CANDI

DASPECI
ES
I
NTRODUCTI
ON:
Candidaspeci esar emajorhumanf ungalpathogensthatcausesbot hmucosalanddeep
ti
ssuei nfect
ions.Candidaspeci esusuallyl
ivesintheski
nandi nsi
det hebodyofli
v i
ng
organismsl i
ket hemout h,throat ,
mucosal membr ane,gut(GIt
ract)andv agi
nawithout
causinganyt rouble,buttheycancausei nfecti
onwhent heygrowoutofcont rol
orifthey
enterdeepi nsidethebody .Ex ampl e:i
nthebloodst r
eam orint
ernalorgansli
kethekidney
,
heart,brain,
etc.Candidaspeci esar eopport
unist
icfungit
hatcausescandi di
asi
sor
candidosis.C.albicansaret hemostcommonagent scausingcandidiasi
s.
HI
STORY:
Initsmanycel l
ularfor
ms, Candidahasbeenani nhabit
antofhumansf oral ongt i
me.Duet o
thetypicalcommensal nat
ureofC.al bicans,itspr esencewi ll
gounnot icedunl essi tcauses
disease.Oneoft hefistCandi
r dadiseasedescr ibedwasor opharyngeal candidiasis,
commonl yref
err
edt oast hrush.Thrushwasf irstdescr i
bedbyt heancientGr eekphy sici
an
Hippocratesin600BCassmal lsoresi nsi
det hemout hbyt hegums.Lat erin130AD, the
thrushwassi mil
arlydescribedbytheRomanphy sici
anCl audiusGalen.Howev er ,
itwasnot
untilt
he19t hcenturythatthecauseoft hesewhi teulcerouslesionswasi denti
fiedasbei ng
duet ofungalovergrowthonmucosal surfacesi nt heoralandv aginal
cav iti
es.
TYPESOFCANDI
DASPECI
ES:
Morethan350speciesofCandi
dahavebeendi
scov
ered.Somecommont
ypesofCandi
da
speci
esthatusual
l
ycausescandidi
asi
are

 C.al
bicans
 C.glabr
ata-al
soknownasTorul
opsi
sglabr
ataC.glabrat
aisoftenthesecondmost
commoncauseofcandi di
asi
sasanopport
unist
icpathogen.Theydonotform ei
ther
hyphaeorpseudohyphae.

 C.t
ropi
cal
i
s
 C.par
apsi
l
osi
s
 C.kr
usei
 C.st
ell
atoi
dea
 C.gui
l
li
ermondi
i
 C.v
ishwanat
hii
 C.aur
is
 C.dubl
i
niensi
s
Morethan90-95%ofcandi di
asishasbeencausedbyf
ourspeciesC.al
bicans(whichcauses
80%oftheinfecti
ons),C.gl
abrata,
C.tr
opi
cali
sandC.parapsi
l
osisandoutoft hosefour
esC.al
speci bicans.Theremaini
ng5-10%hasbeencausedbytheotherCandidaspecies.
MORPHOLOGY:
Candi
daspeci
esaresmallabout3-
5µm, t
hinwal
led,
ovoidorspheri
cali
nshape
(bl
ast
ospor
es)andrepr
oducebybudding.Theyf
orm pseudohyphaeandhyphaewhi
chmay
bef oundinmicroscopi
cexaminat
ion.Cellwal
lcomprisesoftwol ayer
s-Themai ncoreof
thecellwall
iscomposedofβ- Gl
ucan-Chi
tinSkelet
on,whichisresponsiblefort
hestr
engt
h
andshapeoft hecellwall
.Theout
erlayerispackedwithmannopr otei
nst hatar
e
glycosyl
phosphati
dyli
nosi
tol(
GPI)
-modi f
iedandcross-l
inkedtoβ-1,6-Glucans.
Bl
ast
ospor
es(
yeast
)-t
heyar
easexual
fungal
spor
espr
oducedbybuddi
ng.
Pseudohyphae/pseudomy cel
ium-budsthatcharact
eri
sti
cal
lyf
ail
stodetachandbecomes
el
ongatedbycontinui
ngthebuddingprocesstoform achai
nofelongat
edy eastcel
l
s.
Pseudohyphaeisconsi
deredav i
rul
entfact
orinCandida.
Hyphae-Consist
sofphospholi
paseatit
sti
pforinv
asi
on.I
trepresent
sanimport
antphase
i
nthediseaseprocessastheycancauseti
ssuedamagebyinvadingmucosal
epi
thel
ialcel
l
s
l
eadingtobloodinf
ecti
ons.
Chlamydospores-C.albicansandC.dubl ini
ensi
sar et
heonl ytwomember softhegenus
Candidatoproducechlamy dospores.Thef unct
ionsofthesethick-
wall
edcel
lsarecurrent
ly
unknown.Howev er,
ithasbeenf oundt hat5-15daysoldchlamy dospor
escouldbeinduced
toproducedaughterchlamy dospores,pseudohyphae,
blastosporesandtr
uehy phae
dependingontheincubat i
onconditionsused.

