 0:02:47.160 blood test for diabetes, which came back negative. There was 0:02:47.200 --> 0:02:50.960 no obvious cause, so I fell through the cracks a 0:02:50.960 --> 0:02:51.359 little bit. 0:02:52.960 --> 0:02:55.560 The GP had never asked about my environment. 0:02:56.120 --> 0:02:58.120 If they had, we probably would have figured out the 0:02:58.160 --> 0:03:02.360 cause pretty quickly. In the office, my desk was positioned 0:03:02.400 --> 0:03:05.919 directly underneath the air con and I really feel the cold, 0:03:06.160 --> 0:03:09.680 so the office administrator had very kindly given me a 0:03:09.720 --> 0:03:13.120 little heater to put underneath my desk. I like to 0:03:13.120 --> 0:03:17.080 have it snuggle between my knees, which created a really 0:03:17.200 --> 0:03:19.760 lovely warm environment for myself. 0:03:19.720 --> 0:03:24.480 And also for the east. At the time, I didn't 0:03:24.520 --> 0:03:25.480 put two and ty together. 0:03:26.040 --> 0:03:29.680 I just carried on in discomfort for the next few months, 0:03:30.440 --> 0:03:34.440 with the added expense of Caniston on my regular shopping list. 0:03:34.840 --> 0:03:38.120 There were other knock on effects My sleep suffered, my 0:03:38.320 --> 0:03:42.600 relationship suffered. My partner at the time really struggled with 0:03:42.680 --> 0:03:47.080 the reduction of intimacy. So on the night when saying 0:03:47.160 --> 0:03:50.440 no wasn't worth the drama, I would scrab my legs, 0:03:50.520 --> 0:03:53.600 close my eyes and think of England as the saying goes. 0:03:54.600 --> 0:03:56.560 For those who haven't had the pleasure, it feels like 0:03:56.640 --> 0:04:00.880 having sandpaper shoved inside that whole spy bite described earlier. 0:04:01.840 --> 0:04:04.920 Several years later, I'm happily single, I work from home 0:04:05.000 --> 0:04:08.320 and can control my environment, and I am thrush free. 0:04:09.600 --> 0:04:13.720 I found thrush to be extremely isolating, and I hope 0:04:13.720 --> 0:04:15.960 that if anyone can relate to my story that they 0:04:16.000 --> 0:04:19.440 find comfort that they are not alone. Thank you very 0:04:19.480 --> 0:04:20.280 much for listening. 0:05:06.720 --> 0:05:12.479 You know, I feel like that story really, it like 0:05:12.600 --> 0:05:17.599 exemplifies some of the shame that's surrounding things like yeast infections. Yeah. 0:05:17.800 --> 0:05:19.800 Yeah, I feel like no one wants to talk about 0:05:19.839 --> 0:05:21.320 east infections, right. 0:05:21.560 --> 0:05:23.599 And I know that's so common. I'm gonna say, like 0:05:23.680 --> 0:05:26.720 literally every person with a vaginant with vagina has had 0:05:26.760 --> 0:05:27.440 a yeast infection. 0:05:27.600 --> 0:05:30.560 Seventy five percent actually almost every time. That is pretty 0:05:30.600 --> 0:05:31.599 much close to everyone. 0:05:31.839 --> 0:05:36.440 Yeah, yeah, yeah, Thank you so much for sharing your 0:05:36.440 --> 0:05:38.320 story with us and everyone listening. 0:05:38.400 --> 0:05:41.039 We really appreciate it. Yeah, thank you, thank you. 0:05:41.880 --> 0:05:45.240 Hi. I'm Aaron Welsh and I'm Aaron on An Updike and. 0:05:45.279 --> 0:05:47.240 This is this podcast will kill you. 0:05:47.440 --> 0:05:51.080 Welcome to yeast infections. 0:05:50.400 --> 0:05:51.960 And I mean east infections. 0:05:52.000 --> 0:05:52.599 It is broader. 