Candidiasis

CAUSATIVE AGENT:-

Small, oval, thin-walled, budding cells with or without the presence of pseudohyphae
Stains gram-positive
C. albicans is identified by the ability to produce germ tubes and/or chlamydospores in cornmeal agar
All Candida species may be distinguished by sugar fermentation tests.

Epidemiology

Normal host saprophyte yeasts found commonly in the gastrointestinal tract, genitourinary tract and oropharynx
Worldwide distribution
70% of nosocomial candidal infections are due to C. albicans with the rest due to C. glabrata, C. guilliermondii, C. krusei, C. pseudotropicalis, C. stellatoidea and C. tropicalis
Fifth most common blood pathogen isolated from hospitalized patients and the fourth most common in ICU patients
Risk factors for candidiasis:
age extremes
central venous catheters
TPN
burns
exogenous hormone therapy
prosthetic devices
malnourishment
metabolic disease
concurrent infections with other pathogens
antibiotic therapy
uncontrolled diabetes mellitus
GI surgery
AIDS
mechanical disruption of epithelial surfaces
physiological impairment of epithelial barrier function

Clinical syndromes

Candiduria
Cutaneous
Disseminated
Oral candidiasis
Vulvovaginitis

Diagnosis

Diagnosis is dependent on visualization of budding yeast (with or without pseudohypha) and the presence of clinical symptoms
culture
KOH preparation
Gram's stain

Comments on treatment

Cutaneous
Requires drying
Nystatin powder or imidazole (Butoconazole, Clotrimazole, Miconazole , Tioconazole ) powder
Topical steroids initially
Paronychia may require topical imidazole up to 3 months
Oral candidiasis:
Nystatin, Fluconazole, Itraconazole, Clotrimazole.
Candiduria:
Remove predisposing factors, (ie, Foley catheter)
Recommended: Amphotericin B (conventional)
Alternative: Fluconazole
Disseminated:
Drainage or debridement
Recommended: Amphotericin B (conventional)
Alternative: Fluconazole (not effective against C. krusei or C. glabrata)
Endophthalmitis may require subtenonian or intracameral injection of Amphotericin B (conventional)
Vulvovaginitis:
Imidazole derivatives (Butoconazole, Clotrimazole, Miconazole , Tioconazole ) and triazole derivative (Terconazole) (85% to 90%) are more effective than Nystatin
Extensive vulvar inflammation usually requires topical cream
Resistant or recurrent infections: oral agents (Ketoconazole, Fluconazole or Itraconazole)
Prophylaxis: Ketoconazole and Fluconazole