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Updated: Dec 9 2021

Candida albicans

  • 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
  • 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
        • 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
  • Prognosis
    • High mortality in invasive candidiasis
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