0:05:53.080 --> 0:05:55.640 Yeah, well I feel like but it's all yeast or 0:05:55.760 --> 0:06:01.640 yeast like and so it's weird. Yeah yeah, and not 0:06:01.680 --> 0:06:06.200 just Canada ALBACNS Canada Orris Canada. Those are the only 0:06:06.200 --> 0:06:08.839 two I know right now. It's a point in our conversation. 0:06:11.839 --> 0:06:13.200 I can't believe we haven't done this. 0:06:13.839 --> 0:06:19.360 I can is simply too long. That's good, it was. 0:06:22.320 --> 0:06:27.400 Our list is long. And you know we're doing it now. 0:06:27.480 --> 0:06:28.880 That's all we can say. We're doing it now. 0:06:28.960 --> 0:06:31.159 I learned a lot, we're about to learn some more, 0:06:32.080 --> 0:06:34.760 and we're about to tell you about. 0:06:34.480 --> 0:06:39.640 A recipe for our quarantquarantine or please super rita today. 0:06:39.440 --> 0:06:41.720 Super rita. Yeah, actually this you can make it a 0:06:41.800 --> 0:06:42.680 quarantine if you want. 0:06:42.839 --> 0:06:43.239 Sure. 0:06:43.839 --> 0:06:47.200 It's called a cant Yeah. 0:06:47.360 --> 0:06:49.440 The candid shot or just a candid shot. 0:06:49.720 --> 0:06:51.919 Well, the only reason I was thinking a candid shot 0:06:51.960 --> 0:06:54.479 is because candid duh. And then what happens to that 0:06:54.560 --> 0:06:57.239 a we just move it over. But the candid shot. 0:06:57.400 --> 0:06:59.080 In your grammar I like it. 0:06:59.200 --> 0:07:03.800 I mean than a candid shot is fairly simple. It 0:07:03.920 --> 0:07:06.400 is like rose soda and rhubarb. 0:07:07.480 --> 0:07:09.080 I was gonna say, like, you just stand there and 0:07:09.120 --> 0:07:10.160 someone takes your pictures. 0:07:10.200 --> 0:07:13.000 Sorry, that wouldn't be candid. No, you're right. 0:07:16.080 --> 0:07:19.800 Any Ways, you can find them very complicated recipe for that, 0:07:19.880 --> 0:07:22.360 plus e Brita and if you want to add alcohol 0:07:22.480 --> 0:07:24.920 a quarantine on our website, this podcast will Kill You 0:07:24.960 --> 0:07:28.040 dot com and our socials? Are you following us on socials? 0:07:28.480 --> 0:07:31.440 Aaron's making videos of these drinks. 0:07:31.360 --> 0:07:34.679 Or poor videos. Yeah, not very good, but they exist. 0:07:34.800 --> 0:07:43.120 We're trying trying things things Instagram, TikTok, Facebook, website. 0:07:42.440 --> 0:07:46.240 Webs podcast will kill You, dot com transcripts, links to 0:07:46.280 --> 0:07:49.320 merch links to bookshot dot org, affiliate account, links to Goodreads list, 0:07:49.400 --> 0:07:52.240 links to music by Bloodmobile, the sources for each and 0:07:52.280 --> 0:07:56.680 every one of our episodes. There's also embedded YouTube videos there, 0:07:56.680 --> 0:07:58.800 so if you check out our oh you doing that. 0:08:00.840 --> 0:08:02.720 Sometimes I'm a little bit late because I have to 0:08:02.760 --> 0:08:04.559 wait for the day that they publish. It doesn't matter. 0:08:05.080 --> 0:08:09.440 They're there and some other things that contact us form. 0:08:09.960 --> 0:08:12.680 Thank you everyone who has submitted your story for a 0:08:12.680 --> 0:08:15.920 first hand account using our first hand account form. 0:08:16.160 --> 0:08:18.400 Just know it could be years before we contact you, 0:08:18.440 --> 0:08:19.480 but we read them all. 0:08:19.440 --> 0:08:20.320 But we do read them all. 0:08:20.480 --> 0:08:23.880 Yeah, yeah, I think great, that's it. 0:08:23.920 --> 0:08:25.280 You did a great job. Thank you. 0:08:26.160 --> 0:08:28.360 Do you want to hear about the biology of Canada? 