Candidaisis species
Introduction and History
Candidiasis is a fungal infection caused by yeasts from the genus Candida.
The most common species is Candida albicans. Historically, candidiasis
was first described by Hippocrates around 400 B.C. as “mouths affected
with aphthous ulcerations”. The term “thrush” was used in the 17th
century to describe oral candidiasis. Over time, the understanding of
candidiasis has evolved, with significant advancements in diagnosis and
treatment.
Mycological Classification
The genus Candida includes over 150 species, but only a few are
pathogenic to humans. The major pathogenic species include :
Candida albicans : The most common cause of candidiasis.
Candida glabrata : Known for its resistance to antifungal treatments.
Candida tropicalis : Frequently found in patients with hematologic
malignancies.
Candida parapsilosis : Often associated with catheter-related infections.
Candida krusei : Notable for its intrinsic resistance to fluconazole.
Modes of Transmission
1. Candida albicans
Direct Contact: Transmission through direct contact with infected individuals or contaminated
surfaces.
Mother-to-Infant: During childbirth, C. albicans can be transmitted from mother to baby.
Breastfeeding: Infected infants can pass the yeast to their mothers’ nipples during
breastfeeding.
Endogenous Spread: Overgrowth of the yeast already present in the body, often due to a
weakened immune system or disruption of normal microbiota.
2. Candida glabrata
Nosocomial Transmission: Common in hospital settings, especially through contaminated
medical devices like catheters and respirators.
Direct Contact: Can be transmitted through direct contact with contaminated surfaces or
healthcare workers.
3. Candida tropicalis
Nosocomial Transmission: Often transmitted in healthcare settings, particularly in patients
with compromised immune systems.
Direct Contact: Through contact with contaminated surfaces or medical equipment.
4. Candida parapsilosis
Nosocomial Transmission: Frequently associated with contaminated medical devices such as
catheters and prosthetic devices.
Direct Contact: Can spread through contact with contaminated surfaces or healthcare workers.
5. Candida krusei
Nosocomial Transmission: Commonly transmitted in hospital environments, particularly
through contaminated medical equipment.
Direct Contact: Through contact with contaminated surfaces or healthcare workers.
Clinical Manifestation
Candida albicans : Causes oral thrush, vaginal yeast infections, and
invasive candidiasis. Symptoms include white patches in the mouth,
itching, and discharge.
Candida glabrata : Often causes bloodstream infections, particularly in
immunocompromised patients. Symptoms include fever and chills.
Candida tropicalis : Common in patients with hematologic malignancies.
Symptoms include fever and sepsis.
Candida parapsilosis : Associated with catheter-related infections.
Symptoms include fever and sepsis.
Candida krusei : Known for its resistance to fluconazole. Symptoms include
fever and sepsis.
Pathophysiology
Candida albicans : Adheres to epithelial cells, forms biofilms, and secretes
hydrolytic enzymes that damage host tissues. It can switch between yeast
and hyphal forms, aiding in tissue invasion.
Candida glabrata : Exhibits high resistance to oxidative stress and can
survive in macrophages. It does not form true hyphae but can adhere to
host cells effectively.
Candida tropicalis : Produces biofilms and secretes enzymes that degrade
host tissues. It is highly virulent in neutropenic patients.
Candida parapsilosis : Forms biofilms on medical devices and secretes
lipases. It is often associated with infections in neonates and patients with
intravenous catheters.
Candida krusei : Adapts to various environmental conditions and exhibits
resistance to antifungal agents. It is less virulent but poses a significant
challenge due to its drug resistance.
Laboratory Diagnosis
Candida albicans
Identified by germ tube test, culture on CHROMagar, and molecular
methods. The germ tube test is a rapid method to differentiate C. albicans
from other species.
Candida glabrata
Detected using biochemical tests and molecular methods. It often requires
specific media for accurate identification.
Candida tropicalis
Identified by culture characteristics and molecular techniques. It produces
distinctive colonies on CHROMagar.
Candida parapsilosis
Diagnosed using biochemical tests and molecular methods. It can be
identified by its unique colony morphology.
Candida krusei
Identified by its resistance profile and molecular methods. It shows
characteristic growth patterns on selective media.
Treatments
Candida albicans : Treated with fluconazole, echinocandins, or
amphotericin B. Topical antifungals are used for localized infections.
Candida glabrata : Often requires echinocandins or amphotericin B due to
resistance to fluconazole. Combination therapy may be necessary for
severe infections.
Candida tropicalis : Treated with fluconazole or echinocandins. Early
intervention is crucial in immunocompromised patients.
Candida parapsilosis : Managed with fluconazole or echinocandins.
Removal of infected catheters is often required.
Candida krusei : Requires echinocandins or amphotericin B due to intrinsic
resistance to fluconazole. Monitoring for resistance development is
important.
Prevention and Control
Candida albicans : Good oral hygiene, avoiding unnecessary antibiotics,
and using antifungal prophylaxis in high-risk patients. Probiotics may help
maintain healthy microbiota.
Candida glabrata : Minimizing use of broad-spectrum antibiotics and
maintaining good hygiene. Regular monitoring in high-risk patients is
recommended.
Candida tropicalis : Similar to C. glabrata, with emphasis on hygiene and
careful use of antibiotics. Prophylactic antifungals may be used in
neutropenic patients.
Candida parapsilosis : Proper care of catheters and other medical devices.
Sterile techniques in neonatal care units are crucial.
Candida krusei : Avoiding unnecessary use of fluconazole and maintaining
good hygiene. Regular surveillance for antifungal resistance is necessary.
