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 and genitourinary tracts, but when there is an imbalance in the ecological niche, they can invade and cause disease.
Most common risk factors include broad-spectrum antibiotic use, central venous catheter use, receipt of parenteral nutrition, receipt of renal placement therapy by patients in ICUs, neutropenia, implantable prosthetic device use and receipt of immunosuppressive agents.

Diagnosis

  • Laboratory exams are used to help identify the different Candida species and susceptibility to antifungals

Laboratory Tests

Cutaneous Candidiasis
Skin
  • Gram stain or potassium hydroxide (KOH) mount showing predominantly Candida sp
Paronychia and Onychomycosis
  • Gram stain or KOH mount showing predominantly Candida sp
Mucosal candidiasis
Oropharyngeal
  • Gram stain or KOH preparation showing masses of hyphae, pseudohyphae and yeast forms
  • Culture is not reliable because Candida grows easily from normal mouths
  • Irregular esophageal mucosa on radiologic studies
Esophageal
  • Definitive: Biopsy during endoscopy or by brushing
  • In appropriate clinical settings, endoscopic appearance of white patches that show masses of hyphae and pseudohyphae on scraping is enough evidence to initiate therapy
  • To avoid invasive procedures, empiric antifungal therapy may be given to an at-risk patient who presents with typical symptoms along with oral thrush

Intra-abdominal

  • Single or multiple ulcerations containing Candida deep in ulcer beds on endoscopy; white plaques and thickening of mucosal folds in the duodenum and jejunum may also be seen
Vulvovaginal
  • Confirmed by presence of yeast or hyphae and a normal pH (4-4.5) in a wet-mount preparation with the use of saline and 10% potassium hydroxide
Chronic Mucocutaneous Candidiasis
  • Culture and biopsy of involved areas/organs
Invasive Candidiasis
Candidemia
  • Definitive diagnosis can be made only by histopathologic demonstration of the organism invading tissue or by the isolation of Candida sp from normally sterile body sites eg blood
  • However, blood cultures are negative in many patients with disseminated infection
  • A presumptive clinical diagnosis based on the presence of typical signs and symptoms in a high-risk patient is often the basis for initiating antifungal therapy
Chronic Disseminated (Hepatosplenic)

  • Definitive: Biopsy with culture and histopathologic exam or aspiration of  ≥1 abscesses in an attempt to identify the infecting organism
Endocarditis
  • Blood cultures may be negative in mamy patients
  • The presence of endophthalmitis and major embolic episodes should raise suspicion of candidal endocarditis
Endophthalmitis
  • Dilated retinal examination
  • Fundoscopy shows large and off-white cotton ball-like lesions with indistinct borders; cellular aggregates can be seen in vitreous; hemorrhages, Roth Spots, hypopyon, anterior chamber inflammation, iritis
  • Vitrectomy is helpful diagnostically and therapeutically
Genitourinary Tract
  • Renal involvement is indicated by granular casts with hyphal elements on urinalysis
  • Urine fungal culture
  • Cystoscopic visualization with biopsy either biopsy-proven fungus ball or tissue invasion is necessary to determine presence of disease invasion
Central Nervous System
  • Cerebrospinal fluid (CSF) findings: Pleocytosis, hypoglycorrhachia and elevated protein levels, wet mount Gram stain positive for Candida sp
Pulmonary
  • Definitive diagnosis: Biopsy with demonstration of tissue invasion
  • Positive sputum cultures usually represent colonization rather than active infection and therefore should not prompt treatment
Peritonitis
  • Culture of peritoneal fluid
Musculoskeletal
  • Blood cultures are usually negative
  • Osteomyelitis may be diagnosed by percutaneous needle aspiration of the involved area
Infection of the Vasculature
  • Cultures of blood and involved veins

Imaging

Chronic Disseminated (Hepatosplenic)
  • Computed tomography (CT) scan/magnetic resonance imaging (MRI) scan/ultrasonography reveal multiple hepatosplenic filling defects and/or abscesses
  • CT scan is the most specific diagnostic tool
    • The lesions are hypodense and many times have ring enhancement
Endocarditis
  • Echocardiography is used to detect vegetations
Central Nervous System
  • CT scan may show abscesses
Pulmonary
  • X-ray and CT scan are nonspecific
Musculoskeletal
  • X-ray: Nonspecific
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Infectious Diseases - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
30 Nov 2017
Fluarex Tetra - Inactivated quadrivalent influenza vaccine (split virion) vaccine (inj) 0.5 mL - GlaxoSmithKline
02 Nov 2017
In this issue of MIMS Anti-Infective Supplement, we bring you clinical updates related to combating infectious diseases, and also a symposium highlight in conjunction with the launch of ceftolozane/tazobactam (Zerbaxa; Merck Sharp & Dohme Sdn Bhd) in Malaysia. 
Stephen Padilla, 20 Nov 2017
Diclofenac reduces the use of antibiotics in women with uncomplicated lower urinary tract infection (UTI) but remains less effective than norfloxacin for symptom relief of UTI, according to a recent study. In addition, diclofenac appears to be associated with an elevated risk of pyelonephritis.