What is Candidiasis?

Candidiasis

• Wide range of infections
• Candida albicans is the most virulent species
• Candida spp. are common organisms of the skin, GI and UG tracts.
• Candidiasis is a disease of compromised hosts.

Mucocutaneous (T CELL IMPAIRMENT)
Systems affected:

• GI tract, skin, vagina
• Onychomycosis
• Keratitis

Symptoms: Odynophagia, stridor etc.
Diagnosis: White pseudomembranous plaques with hyphae, pseudohyphae, and budding yeast.
                          
Direct smear of urine from a patient with candidiasis of the kidney showing C.albicans in mycelial or tissue with blastoconidia budding from the pseudohyphae

                           

Screening test for the identification of C.albicans.

Production of germ tubes by C.albicans in serum or plasma after 2-3 hours incubation at 37 degree/Centigrade.

> Groups at risk

• HIV patients
• Diabetics
• Pregnancy
• Age
• Antibiotics
• Steroids

Chronic mucocutaneous candidiasis – autoimmune polyendocrinopathy candidosis ectodermal dystrophy
• Inherited disorder of CMI to candida along with polyendocrinopathies
• Intractable candida infection of the mucocutaneous areas
• Concurrent adrenal insufficiency and hypoparathyroidism

• Type I diabetes
• Hypothryroidism
• Hypogonadism
• Ectodermal dystrophy

Deeply invasive Candidiasis (think CANCER)
> Systems affected/ symptoms and signs:

• Candidemia
• Endocarditis – organism is sticky
• Hepatosplenomegaly
• Acute, shock-like syndrome
• Renal dysfunction

> At risk groups:  

• Altered barriers
• Neutropenia
• Transplant
• Hemodialysis

> Pathogenesis

• Adherence and colonization
• Penetration through mucosal barriers and angioinvasions/access through catheters
• Hematogenous spread
• Replication yields necrosis +/- abscess with budding yeast and hyphae

Look at the fundus!  Candida goes to the eyes!

Virulence factors of Candida

• Surface receptors
• Cell wall is an immune modulator
• Hydrolytic enzymes – e.g. acid protease, phospholipase
• Host mimicry – e.g. C3D receptor
• Dimorphism – makes it hardy!    >> Germ tube + species.

Following are the examples of Candidiasis of some specific areas

Angular Cheilitis an intertrigo and fissuring caused by maceration of the corners of the mouth is 

frequently complicated by chronic infection with C.albicans.

Interdigital Candidiasis of the hands may develop particularly in persons whose hands stay wet,

especially with sugar solution or contact with flour.

Interdigital candidiasis of the feet explain 1% of cases or athletes foot and must be distinguished from tinea pedis

caused by dermatophytes.

Intertriginous or flexural candidiasis of the groin may also mimic tinea cruris caused by a dermatophyte.

Note erythematous scaling lesions with distinctive border and several small satellite lesions.

Intertriginous or flexural candidiasis behind the knee showing an extensive erythematous scaling lesion and several smaller satellite lesions caused by C.albicans.