0:08:28.520 --> 0:08:29.280 Of course I do. 0:08:29.520 --> 0:08:45.240 Let's take a break and get into it. So the 0:08:45.280 --> 0:08:50.040 star of today's show is a fungus, and as we've 0:08:50.120 --> 0:08:53.719 learned in previous fungal episodes, funk i tend to be 0:08:53.760 --> 0:08:57.840 a little bit complicated. They do, they really do. And 0:08:57.920 --> 0:09:01.160 in the case of Canada, often people cited as a yeast, right, 0:09:01.200 --> 0:09:04.880 we think yeast infection, and a yeast is a single 0:09:05.120 --> 0:09:08.120 celled fungus, right, like the kind of use that you 0:09:08.200 --> 0:09:13.800 use for bread. But Canada also exists as a filamentous 0:09:13.880 --> 0:09:17.640 mold with its little hiphi or sometimes pseudo hyphie branching out. 0:09:18.280 --> 0:09:21.679 So it's really quite multifaceted, and it might not be 0:09:21.720 --> 0:09:25.720 surprising that, in part because of that, Canada can cause 0:09:25.800 --> 0:09:30.440 a really wide range of potential infections, not just vaginal 0:09:30.520 --> 0:09:35.040 yeast infections. There are several different species of Canada that 0:09:35.120 --> 0:09:38.360 cause infections in humans, the most common of which is 0:09:38.480 --> 0:09:42.120 Canada albacans, but there are I think there's a push 0:09:42.160 --> 0:09:44.079 to group all of the other ones as like non 0:09:44.480 --> 0:09:50.920 albacans Canada or none nac and acy non albcans Canada yeast. Anyways, 0:09:52.040 --> 0:09:54.440 and these actually some of them have been growing in 0:09:54.480 --> 0:09:58.439 abundance and posing a growing concern to infectious disease specialists 0:09:58.480 --> 0:10:02.800 and in public health official and infection preventionists in hospitals. 0:10:03.280 --> 0:10:05.400 Well, because that's what I was wondering, So why would 0:10:05.400 --> 0:10:11.600 you like, are all non albacans Canada as pathogen like 0:10:11.679 --> 0:10:13.559 equally pathogenic and problematic? 0:10:13.880 --> 0:10:18.959 All of them tend to be more apt to resistance, 0:10:19.000 --> 0:10:21.400 which is one of the big concerns about them. 0:10:21.600 --> 0:10:22.560 Yeah, very interesting. 0:10:22.720 --> 0:10:22.960 Yeah. 0:10:23.480 --> 0:10:26.079 So the kind of most notable ones, and there are 0:10:26.080 --> 0:10:27.920 more than these two, but kind of the most notable 0:10:27.920 --> 0:10:30.480 ones are Canada Orus and we'll talk more about that later. 0:10:31.120 --> 0:10:33.800 And then what used to be called Canada glebrata but 0:10:33.880 --> 0:10:39.880 what is now has been reclassified as NA Gonna sayomics glebratis, 0:10:40.400 --> 0:10:43.280 okay uh. And I think that's also part of why 0:10:43.400 --> 0:10:47.560 they're saying call everything non albacans because it's like they've 0:10:47.600 --> 0:10:51.560 been renaming some things, which is important but also gets confusing. 0:10:52.280 --> 0:10:53.319 Yeah. 0:10:52.840 --> 0:10:53.040 Yeah. 0:10:53.360 --> 0:10:58.840 And then also Canada parasilosis, so that's the other one, sure, 0:10:59.000 --> 0:11:02.080 And all of three of them do tend to have 0:11:02.440 --> 0:11:07.480 more resistance to antifungals than Canada albacans. And so we'll 0:11:07.480 --> 0:11:09.679 talk a little bit more about them a little bit, 0:11:09.679 --> 0:11:11.440 and you can ask questions and I might have the answers. 