candidiasis
CANDIDIASIS
Candida sp are the most common cause of fungal infections.
 It can cause infections that range from benign mucocutaneous illnesses to invasive process that may affect any organ.
 It is considered as normal flora in the gastrointestinal & genitourinary tracts, but when there is an imbalance in the ecological niche they can invade & cause disease.
Most common risk factors include: broad-spectrum antibiotics use, central venous catheters use, receipt of parenteral nutrition, receipt of renal placement therapy by patients in ICUs, neutropenia, implantable prosthetic devices use & receipt of immunosuppressive agents.

Introduction

  • Candida sp are the most common cause of fungal infections
  • It can cause infections that range from benign mucocutaneous illnesses to invasive process that may affect any organ
  • Considered as normal flora in the gastrointestinal & genitourinary tracts, but when there is an imbalance in the ecological niche they can invade & cause disease

Signs and Symptoms

Cutaneous Candidiasis
Skin
  • Signs & symptoms: Erythematous papules or macules that may be confluent & are very pruritic
  • Usually occurs in warm moist places (eg inguinal, axillary & intergluteal regions)
Paronychia & Onychomycosis
  • Signs & symptoms of paronychia: Well-localized area of inflammation that becomes warm, glistening, tense & may extend extensively under the nail
Mucosal Candidiasis
Oropharyngeal
  • Signs & symptoms: Creamy white, curd-like patches on the tongue & other oral mucosal surfaces

Esophageal

  • Symptoms: Painful swallowing, a feeling of obstruction on swallowing, substernal chest pain, N/V
Non-esophageal Involvement of the GIT
  • Symptoms: Abdominal pain (symptoms of gastritis)
Chronic Mucocutaneous Candidiasis
  • A group of disorders that includes Candida infections of the skin, mucous membranes, hair & nails characterized by a protracted & persistent course despite what is usually adequate therapy
  • Signs: Alopecia, esophageal stenosis, disfiguring lesions of the face, scalp, hands

Candidemia & Acute Hematogenously Disseminated Candidiasis

  • Positive for Candida in a single central-line or peripheral blood culture (BC)
  • The following factors predispose to the condition:
    • Abdominal surgery
    • Neutropenia
    • Broad-spectrum antibiotics
    • Indwelling IV catheters
    • Peripheral alimentation
    • Cancer chemotherapy
    • Immunosuppressive therapy in transplant patients
    • Colonization w/ Candida sp
  • Clinical features include:
    • Fever of unclear etiology
    • Sepsis syndrome
    • Signs of multiple organ involvement including the kidney, brain, myocardium & eye
  • Macronodular skin lesions
  • Endophthalmitis
  • Suppurative manifestations ie micro- & macro-abscesses
Specific Deep Organ Candidal Infections
Hepatosplenic
  • Most infections occur in severely immunocompromised patients & manifest during their recovery from neutropenia
  • Signs & symptoms: Persistent fever, abdominal pain, hepatosplenomegaly, increased alkaline phosphatase levels, leukocytosis
Endocarditis
  • Candidal endocarditis is associated w/ the following factors:
    • Underlying valvular heart disease
    • Heroin addiction
    • Cancer chemotherapy
    • Implantation of prosthetic valves
    • Prolonged use of IV catheters
    • Preexisting bacterial endocarditis
  • Signs & symptoms are similar to bacterial endocarditis w/ the exception of the occurrence of large emboli to major vessels & include the following:
    • Hepatosplenomegaly
    • Hematuria, proteinuria, pyuria
    • Splinter hemorrhages
    • Osler’s nodes
    • Janeway lesions
GUT
  • Risk factors:
    • Diabetes
    • History of previous antibiotic use
    • Indwelling urinary catheters
    • Immunosuppressive therapy
  • Male patients: Urethral candidiasis usually results from sexual contact w/ women w/ Candida vaginitis
  • Female patients: Urethral candidiasis infection may be acquired from the extension of Candida vaginitis
  • Signs & symptoms: Lower tract infection (cystitis) is usually asymptomatic but may present w/ dysuria, hematuria, frequency
CNS
  • Most cases occur in the setting of trauma, neurosurgery, immunosuppression or AIDS
  • Signs & symptoms:
    • Meningeal irritation (eg headache, stiff neck, irritability)
    • In the comatose or non-communicative patient, observation of abnormalities is difficult
Pulmonary
  • Signs & symptoms: Fever & cough
Peritonitis
  • Often a complication of peritoneal dialysis, GIT surgery & perforation of an abdominal viscus
  • Prior antibiotic administration is a predisposing factor
Musculoskeletal
  • Signs & symptoms: Arthritis & osteomyelitis (eg similar to disease of bacterial etiology, includes suppurative synovitis)
Infection of the Vasculature
  • Often occur in association w/ IV catheters
  • Signs & symptoms:
    • In patients w/ peripheral septic thrombophlebitis, symptoms may be minimal w/ the extent of the disease being greater than is apparent on initial clinical assessment
    • Patient may have fever, signs of sepsis & persistent candidemia
    • Suppuration & thrombosis may be present
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