DI
SEASESANDSYMPTOMS:
C.albicansisanoppor tunisti
cfungalpat
hogenthatisresponsibleforcandidi
asisi
nhuman
host.Ty pi
call
y,t
heyli
v eashar mlesscommensalsi nthebody .Severalev
entscansparkan
i
mbal anceandt heov ergrowthoftheseorgani
smswi l
ll
eadt odiseases.Someexampl esare
-useofant ibi
oti
cscandecr easetheamountoflactobaci
ll
usbact eri
a,whichdecreasesthe
numberofaci di
cproductsandt hepHoft hevagina,C.al
bicansar eabletotakeadvantage
ofthecondi ti
onsandout compet ethenormalmicrofl
ora,r
esul t
ingincandidi
asisorayeast
i
nfection.
Condit
ionslikepregnancy
,HI
V,chemotherapy,
diabet
esandcer t
ainsur
gicalproceduresl
ike
tr
ansplant
ationsandi mpl
ement
ati
onsmaket hem mor esuscept
ibl
etothisdisease.They
canalsoaffectpatient
soncor
ti
coster
oids,i
ncl
udinginhal
edsteroi
dsusedforast hma.
Ot
hercausesmayincl
udestress,smoking,
warm/humidweat
her,
drymout
h,obesi
tyandnot
mai
ntai
ningpr
operhygi
ene.Lesionscausedbycandi
daareasfol
l
ows:
1)MUCOCUTANEOUSI
NFECTI
ON:
1.Or
ophar
yngeal
candi
diasi
s(or
alt
hrush)
-thi
sischar
act
eri
sedbycr
eamywhi
te
 plaquesintheoral
mucosa.Painful
orbur
ningsensat
ioni
nthemout
h,l
ossof
tasteandrednessispr
esenti
nsideorcor
nersofthemout
h.
2.Esophagi
ti
s-t
hisi
schar
act
eri
sedwi
thpai
nonswal
l
owi
ng,
wit
horwi
thoutt
hrust
.
3.Vulvovagi
niti
s-thi
sischar
acteri
sedwi
thi
tchi
ng,
irr
it
ati
on,
pai
n,r
edness,
abnormaldischargei
nthevagina.
4.Candi
daBal
ani
ti
s-i
tist
hei
nfl
ammat
ionoft
hef
oreski
nandheadoft
hepeni
s.
2.CUTANEOUSI
NFECTI
ONS:
1.Int
ert
ri
go-thi
sist
heinf
lammatoryl
esi
onsont
heski
nfol
ds,
usual
l
yint
hear
mpi
ts,
under
neaththebr
east
,groi
n,et
c
2.Par
onychi
a-i
tist
hei
nfl
ammat
ionoft
henai
lfol
dsusual
l
yaf
fect
ingt
hehand
nai
l
sandatti
mesnai
lsoft
hef
eet.
3.Diaperdermati
ti
s-Al
soknownasnapkincandi
diasi
s.Thecondi
ti
ongeneral
ly
star
tsintheperi
anal
areaandspreadsov
ertheperi
neum i
ntheregi
onofdiaper
contact
.Diaperr
ashcanbecausedwhenproperhygi
eneisnotmaint
ained.
3.SYSTEMATI
CINFECTI
ONS:
1.Candidemia-thi
sisthei
nfecti
onofbloodbyCandidaspeci
es.Theymaybe
acqui
redthroughuseofimmunosuppr essi
on,maj
orsurger
yorplacementofa
medicaldevi
celikef
eedi
ngt ubesandcatheter
.
2.Endopht
halmit
is-iti
sthei
nfl
ammat i
onoft ecausedbyCandi
heey da.The
condi
ti
oncanaf f
ectoneorbothey
es.Insomecases,
puscanbepresenti
nthe
ti
ssueoftheeye.
3.Urinar
yt ractinfecti
on(UTI
)-CandidaUTIcanoccuri
nthelowerport
ionofthe
urinar
yt r
actori nsomecasescanascendupt othekidneys.I
tcanbe
characterisedwi t
hpainf
ulorburni
ngsensati
onwhenur i
nati
ngandsometimes
bloodint heurine.
CULTURALCHARACTERI
STI
CS:
1.SabouraudDextroseAgar(SDA):Candi
daspeci
escanbeeasi l
ycultur
edinSDAatr oom
temperatur
einabout48hours.Thecoloni
eshaveyeast
-l
ikeodour.Cream colour
ed,
smooth,
pastycol
oniesareobserv
ed.Sabourauddext
roseagarwascreatedin1892f or
dermatophytecul
ture.
2.Bl
oodAgar
:C.al
bicansexhi
bit
shaemol
yti
cact
ivi
tywhengr
ownongl
ucoseenr
iched
bl
oodagar
.
3.CHROMagar :Thisisarapid,plate-basedtestfortheisol
ati
onandidenti
fi
cati
onofvari
ous
Candidaspecies.Thisisarelati
v elynewmedi um t
hatdisti
ngui
shesdif
f entCandi
er da
speciesbycolourasar esultofbi ochemicalreacti
ons.Example:Gr
eencolourcolonywas
observedinC.albicans,bl
uecol onieswi t
hdar kcentersurr
oundedbygreyholl
owi nC.
tr
opicali
s.Pi
nkr oughandspr eadi ngcolonieswithboardwideedgesofC.krusei,et
c.