0:11:11.480 --> 0:11:13.800 But for most of this episode, especially for the like 0:11:13.960 --> 0:11:17.000 pathogenicity part of things, I'm going to focus on Canada albacans. 0:11:17.400 --> 0:11:20.280 It is by far the most common, something like ninety 0:11:20.360 --> 0:11:23.920 percent of us are colonized right now as we speak, 0:11:24.160 --> 0:11:26.720 on our skin, or in our mouths, or in our 0:11:26.840 --> 0:11:29.520 vaginas or in our guts because it can live there too. 0:11:30.800 --> 0:11:34.600 So Canada is or causes what we often call an 0:11:34.679 --> 0:11:39.560 opportunistic infection, meaning that when the opportunity arises, it will 0:11:39.559 --> 0:11:42.960 cause infection, and when it does not arise, it simply 0:11:43.040 --> 0:11:43.920 coexists with. 0:11:43.920 --> 0:11:47.600 Us and maybe even beneficial. 0:11:47.320 --> 0:11:50.520 Maybe though I didn't research that at all. It's okay, 0:11:50.559 --> 0:11:54.520 I have a paper love it, and it lives not 0:11:54.679 --> 0:11:56.640 just on our skin and in our mucous membranes, but 0:11:56.679 --> 0:11:59.920 also in the environment, and mostly just hangs out there 0:12:00.080 --> 0:12:04.240 a little bit unobtrusive until it becomes a problem. I 0:12:04.280 --> 0:12:07.760 think of it as just getting too big for its 0:12:07.800 --> 0:12:12.160 breeches and deciding to take over the place, writing executive orders, 0:12:12.200 --> 0:12:15.200 and all of the judges and other lawmakers are nowhere 0:12:15.200 --> 0:12:16.880 to be found, can't keep it in check. 0:12:17.400 --> 0:12:19.360 Just kidding, I guess this is fine for me to 0:12:19.400 --> 0:12:22.960 take over. No one's here, like. 0:12:23.160 --> 0:12:25.959 Yeah, no one else is here, I'll just move in. 0:12:26.320 --> 0:12:26.520 Yeah. 0:12:26.840 --> 0:12:29.520 So let's talk about what kinds of problems it can cause, 0:12:30.000 --> 0:12:34.199 because it's really varied, and not all Canada infections are 0:12:34.200 --> 0:12:39.400 created equal. There are broadly two big categories of candidal infections. 0:12:39.520 --> 0:12:43.520 There's muco cutaneous infections, so skin and mucus membranes, and 0:12:43.559 --> 0:12:47.000 then there are systemic infections. You can probably guess which 0:12:47.040 --> 0:12:51.840 one is more severe the most I don't even know 0:12:51.840 --> 0:12:53.439 if this is I don't know if it's true to 0:12:53.480 --> 0:12:55.800 say the most common, but probably like the thing that 0:12:56.200 --> 0:12:58.400 certainly I think about in that most people probably think 0:12:58.400 --> 0:13:03.400 about with Canada is a vaginal infection or volvovaginal candidiasis. 0:13:03.960 --> 0:13:05.720 And we kind of said this already, but something like, 0:13:05.800 --> 0:13:08.320 seventy five percent of people with a vagina will have 0:13:08.440 --> 0:13:13.120 candidiasis at least once in our lives. Six to ten 0:13:13.160 --> 0:13:17.600 percent of us may have recurrent volvovaginal candidiasis, which is 0:13:17.720 --> 0:13:20.800 usually defined in the literature as more than four per year, 0:13:21.280 --> 0:13:24.360 with resolution of the symptoms in between each episode. 0:13:25.200 --> 0:13:28.720 Okay, not just like persistent, Like so, I mean, okay, 0:13:28.760 --> 0:13:31.520 that is the chronic part. Are there? How long? 0:13:31.679 --> 0:13:31.839 Oh? 0:13:31.920 --> 0:13:34.000 Okay? Never mind? Am I getting ahead of things already? 