opportunistic pathogenic

About Candida albicans

common member of the human gut flora

Small, oval, measuring 2-4 µm in diameter larger than bacteria

• Normal condition: Yeast (unicellular, reproduce by budding)

yeast and pseudo-hyphae
• Special condition (pH, Temperature): Pseudohyphae
Polymorphic fungus
true hyphae
Morphology gram positive
( 80-90% of cell wall is carbohydrate)
Can form biofilms

Creamy, pasty colonies, smooth after 24-48 hours at 25-37°C

Yeast smell (odour)

Yeast, pseudohyphae and hyphae, Hyphae

Polymorphism:
is more important for infection
Candida albicans Sets of glycosylphatidylinositol (GPH)- linked cell surface
Adhesins (Als 3 Protein):
glycoproteins that allow it to the surfaces of microorganisms

Helps with the invasion of C. albicans into

Pathogenesis Invacins (Als 3 Protein):
host epithelial and endothelial cells

Biofilm Formation

3 main classes of hydrolases:

Secreted hydrolases Helps in active penetration into host cells
proteases, phospholipases and lipases.

● local overgrowth on mucous membranes (oropharyngeal involvement, vaginitis)

The most benign infections
● result of changes in the normal microbiota
● affected group : individuals with deficiencies in cell-mediatedimmunity, such
as acquired immunodeficiency syndrome (AIDS).

infections
In the neutropenic host or the severely ill ● widespread visceral dissemination
patient in the ICU ● Candida species gain access to the bloodstream

Invasive focal infections, such as ● after hematogenous spread

pyelonephritis, endocarditis, and
meningitis
● when anatomic abnormalities or devices are present (eg,
prosthetic heart valves or central nervous system shunts)
 LOCAL MUCOCUTANEOUS INFECTIONS
Batool Jamal

Oropharyngeal candidiasis / thrush Esophageal candidiasis Metal modified GIC

●infants ● human immunodeficiency virus (HIV) / AIDS ● 29– 49% of premenopausal women reporting at least one episode of
● older adults who wear dentures ● patients with hematologic malignancies candidiasis
● patients treated with antibiotics, chemotherapy, ● Candida spp. may be found in the lower genital tract of 10–20% of
or radiation therapy to the head and neck asymptomatic women
● patients with cellular immune deficiency states,
affected group such as AIDS ● Diabetes
● HIV
● recent antibiotics
● pregnancy
✖️ Candidal infection is uncommon in prepubertal women
● White patches on the inner cheeks, tongue, roof of the ● pruritus
mouth, and throat (photo showing candidiasis in the mouth) ● dysuria
● Redness or soreness ● pain or difficulty with swallowing ( the halmark) ● dyspareunia
Symptoms ● Cotton-like feeling in the mouth --> Patients usually localize their pain to a discrete
● Loss of taste retrosternal area
● Pain while eating or swallowing
● Cracking and redness at the corners of the mouth
scraping the lesions with a tongue depressor and endoscopy microscopy is negative in
performing a Gram stain or potassium hydroxide (KOH) pH and microscopy or point- around 50% of cases.
preparation on the scrapings mucosal plaque-like lesions are noted of-care molecular tests
Vaginal pH is around 4– 4.5
Budding yeasts with or without pseudohyphae are seen
10% KOH may allow recognition of yeast and hyphae
diagnosis
only 34% of those women self- diagnosing
Self-diagnosis unreliable
candidal infection actually had it

patients with persistent discharge

or recurrent symptoms culture
unresponsive to azole treatment

picture

topical therapy relieving symptoms more

90% of cases represent uncomplicated
rapidly
1) Oral and topical treatments are similarly infections (healthy, non- pregnant women with
effective mild/ moderate symptoms, infrequent episodes
oral being preferred by women, e.g. PO and infection with C. albicans).
fluconazole

treatment 2) The immunosuppressed and those with

7– 14 days of topical therapy is
severe symptoms are unlikely to respond to
recommended
short treatment courses

Oral azoles are

treat only for symptoms using a topical
3) Pregnancy
imidazole for 7– 14 days (e.g. clotrimazole)
pregnancy ✖️✖️✖️
contraindicated in
 Those with hematologic malignancies

those requiring intensive care / Immunocompromised Recipients of solid organ or

affected group
patients at special risk for candidemia include: hematopoietic cell transplants

Those given chemotherapeutic agents

for a variety of different diseases

Candidemia refers to presence of Candida species in the blood.

Candida in a blood culture should never be viewed as a contaminant

and should prompt evaluation for metastatic infection.

osteoarticular infection
Invasive candidiasis refers to systemic Candida infection, in the
About candidemia
presence or absence of candidemia include :
hepatosplenic candidiasis
Invasive candidiasis / candidemia
Candidemia is the most common manifestation of invasive candidiasis.

important nosocomial infection. Although Candida albicans is the

most common cause of candidemia,

vary from minimal fever to a full-blown sepsis syndrome

that resembles severe bacterial infection

Invasive candidiasis is defined by hematogenous spread to

multiple viscera (eg, eye, kidney, heart valves, brain)

positive culture.
The clinical manifestations of candidemia The gold standard for the diagnosis
Blood cultures yield Candida species.
Invasive Candida infections
● echinocandins Candida infections acquired in hospital
" candidemia " early and appropriate antifungal therapy ● azoles settings appear to be more resistant to
● amphotericin B certain antifungals
Management / treatment consists of
targeted source control such as central
venous catheter removal (if present).

● an emerging yeast that can be misidentified as other organisms

about ● is multidrug resistant
● can spread in healthcare settings.
should be obtained from a normally sterile site (e.g., bloodstream,
Invasive Candida infections – cerebrospinal fluid) be identified to the species level so that appropriate
yeast isolates
Candida auris initial treatment can be administered based on the typical, species-specific
susceptibility patterns

Reports of echinocandin- or pan-resistant C. auris cases in the world are increasing. Multiple
outbreaks have been identified involving people with overlapping healthcare exposures and
without previous antifungal treatment, suggesting transmission of resistant strains
 A widespread encapsulated yeast that inhabits soil around pigeon
about
roosts

● AIDS
affected group ● cancer
● diabetes patients
Cryptococcus neoformans Infection of lungs leads to cough, fever, and
" cryptococcosis" lung nodules
infections
Dissemination to meninges and brain can cause
severe neurological disturbance and death.

Microscopic India Ink for capsule stain (50-80% + CSF)

Diagnosis • Bird seed agar

• Routine blood culture
Culture
• PCR
• Sabouraud agar

Very common airborne soil fungus

about
600 species, 8 involved in human disease A. fumigatus most commonly

Other fungal infections with ● AIDS

invasive potential affected group ● leukemia
● transplant patients
Aspergillosis: Diseases of the
spores germinate in lungs and form fungal
Genus Aspergillus usually occurs in lungs balls; can colonize sinuses, ear canals,
eyelids, and conjunctiva
Infection
Bronchopulmonary allergy or Invasive aspergillosis in preformed
cavitis can produce necrotic pneumonia, and infection of brain, heart,
and other organs.

treatment Surgery , Amphotericin B and nystatin

affected group immunocompromised persons, particularly those with AIDS

depends on finding organisms of typical morphology in

PNEUMOCYSTIS appropriate specimens (Sputum, BAL)
diagnosis
Pneumocystis jirovecii
The organism has not been grown in culture ✖️✖️✖️ instead we perform a biopsy

PJP does not respond to antifungal treatment✖️✖️

TMP-SMX is treatment of choice ✔️✔️

treatment