CANDIDIASIS full report
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CANDIDIASIS
INTRODUCTION

Candidiasis is an infection of skin, mucosa & rarely of internal organs, caused by yeast-like fungus Candida albicans.
C. albicans is member of normal microbiota within gastrointestinal tract, respiratory tract, vaginal area & mouth.
In healthy individuals, C. albicans does not produce disease. Growth is suppressed by other microbiota.
However, if anything upsets normal microbiota, Candida may multiply rapidly & produce candidiasis.
Most infections involve skin or mucous membranes. This occurs because C. albicans is strict aerobe & finds such surfaces very suitable for growth.
Cutaneous involvement usually occurs when skin becomes overtly moist or damaged.
Types of Candidiasis
Oral candidiasis or thrush- common disease in newborns. Creamy white patches appear on tongue or buccal mucosa that leave a red oozing surface on removal.
Paronychia & onychomycosis- associated with Candida infections of subcutaneous tissues of digits & nails respectively.
These infections usually result from continued immersion of appendages like hands in water.
3. Intertriginous candidiasis involves those areas of body, usually opposed skin surfaces, that are warm & moist: axillae, groin, skin folds.
6. Bronchopulmonary candidiasis- complication of pre-existing pulmonary or systemic disease.
7. Systemic infections such as septicemia, endocarditis & meningitis may occur as terminal complications in diseases like leukemia & in persons on prolonged immuno-suppression.
ORGANISM
Candida albicans is an oval or spherical budding cell; cell elongates & develops pseudo-mycelia.
In sputum both budding cells (i.e. blastospores or yeasts) & pseudomycelia can be seen.
Chlamydospores are present only in C. albicans.
Causative agents- Candida albicans
C. tropicalis
C. pseudotropicalis
C. guilliermondii
C. brumptii
C. parapsilosis
C. krusei
Under normal conditions, Candida spp. saprophytes.
In human beings, C. albicans is an endo-saprophyte of GI tract & vagina.
Common predisposing factor -diabetes
LAB DIAGNOSIS
Collection of infected material- Skin or nail scrapings, mucous patches from mouth, vagina or anus, sputum, blood, CSF or faeces (collected in sterile conditions or as smears on slides).
Microscopy- Skin & nail scrapings mounted in 10% KOH, with a coverslip & heated gently.
Sputum or mucous material should be pressed to a thin film with a cover glass on slide.
Stained by Gram method or Lactophenol Cotton blue.
Candida seen as ovoid yeast measuring 2.5-4µm in diameter & as budding yeast cells.
Pseudo-mycelium present in most cases (indicates colonization & tissue invasion).
3. Culture- On SDA at room temperature & at 25-37°C.
Colonies are creamy white, smooth & with a yeasty odour.
C. albicans forms chlamydospores on corn meal agar at 20°C.
4. Germ tubes- C. albicans forms germ tubes within 2h when incubated in human serum at 37°C (Reynolds- Braude phenomenon). Germ tubes seen as long tube like projections extending from yeast cells.
5. Antigen detection- Tests (ELISA, RIA) for detection of Candidal antigen.
6. Animal inoculation test- C. albicans pathogenic for rabbits, guinea pigs & mice.
Intravenous inoculation of C. albicans in rabbits kills animal in 4-5 days with typical abscesses in kidney. Test not much of diagnostic value.
Treatment & Prevention
No specific treatment for candidiasis; Candida resistant to all antibiotics.
Remove predisposing factors in all cases.
Affected area should be kept dry.
Superficial infections (Cutaneous lesions) treated with topical agents like Sodium caprylate, Sodium propionate, Gentian- violet, Nystatin, Miconazole & Trichomycin.
Systemic candidiasis- Ketoconazole, Amphotericin- B, Flucanazole, Itraconazole & Flucytosine.
Disseminated candidiasis- Amphotericin-B, 5-Fluorocytosine & Clotrimazole.
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