0:13:34.080 --> 0:13:34.440 Yeah? 0:13:34.480 --> 0:13:35.400 You're asking a lot. 0:13:35.240 --> 0:13:37.840 Of questions like how long does the east infection last? 0:13:37.840 --> 0:13:39.640 How long does treatment? How long does it take to 0:13:39.679 --> 0:13:43.719 resolve things? How long does it? Yeah, does it ever 0:13:43.760 --> 0:13:44.439 self resolve? 0:13:44.880 --> 0:13:47.880 Yeah, certainly can certainly can self resolve. How long it 0:13:47.960 --> 0:13:50.120 lasts just totally depends on the person and their immune 0:13:50.160 --> 0:13:52.800 system and what kind of treatment they get, if they 0:13:52.800 --> 0:13:57.320 get treatment. Treatment depends on the situation. It can be topical, 0:13:57.360 --> 0:14:00.000 so sometimes we use like vaginal suppositories or vaginal creams, 0:14:00.160 --> 0:14:02.240 or it can be oral and that's usually a shorter 0:14:02.400 --> 0:14:06.400 course unless it's a more resistant strain or you have 0:14:06.480 --> 0:14:07.560 recurrence or something like that. 0:14:07.559 --> 0:14:08.559 Then sometimes you need a. 0:14:08.559 --> 0:14:11.240 Prolonged course of oral antifungals. 0:14:12.480 --> 0:14:15.560 Okay, what real quick one question? Okay, So, for the 0:14:15.600 --> 0:14:20.160 people who have recurrent yeast infections, what is driving that recurrence? 0:14:20.560 --> 0:14:23.840 Isn't that a great question? We don't know. We don't know. 0:14:24.120 --> 0:14:27.680 Okay, Yeah. What I can tell you a little bit about, 0:14:27.760 --> 0:14:29.360 since I haven't even mentioned it yet, is what the 0:14:29.400 --> 0:14:31.400 symptoms of a vaginal uast infection are. 0:14:31.920 --> 0:14:34.040 Sorry, I just got excited. 0:14:34.240 --> 0:14:38.080 I love it, Aaron, don't ever apologize for your excitement. 0:14:39.040 --> 0:14:41.360 But again, most of us is probably other things. Yes, 0:14:45.480 --> 0:14:48.440 most of us have probably experienced this. We can see inflammation, 0:14:48.760 --> 0:14:54.000 we see a white, chunky, cheesy kind of cottage cheese discharge, itching, 0:14:54.280 --> 0:14:58.680 burning pain. And this is an infection that is very 0:14:58.720 --> 0:15:01.280 easy for people to and by people I mean the 0:15:01.320 --> 0:15:07.200 people not experiencing it. But it has a substantial economic 0:15:07.400 --> 0:15:10.000 and morbidity burden. And we'll talk a little bit more 0:15:10.000 --> 0:15:14.760 about that later on in this episode. The risk factors 0:15:14.800 --> 0:15:17.360 for like why do people get YaST infections and some 0:15:17.400 --> 0:15:19.600 people don't? Or when does someone get a east infection? 0:15:20.040 --> 0:15:24.760 Risk factors can include poorly controlled diabetes. Sometimes we see 0:15:24.760 --> 0:15:27.920 associations with sexual activity, but it's not considered by any 0:15:27.960 --> 0:15:30.440 means of sexually transmitted infection because again this is like 0:15:30.480 --> 0:15:34.680 a commensal We also can see an increase in cases 0:15:34.880 --> 0:15:38.720 with increased estrogen states, so like during pregnancy and things, 0:15:39.520 --> 0:15:43.840 But by far the most common is antibiotic use. Yeah, 0:15:44.120 --> 0:15:46.960 and that's true for a lot of candidal infections, not 0:15:47.120 --> 0:15:52.760 just global vaginal infactions, right, But it's not just the vagina. 