1. Candida Species

2. Epidemiology Most common fungal pathogen
4th most common nosocomial infection
75% of women may become infected at least once in their lifetime
Common infection in patients with AIDS , cancer ( ex:-leukemia)
Most common fungus affecting immunecompromised

3. Mycology Yeast like fungus There are 6 species that infect man
C. tropicalis, C. glabrata, C. parapsilosis, C.kusei, & C. lusitaniae
The most common species is Candida albicans
Found in mouth , vagina and intestinal tract in small colonies suppressed by immune system and other flora

4. Candida albicans

5. Morphology solitary, unicellular reproduction via budding
rounded shape
moist & mucous colonies

6. Pathogenesis
Surface molecules that permit adherence of the organism to other structures (eg, human cells, extracellular matrix, prosthetic devices)
Acid proteases and phospholipases that involve penetration and damage of cell envelopes
Ability to convert to a hyphal form (phenotypic switching)

8. Virulence assay of different C. albicans
strains using the skin equivalent

9. Figure 1. skin equivalent before infection

10. Figure 2. Infection with pathogenic clinical isolate of C. albicans.
After 48 h the yeast penetrates the skin equivalent and destroys
the tissue

11. Figure 3. Infection with non-pathogenic C. albicans
Figure 3. Infection with non-pathogenic C. albicans. This strain is not able to penetrate into the tissue and thus behaves as a virulent as shown in the mouse model of systemic infection

12. How Does It Cause Disease ? Effects on immune system
Disturb immune system
Stimulate the body to form autoantibodies
Induce endocrinopathies
IgA protease
Contain glycoproteins that stimulate mast cells to release histamine and prostaglandins

13. How Does It Cause Disease Effects of its growth
It assimilates all sugars except lactose.
It depresses the activity of lactase.
Dietary carbohydrates are fungal growth promoters and associated with increased adherence of Candida species to mucosal epithelial cells.
Release of toxic fungal metabolites.

14. Risk Factors of Infection
Physiological:- Pregnancy, age (elderly & infants) ,Diet high in sweets, fruit juices, alcohol
Trauma:- Infection, burn wounds.
Haematological:- Neutropenia, cellular immunodeficiency (leukemia, lymphoma, AIDS, aplastic (anemia

15. Risk Factors of Infection
Endocrinological:- Diabetes mellitus, Addison’s disease, hypoparathyroidism
Iatrogenic:- Chemotherapeutics, corticosteroids, oral contraceptives, antibiotics catheters, surgery
Others:-Intravenous drugs, malnutrition, malabsorption, Chronic Stress

16. Diseases by C. albicans
Thrush
Esophagitis
Cutaneous candidiasis
Genital candidiasis
Deep candidiasis
Note:- Esophagitis and Deep Candidiasis occur only in immuncompromised patients

17. Thrush
Common in infants (Considered normal unless it lasts longer than a couple of weeks.)
Diabetics are more likely to get oral thrush because the extra sugar in their saliva acts like food for Candida.
High antibiotics doses or prolonged use increases the risk of oral thrush. Antibiotics kill some of the healthy bacteria that help keep Candida from growing too much.
Poorly fitting dentures are increases the risk of thrush.
Common in immunocompromised hosts,such as those with HIV infection.

18. multiple white plaques on lips, gingivae, tongue, and palate
Thrush appears as whitish, velvety lesions in the mouth and on the tongue. Underneath the whitish material, there is red tissue that may bleed easily. The lesions can slowly increase in number and size.
Oral thrush
multiple white plaques on lips, gingivae, tongue, and palate

20. Oropharyngeal Thrush Features
Pseudo membranous

21. Oropharyngeal Thrush Features
Atrophy of tongue

22. Oropharyngeal Thrush Features
Angular chelitis

23. Candida Esophagitis

24. Cutaneous Candidiasis
This child has a large rash caused by Candidiasis, affecting the skin around the mouth. There are also other lesions that aren't connected to the large lesion, called "satellite lesions".

25. Vulvovaginal Candidiasis (VVC)
Vulvar component often dominant
Women are often misdiagnosed as having VVC when they really have
- Genital herpes - Contact dermatitis
- Lichen planus - Atrophic vaginitis
- Recurrent BV (Bacterial Vaginosis)

26. Vulvovaginal Candidiasis

27. Deep Candidiasis Four forms of invasive candidiasis
Catheter related candidemia Acute disseminated candidiasis Chronic disseminated candidiasis Deep organ candidiasis

28. Candidemia Onchomycosis Nail infections are much more difficult to
cure and can last a lifetime without proper
treatment

29. Candidemia
Hematogenous seeding
Spread to the eye Can cause blindness

30. Laboratory diagnosis
Specimen
Scrapings of surfaces

31. Visualization of pseudohyphae (mycelia) and/or budding yeast (conidia)
Laboratory diagnosis
Slide preparations
Visualization of pseudohyphae (mycelia) and/or budding yeast (conidia)
KOH or saline

32. Staining Laboratory diagnosis Lacto phenol blue
Gomoris methylamine sliver stains
(GMS)

33. Laboratory diagnosis Culture Sabourauds glucose agar medium
Brain heart infusion.

34. Serology CFT Latex agglutination ELISA Fluorescent Abs
Laboratory diagnosis
Serology
CFT
Latex agglutination
ELISA
Fluorescent Abs

35. Laboratory diagnosis
Other Diagnostic
Methods
Skin test
PCR

36. Candida culture

37. Immunofluorescence

38. Treatment of Candida albicans
Dietary :-
Eliminate all sugar:
–fruit juice
–white flour
–refined grains
Eat a higher protein, lower carbohydrate and high fiber diet.
Avoid fermented foods including alcohol.

39. Treatment of Candida albicans
Antifungal drugs:-
Amphotericin B (Fungizone)
Clotrimazole (Mycelex)
Fluconazole (Diflucan)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Nystatin (Mycostatin)