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.

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

Esophageal

  • Symptoms: Painful swallowing, a feeling of obstruction on swallowing, substernal chest pain, nausea/vomiting
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 and nails characterized by a protracted and 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 intravenous catheters
    • Peripheral alimentation
    • Cancer chemotherapy
    • Immunosuppressive therapy in transplant patients
    • Colonization with Candida sp
  • Clinical features include:
    • Fever of unclear etiology
    • Sepsis syndrome
    • Signs of multiple organ involvement including the kidney, brain, myocardium and eye
  • Macronodular skin lesions
  • Endophthalmitis
  • Suppurative manifestations ie micro- and macro-abscesses
Specific Deep Organ Candidal Infections
Hepatosplenic
  • Most infections occur in severely immunocompromised patients and manifest during their recovery from neutropenia
  • Signs and symptoms: Persistent fever, abdominal pain, hepatosplenomegaly, increased alkaline phosphatase levels, leukocytosis
Endocarditis
  • Candidal endocarditis is associated with the following factors:
    • Underlying valvular heart disease
    • Heroin addiction
    • Cancer chemotherapy
    • Implantation of prosthetic valves
    • Prolonged use of intravenous catheters
    • Preexisting bacterial endocarditis
  • Signs and symptoms are similar to bacterial endocarditis with the exception of the occurrence of large emboli to major vessels and 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 with women with Candida vaginitis
  • Female patients: Urethral candidiasis infection may be acquired from the extension of Candida vaginitis
  • Signs and symptoms: Lower tract infection (cystitis) is usually asymptomatic but may present with dysuria, hematuria, frequency
CNS
  • Most cases occur in the setting of trauma, neurosurgery, immunosuppression or AIDS
  • Signs and symptoms:
    • Meningeal irritation (eg headache, stiff neck, irritability)
    • In the comatose or non-communicative patient, observation of abnormalities is difficult
Pulmonary
  • Signs and symptoms: Fever and cough
Peritonitis
  • Often a complication of peritoneal dialysis, gastrointestinal tract surgery and perforation of an abdominal viscus
  • Prior antibiotic administration is a predisposing factor
Musculoskeletal
  • Signs and symptoms: Arthritis and osteomyelitis (eg similar to disease of bacterial etiology, includes suppurative synovitis)
Infection of the Vasculature
  • Often occur in association with intravenous catheters
  • Signs and symptoms:
    • In patients with peripheral septic thrombophlebitis, symptoms may be minimal with the extent of the disease being greater than is apparent on initial clinical assessment
    • Patient may have fever, signs of sepsis and persistent candidemia
    • Suppuration and thrombosis may be present
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