0:15:52.840 --> 0:15:56.200 Our other mucous membranes can often get infected. So we 0:15:56.200 --> 0:16:00.200 can see oral or esophageal candidiasis, which at least east 0:16:00.240 --> 0:16:02.400 in the US we often call thrush, and I think 0:16:02.400 --> 0:16:06.360 that they call thrush like a variety of candidle infections 0:16:06.360 --> 0:16:09.880 in other countries too. But that is when you get 0:16:09.920 --> 0:16:13.200 infection of the tongue, the oral mucosa, the gingabus, or 0:16:13.200 --> 0:16:16.600 your gums or your throat or esophagus, and you usually 0:16:16.640 --> 0:16:20.360 will see this kind of off white yellowish. It can 0:16:20.400 --> 0:16:22.920 almost be like almost so dark that it looks kind 0:16:22.960 --> 0:16:27.080 of brownish or blackish, just depending on like how long 0:16:27.080 --> 0:16:29.640 it's been there in things. But this plaque that forms 0:16:29.680 --> 0:16:32.520 in the mouth or in the throat, most of the 0:16:32.640 --> 0:16:36.600 time with these infections, we see them with some type 0:16:36.600 --> 0:16:40.800 of immunal compromising condition, so something like HIV, AIDS or 0:16:41.040 --> 0:16:45.200 chronic steroid use, including yes, inhaled corticosteroids if you're not 0:16:45.280 --> 0:16:47.520 rinsing your mouth, and that's why you're supposed to rinse 0:16:47.520 --> 0:16:49.360 your mouth after you use like a inhaler. 0:16:49.440 --> 0:16:50.960 That's interesting, okay, okay. 0:16:51.600 --> 0:16:54.880 Or conditions that cause like a reduction in saliva, which 0:16:54.920 --> 0:16:56.880 is going to help to wash out the yeast that's 0:16:56.920 --> 0:16:58.160 in your mouth and keep it moving. 0:16:58.440 --> 0:16:59.960 What would that what reduces sali? 0:17:00.560 --> 0:17:03.840 Oh, something like chogrin syndrome, which is quite rare. But 0:17:03.880 --> 0:17:06.280 then there's other things that I don't know, other specific 0:17:06.280 --> 0:17:08.920 conditions where people might have less saliva, or people who 0:17:08.920 --> 0:17:11.040 wear dentures I think too, are at higher risk of 0:17:11.240 --> 0:17:15.000 oral candidiasis. Okay, But we can also see it on 0:17:15.080 --> 0:17:18.080 our skin or in our nails. We can get intertrigo, 0:17:18.240 --> 0:17:21.320 so like in the skin folds maybe say axila growin 0:17:21.640 --> 0:17:25.320 diaper rash for babies. You can get it on the penis, 0:17:25.320 --> 0:17:28.480 we call that balinitis. You can also get it on 0:17:28.560 --> 0:17:32.199 the nails, so either with like an ingrown nail, so 0:17:32.240 --> 0:17:36.320 we call that paranikea or onycomycosis, which is like the 0:17:36.400 --> 0:17:37.040 nail infection. 0:17:37.320 --> 0:17:39.760 Is that like on top of your nail or under 0:17:39.800 --> 0:17:41.520 your nail or like, how does that happen? 0:17:41.640 --> 0:17:46.560 It's like within the nail itself, rail itself. Yeah yeah, okay, yeah, 0:17:46.960 --> 0:17:49.440 it's here, it's there, it's everywhere. So given the right 0:17:49.480 --> 0:17:54.280 set of circumstances, it can absolutely flourish, and sometimes it 0:17:54.280 --> 0:17:57.639 can really go too far and cause a systemic or 0:17:57.680 --> 0:18:02.719 invasive infection inside of our box. The most common and 0:18:02.760 --> 0:18:08.119 most serious of these invasive candidal infections is called candidemia, 0:18:08.240 --> 0:18:11.800 which is a bloodstream infection, so yeast growing in our bloodstream, 0:18:12.720 --> 0:18:16.800 and this has a mortality rate of thirty to forty percent, 0:18:16.960 --> 0:18:19.280 depending on how you calculate it. And that's today, and 0:18:19.320 --> 0:18:20.919 that's in high income countries. 