1. Candidiasis (candidosis) old name Moniliasis General: This is any infection caused by any species of the yeast fungus Candida or few other yeasts It ’ s considered opportunistic infection affecting compromised individuals Predisposing factors: Young age and elderly, Cancer patients (Malignancies, Lymphoma, broad spectrum antibiotics, altered immunity (AIDS, inherited) Certain drugs (Steroids, immun-osupressive, cytotoxic) For virginities pregnancy-B.C.P-IUCD0adult female Malnutrition and iron deficiencies, diabetes, dentures, xerostomia, intensive care patients and other hospitalized patients The source of the infection is endogenous because Candida species are normal flora of the body

2. Clinical types: A: mucocutaenous and cutaenous: 1.Oral thrush: white or grey pseudo membranous patches on oral surfaces especially tongue with underlying erythema. Common in neonates infants, children, elderly, compromised host, AIDS 2.Diaper (Napkin) rash: rash on groin of diaper wearers 3.Mycotic virginities (vulvovaginitis)=vaginal thrush  Whitish or erythematous patches on vaginal mucosa  Singes: vaginal discharge (whitish yello) and pruritius  Adult ladies especially pregnant, contaceptive users (B.C. P. IUCD) 4. Interigeous candidiasis: erythematous lesions on body skin fold. More seen in over weight individuals 5. Paronochea: infection of tissue distal or nail 6. Onychomycosis: nail infection

3. B. bronchopulmonary candidiasis: bronchitis/pneumonia in compromised host-diagnosis difficult C. Other opportunistic systemic candidiasis: 1.Urinary tract infection -105 CFU/ml MSU 2.More seen in catheterized patients 3.Septicemia: blood infection-more than one culture 4.Meningitis in compromised host

4. Etiology ” Any species of the genus Candida. Candida is a yeast fungus It is imperfect, reproducing asexually by budding It has a cream moist colony, fast growing on Sabouruaud dextrose agar (SDA) and Blood agar Structure on Cornmeal agar (CMA0: budding yeast cells Pseudohyphae. Blastospores It is part of body flora and other habitats There are many species of Candida the common ones to cause infection are Candida albicans C. glaborata C. tropicalis C. krusei C. parapsilosis

5. C. albicnas is the most common species to cause infection among all yeasts (causes about 50% to 60% of the cases, therefore thereare short cut tests to identify it which are:  Germ tube test in serum  Chlamydospore production in CMA  Resistance to 500 ug/ml cycloheximide (will grow on mycobiotic medium) If these 3 are +, yeast is C. albicans, if no other yeasts The test to identify any yeast in the clinical lab. Is carbohydrate assimilations and fermentation. There are commercial kits availablr for this like API20C, ID32, Cand-tech, Miro-ring Yeast other than candida that may cause candidiasis include Sacharomyce cerevisia, Trichosporon beigelii Rhodotorula species

6. Laboratoey diagnosis specimens obtained depends on site of infection Swabs, urine, blood, respiratory specimens, CSF blood for serology,, if available In the lab. Direct microscopic (DM, culture and serology direct M. if + pseudohyphae and budding yeast cells will be seen in stained smear or KOH Culture on SDA and Blood agar at 37C, if + cream moist colonies in 24-48 hrs Identify GTT, chlamydosapores chyclohexamide carbohydrateassimialtion Serology Patient serum test for AG (mannan, enolase, proteinase) or Ab. Use immunodiffusion or counterimmunoelectrophoresis (CIE)

7. Treatment: Oropharyngeal: tropical Nystatin suspention Clotrimazole troches (lozenges), micronazole, fluconazole suspention Vaginitis topical: miconazole. Clotrimazol, nystatin Systemic Rx: amphotericin B, liposomal amphotericin B, fluconazole, caspofungin, voriconazole If resistant to Rx request antifungal sensitivity