PATHOGENI
CITY:
Themostst edCandi
udi daspeci C.al
es, bicanshassev
eral
knownv
irul
encef
act
ors
contri
buti
ngt oi
tspathogeni
cit
ythati
ncludestheat
tachmenttoepithel
ial
andendot
hel
ial
cell
s,prot
einaseproducti
on,
pseudohyphaef or
mati
on,phenotypi
cswitchi
ng,
phosphol
i
pase
producti
onandantigenicmodulat
ionasar esul
tofpseudohyphaeformati
on.
Af t
eryeastcellsofCandidaencount erpar t
icularhostt i
ssues,col
oni sat
iont akesplaceat
thelocalsiteoriti
nvadesdeeperi nt
ot hehostt ssues.C.al
i bi
cansandC.t ropical
isproduce
aspartylprot nase i
ei nv iv
o, whichisani mpor tantfactorforpathogenicit
y.The
transf
ormat ionint
othehy phal f
ormi sobser veddur i
nganact i
veinfecti
on.The
phosphol i
paseconcentratedatt hehy phalti
pmakest hehyphaemor einvasiveascompar ed
tothey eastform.Moreov er,hyphaebei nglargerthant heyeastform aremor eresi
stantto
phagocy tosi
s.
Candidaalbi
canshav etheabil
it
ytoform biofi
l
msonl iv
ingandnon-l
ivi
ngsurfaces,
suchas
mucosal membranesandcat heter
s,respecti
vely
.Af t
ertheatt
achmentofy eastcel
l
st othe
sur
f ace,
ther
eisdevelopmentofhy phaecellsintheupperpartofthebiofi
lm.Event
uall
y,thi
s
l
eadst oamor eresi
stant,matur
ebiofil
m andthedi spersi
onofyeastcell
sbothcontri
buti
ng
tothepathogen’
sv i
rulence.
MODEOFTRANSMI
SSI
ON:
Candidaal
bicansisusual
l
ytransmi
tt
edfr
om mothert
oinfantt
hroughchi
l
dbi
rt
h,l
act
ati
on
per
iod,andremainsaspartofanor
malhuman’
smi cr
ofl
ora.
Candi
diasi
sdoesnottypicall
ypassf r
om onepersontoanotherbutiti
spossi
ble.Vaginal
candi
diasi
smaybetransmi tt
edduringint
ercour
se.People-
to-
peopleacqui
redi
nf ect
ions
mostl
yhappeninhospitalsett
ingswhereimmunocompr omisedpatient
sacqui
ret heyeast
fr
om healt
hcar
eworkers;studiesshowabouta40%i nci
dentrate.