0:18:20.840 --> 0:18:23.120 And that's with all the treatments available. 0:18:22.800 --> 0:18:27.879 Exactly yep, yeah wow. And part of that is because 0:18:27.920 --> 0:18:30.720 of just how hard it is to diagnose and treat 0:18:31.200 --> 0:18:35.320 these infections, especially once they've gotten into our bloodstream, but 0:18:35.480 --> 0:18:38.880 also because the vast majority of people who end up 0:18:38.960 --> 0:18:42.720 with a bloodstream infection are very stick to begin with. 0:18:42.880 --> 0:18:45.680 So we see this really commonly in things like icee use, 0:18:45.840 --> 0:18:48.159 when people are already you know, their immune systems are 0:18:48.200 --> 0:18:52.879 kind of at their limit and things like that. Once 0:18:53.000 --> 0:18:57.000 someone has an invasive candidal infection. They can end up 0:18:57.119 --> 0:18:59.840 with a number of other places that this candida in 0:19:00.000 --> 0:19:02.800 effects thereafter. So you can get an infection in the 0:19:02.920 --> 0:19:06.440 eye and it can cause candida end ophthalmitis, which can 0:19:06.480 --> 0:19:11.440 potentially cause permanent blindness. It can go into the heart 0:19:11.600 --> 0:19:14.439 and cause endocarditis, so infection of the heart and. 0:19:14.440 --> 0:19:15.320 The valves of the heart. 0:19:15.680 --> 0:19:18.439 Okay, it can get into the central nervous system, and 0:19:18.480 --> 0:19:23.240 we see this commonly in premature newborns something like fifteen 0:19:23.280 --> 0:19:25.960 to twenty percent of the time if a premi ends 0:19:26.040 --> 0:19:28.920 up with invasive candidiasis, it will end up in their 0:19:28.960 --> 0:19:31.960 central nervous system, so with ameninditis or and encephalitis, I know. 0:19:33.280 --> 0:19:37.280 And then especially after surgeries or other like abdominal procedures, 0:19:37.359 --> 0:19:40.439 people can get abdominal candidiasis and that can result in 0:19:40.480 --> 0:19:44.440 like a fungal abscess or can sometimes infect the liver 0:19:44.560 --> 0:19:46.880 or the spleen and in those cases can sometimes cause 0:19:46.880 --> 0:19:49.320 a really prolonged infection that's really hard to treat. 0:19:50.840 --> 0:19:55.120 Do we have a more granular answer as to how 0:19:55.200 --> 0:19:59.639 this happens. Then there's a breakdown immunosuppression and things just 0:19:59.680 --> 0:20:02.520 sort of bill over. It's a good question, not not 0:20:02.640 --> 0:20:03.359 a super more. 0:20:03.280 --> 0:20:07.080 Granular one than that. Okay, there's always, I mean almost always, 0:20:07.080 --> 0:20:09.119 there's going to be some I say almost just a hedge. 0:20:09.160 --> 0:20:11.479 But realistically there's always going to be some kind of 0:20:11.520 --> 0:20:15.399 like precipitating events, right, whether it's some other infection, whether 0:20:15.440 --> 0:20:19.080 it's you know, a bone marrow transplant, a solid organ transplant, 0:20:19.240 --> 0:20:24.240 you're on immunosuppressive drugs, you have, you know, HIV AIDS, 0:20:24.359 --> 0:20:29.560 like you're born with an immunodeficiency. So many potential conditions 0:20:29.560 --> 0:20:32.520 that lead someone to be more susceptible, and then it's 0:20:32.560 --> 0:20:35.520 like those right set of circumstances. The other thing that's 0:20:35.760 --> 0:20:39.040 very commonly predisposed of someone to an invasive infection, especially 0:20:39.040 --> 0:20:42.680 a bloodstream