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 KOH mount showing predominantly Candida sp
Paronychia & 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

Non-esophageal Involvement of the GIT

  • 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
Chronic Mucocutaneous Candidiasis
  • Culture and biopsy of involved areas/organs
Candidemia & Acute Hematogenously Disseminated Candidiasis
  • 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
GUT
  • Renal involvement is indicated by granular casts with hyphal elements on urinalysis
  • Urine fungal culture
CNS
  • CSF findings: Pleocytosis, hypoglycorrhachia and elevated protein levels, wet mount Gram stain positive for Candida sp
  • CT scan may show abscesses
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
  • X-ray and CT scan are nonspecific
Peritonitis
  • Culture of peritoneal fluid
Musculoskeletal
  • X-ray: Nonspecific
  • 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

Specific Deep Organ Candidal Infections
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
  • 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 many patients
  • The presence of endophthalmitis and major embolic episodes should raise suspicion of candidal endocarditis
  • Echocardiography to detect vegetations
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