Scribd
Upload
7 views19 pages

3- Candidiasis

Uploaded by

olamicro64
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
7 views19 pages

3- Candidiasis

Uploaded by

olamicro64
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 19

Candidiasis

Opportunistic mycoses
➢Patients with compromised host defenses are susceptible to some
fungi to which healthy people are exposed but usually resistant
(Opportunistic fungi).

➢Candida and related yeasts are endogenous opportunists. While other


opportunistic mycoses are caused by exogenous fungi that are present in
soil, water and air.
➢ The most common opportunistic mycoses are
▪ Candidiasis
▪ Cryptococcosis
▪ Aspergillosis
▪ Mucormycosis
▪ Pneumocystis pneumonia
▪ Penicilliosis
▪ Hyalohyphomycosis
▪ Phaeohyphomycosis
Candidiasis
• Several species of the Candida are members of the normal flora of the
skin, mucous membranes, and gastrointestinal tract.
• Candidiasis is the most prevalent systemic mycosis, and the most
common agents are
• C albicans
• C parapsilosis
• C glabrata,
• C tropicalis
• C dubliniensis
Morphology and Identification:
▪ Candida species grow as oval, budding yeast cells. They also form
pseudohyphae when the buds continue to grow but fail to detach.

▪ On agar media or within 24 hours at 37°C or room temperature,


Candida species produce soft, cream-colored colonies with a yeasty odor.
• Two tests distinguish C. albicans from other species of candida:

1. Germ tube test: After incubation in serum for about 90 minutes at 37°C,
yeast cells of C. albicans will begin to form true hyphae.

2. On nutritionally deficient media C albicans produces large, spherical


chlamydospores.

• Sugar fermentation and assimilation tests can be used to confirm the


identification and speciate the more common Candida isolates.
• CHROMagar
Antigenic Structure:

• There are two serotypes of C albicans: A and B.

• During infection, cell wall components, such as mannans, glucans, other

polysaccharides and glycoproteins, as well as enzyme are released and

elicit innate host defenses and Th1 and Th2 immune responses.
Pathogenesis and Pathology:
• Superficial (cutaneous or mucosal) candidiasis is established by an
increase in the local census of Candida and damage to the skin or epithelium.
These lesions is characterized by inflammatory reactions varying from
pyogenic abscesses to chronic granulomas.
• Systemic candidiasis occurs when Candida enters the bloodstream and the
phagocytic host defenses are inadequate. From the circulation, Candida can
infect the kidneys, attach to prosthetic heart valves, or produce candida
infections almost anywhere (eg, arthritis, meningitis, endophthalmitis).
Clinical Findings of candidiasis:
A. Cutaneous and Mucosal Candidiasis: The risk factors include AIDS,
pregnancy, diabetes, young or old age, birth control pills, administration of broad
spectrum antibiotics and trauma.
1-Oral thrush can occur on the tongue, lips, gums, or palate.
2-Vulvovaginitis: it is characterized by irritation, pruritus, and vaginal discharge.
3-Other forms of cutaneous candidiasis include invasion of the skin which is
weakened by trauma, burns, or maceration. This infection occurs in moist, warm
parts of the body such as the axillae, groin.
4-Onychomycosis: Candidal invasion of the nails and around the nail plate
resembling a pyogenic paronychia.
B. Systemic Candidiasis:
• Candidemia can be caused by indwelling catheters, surgery, intravenous
drug abuse, aspiration, or damage to the skin or gastrointestinal tract.

• Risk factors: chronic administration of corticosteroids or other


immunosuppressive agents; leukemia, lymphoma, and aplastic anemia; or
with chronic granulomatous disease.
C. Chronic Mucocutaneous Candidiasis (CMC):
• It is a rare disease characterized by formation of granulomatous
candida lesions on any or all cutaneous and mucosal surfaces.

• The most common forms present in early childhood and are associated
with autoimmunity and hypoparathyrodism and result in chronic
superficial disfiguring infections on the skin or mucosa.

• Most patients with CMC are unable to mountan effective Th17


response to Candida.
Chronic Mucocutaneous Candidiasis (CMC)
Diagnostic Laboratory Tests:
A. Specimens
Specimens: swabs and scrapings from superficial lesions, blood, spinal fluid,
tissue biopsies, urine, exudates, and material from removed intravenous
catheters.

B. Microscopic Examination
• Tissue biopsies, centrifuged spinal fluid, and other specimens may be
examined in Gram-stained smears or histopathologic slides for pseudohyphae
and budding cells.
• Skin or nail scrapings are first placed in a drop of 10% KOH and calcofluor
white.
Gram-stained film shows Candida species
C. Culture
✓ All specimens are cultured on fungal or bacteriologic media at room
temperature or at 37°C. Yeast colonies are examined for the presence of
pseudohyphae.
✓ Candida albicans is identified by the production of germ tubes or
chlamydospores. Candida albicans ferments glucose and maltose with acid
and gas production.
✓ CHROMagar is a useful commericial medium for the rapid identification
of several candida species

D. Molecular methods: The specificity of DNA tests for candidemia is excellent.


Germ tube test
Treatment:
• Thrush and other mucocutaneous candidiasis are usually treated with topical
nystatin or oral ketoconazole or fluconazole.

• The clearing of cutaneous lesions is accelerated by eliminating contributing


factors such as excessive moisture or antibacterial drugs.

• Systemic candidiasis is treated with amphotericin B.

• Chronic mucocutaneous candidiasis responds well to oral ketoconazole and


other azoles.

• Prophylactic regimen for patients at risk, though treatment with an azole or with
a short course of low-dose amphotericin B.

You might also like