infection, would be having indwelling lines. So if 0:20:42.680 --> 0:20:46.480 you have ports, if you have catheters, as we'll see, 0:20:46.680 --> 0:20:51.800 Canada forms biofilms very easily, and so they can colonize 0:20:51.800 --> 0:20:55.120 and form a biofilm on those indwelling lines and then 0:20:55.160 --> 0:20:57.800 put you at risk for invasive infection because it's just 0:20:58.080 --> 0:21:00.679 bopping off little Yeasti's from the bio film. 0:21:01.119 --> 0:21:04.840 I feel like. So on this podcast, we have talked 0:21:04.880 --> 0:21:08.600 about a few other opportunistic pathogens that tend to just 0:21:08.640 --> 0:21:11.600 hang out and then crop up when something is a 0:21:11.680 --> 0:21:15.320 little bit out of balance, there's dysbiosis whatever. And I 0:21:15.720 --> 0:21:21.159 do we know why Canada rather than staph oreus? Or 0:21:21.200 --> 0:21:24.679 why Canada rather than strap? You know, like, what is 0:21:25.080 --> 0:21:26.320 that deciding factor? 0:21:26.560 --> 0:21:28.840 I don't, Well, I don't think it's always an either 0:21:29.000 --> 0:21:32.639 or sure of course not yeah, but yeah, I don't. 0:21:33.200 --> 0:21:33.600 I don't know. 0:21:33.640 --> 0:21:35.560 It's a good question, I mean, and it could be 0:21:35.600 --> 0:21:37.800 any of those. So it might just depend on that individual. 0:21:37.920 --> 0:21:40.199 What is their skin more colonized with, what do they 0:21:40.240 --> 0:21:43.399 happen to have on their bodies, what other antibiotics are 0:21:43.400 --> 0:21:46.520 they being exposed to, what happens to gain that foothold 0:21:46.520 --> 0:21:50.639 to begin with, or what other you know, Because our 0:21:50.680 --> 0:21:54.840 immune systems respond to bacteria and to fungi in different ways. 0:21:55.200 --> 0:21:58.440 So what type of immunal compromising condition do you have? 0:21:58.680 --> 0:22:01.320 And does it leave you more susceptible to fungus because 0:22:01.359 --> 0:22:04.080 your immune system is just not as good at getting 0:22:04.080 --> 0:22:07.200 at that fungus versus a bacteria or something like that. 0:22:07.840 --> 0:22:10.480 Are you already on all the antibiotics possible and so 0:22:10.800 --> 0:22:13.399 you've killed all those and now only the yeast are left. 0:22:13.640 --> 0:22:14.160 Yeah. 0:22:14.359 --> 0:22:16.360 Yeah, and as a. 0:22:16.320 --> 0:22:20.240 Fungus, Canada is already in some ways kind of harder 0:22:20.240 --> 0:22:23.120 for us to fight off compared to some bacteria because 0:22:23.160 --> 0:22:25.800 it's a eukaryote rat, right, so it's a little bit 0:22:25.920 --> 0:22:28.680 closer to us, So it's harder for us to have 0:22:28.720 --> 0:22:33.000 anti fungals. It's harder for our body to recognize it sometimes. However, 0:22:33.359 --> 0:22:36.280 Canada is also special and has quite a number of 0:22:36.359 --> 0:22:39.840 virulence factors that facilitate its ability to infect us and 0:22:39.880 --> 0:22:43.680 cause disease. For one thing, it can do that switching 0:22:43.720 --> 0:22:45.879 thing that I mentioned at the top. It can exist 0:22:45.880 --> 0:22:50.560 as a yeast or as this filamentous hyphie form depending 0:22:50.600 --> 0:22:55.160 on its environment, and this allows it to disseminate widely 0:22:55.320 --> 0:22:57.879 when it's a yeast, right, it's really hardy. It can 0:22:57.920 --> 0:23:00.679 exist in the environment, it can beat bop but between people, 0:23:01.720 --> 0:23:05.400