LABORATORYDI
AGNOSI
S:
Specimensofski narecol
l
ectedi ntofol
dedsquaresofblackpaperorcar
d.Forinf
ect i
onof
themout horv agi
na,t
hescrapingsar et
akenwithabluntscal
peloraspatul
afrom thearea
withwhiteplaques.I
ncaseofer ythema(reddeni
ng),
swabscanbeusedwhi chmustbe
moi st
enedwi t
hsteri
lewaterorsalinebefor
etaki
ngasampl eandsenttothelaboratoryi
n
cleartr
ansportmedium.
1.Bloodcul
turetest
:Itist
hemostcommontestforCandi
diasi
swher
ethebl
oodsampl
eis
takenandsenttothelabor
ator
ytoseet
hegr
owt hofCandi
daspeci
es.
2.Gram st
aini
ng:I
nGram-st
ainedsmearsofmucousmembr
anesampl
es,
thef
ungusi
s
seenasabuddinggram-
posit
iveyeastcel
l
.
3.KOHPr eparati
on:Thisi
sasimple,
non-i
nvasi
veprocedur
ef ordiagnosingfungal
i
nfecti
onsoft heski
nandnail
s.Cel
lsareobtai
nedfr
om theaffectedarea, pl
acedonaslide
withasoluti
onconsist
ingofKOH,andexaminedundermicroscopet olookforsignsof
fungusinf
ecti
on.
4.Radi
odiagnosis:
Thistechni
quehasbeenhelpf
ulfort
hedi
agnosi
sofdeep-
seat
ed
candi
diasi
stolocal
isethesit
eandextentoft
helesi
ons.

TREATMENT:
1.I
ntr
avenousAnt
i-
fungal
Medi
cat
ions:Ex
ampl
e;Amphot
eri
cinB.i
sapol
yenesubst
ance
thati
soneofthemosteff
ect
ivedr
ugsforthet
reat
mentoffungalinf
ecti
ons.Theef f
ici
ency
andrenal
safet
yofAmphoter
ici
nBwasassessedin>900patient
swi t
hcandidiasi
s.
Amphoteri
cinBcanbecombi
nedflucy
tosi
neincasesofsy
stemicCandidiasi
s.
2.ImidazoleGroup:Fluconazole,
mi conazole,cl
otr
imazoleareusedf orthetr
eatmentof
superfi
cial
candidi
asisandchr oni
cmucocut aneouscandidi
asis.TheImidazolegroup
contai
nsant i
-bact
eri
al,anti
-f
ungal,anti
protozoalandanthel
mintic(anti
parasi
ti
c)proper
ti
es.
3.Gr
anulocyt
eTr ansf
usion:Theyarenotusedonawidescalebasi
s,andthei
ref
fi
ciency
hasnotbeenclearl
yestabl
ishedfr
om theti
meitwasdiscov
eredti
ll
date.
4.Remov ingpr edi
sposi
ngf act
ors:Pr
edisposingfactorsarethecondi
tionsandact
ivi
ti
es
thatcanleadt othedevelopmentofdiseaseswithinal i
vi
ngorgani
sm.Fort her
emovalof
thesepredisposingfact
ors,maint
aini
ngpr operhygiene,di
etandnutr
it
ioncanenhancethe
i
mmunesy st
em.