Updated: 11/21/2018

Candida albicans

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Snapshot
  • A 58-year-old man presents to the emergency room for fevers. He reports having a persistent fever for the past 2-3 days. He denies having any respiratory symptoms or any skin infections. His past medical history includes diabetes, IV drug use, and a recent admission for pneumonia requiring broad-spectrum antibiotics.  He is admitted to the hospital for further management and again started on broad-spectrum antibiotics as well as anti-fungal drugs. A bedside echo reveals vegetations on the tricuspid valve and blood cultures eventually grow Candida.
Introduction
  • Classification
    • Candida albicans
      • yeast with budding and pseudohyphae
      • germ tube formation at 37°C (diagnostic)                                                   
        • true hyphae sprout from yeast
    • immunocompetent hosts usually present with skin and mucous membrane infections
      • oral thrush
        • inhaled corticosteroids
        • HIV patients with CD4+ cell count < 500/mm3
      • candidal intertrigo
        • yeast infection in the skin folds
      • diaper rash
      • vulvovaginitis
      • perleche or angular cheilitis
        • cracks at corner of the mouth
        • associated with malnutrition
    • immunocompromised hosts usually presents with systemic disease
      • esophagitis
        • HIV patients with CD4+ cell count < 100/mm3
      • endocarditis
        • associated with IV drug users
      • disseminated/invasive candidiasis
      • chronic mucocutaneous candidiasis
  • Epidemiology
    • risk factors
      • neutropenia
      • immunocompromised status
      • indwelling catheter
      • hospital admission, especially in the ICU
      • recent use of antibiotics
      • recent use of corticosteroids
  • Pathogenesis
    • neutropenia in patients causes systemic Candida infections
    • T-cell deficiency causes local infections
    • antibiotic use may lead to overgrowth of Candida due to disruption of normal flora
  • Prognosis
    • high mortality in invasive candidiasis

 

 Presentation
  • Oral thrush
    • white plaque on tongue that can be scraped off
  • Intertrigo
    • well-demarcated, erythematous, and itchy patches in skin folds
  • Esophagitis
    • dysphagia
    • throat pain
  • Vulvovaginitis
    • thick “cottage cheese” white discharge
    • itchiness
  • Endocarditis
    • fevers
    • heart failure
    • new murmur
  • Invasive candidiasis
    • fever
    • septic shock
    • pain or swelling at site of initial infection
Imaging
  • Endoscopy
    • indication
      • esophagitis
    • findings
      • white plaques along esophagus
Studies
  • Labs
    • blood or other tissue culture
      • definitive diagnosis
  • Wet mount of vaginal fluid
    • yeast and pseudohyphae visualized with potassium hydroxide
  • Biopsy
    • yeast and pseudohyphae visualized
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
Differential
  • Bacterial infection
    • distinguishing factor
      • cultures will often grow bacteria
Treatment
  • Medical
    • nystatin
      • indication
        • local infections
    • azoles
      • indications
        • local and systemic infections
        • first-line if the fungus is not resistant
    • echinocandins
      • indications
        • systemic infections
        • often first-line due to increased resistance to azoles
    • amphotericin B
      • indications
        • systemic infections
        • second-line or in pregnant women
Complications
  • Disseminated disease

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