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 and cause disease
Signs and Symptoms
Cutaneous Candidiasis
Skin
Oropharyngeal
Skin
- Signs and symptoms: Erythematous papules or macules that may be confluent, very pruritic, frequently pustular with distinct border and sometimes accompanied by creamy white exudate or scaling
- Usually occurs in warm moist places (eg inguinal, axillary and intergluteal regions)
- Signs and symptoms of paronychia: Well-localized area of inflammation that becomes warm, glistening, tense and may extend extensively under the nail that usually occurs in persons who frequently immerse hands in the water
- Signs and symptoms of onychomycosis: Thickened, opaque and onycholytic nails
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 and vomiting
- Occur in patients that have had recent abdominal surgery or intra-abdominal events refers to a heterogenous group of infections that includes peritonitis, abdominal abscess and purulent or necrotic infection at sites of gastrointestinal perforation or anatomic leak
- Symptoms: Abdominal pain (symptoms of gastritis)
- Common in postpubertal females or females in childbearing age
- Symptoms: Vaginal discomfort, vulvar pruritus, curdlike discahrge, erythematous and swollen labia, erythematous with white plaques vaginal walls
- 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
Invasive Candidiasis
Candidemia
- It is the isolation of Candida sp from ≥1 blood culture specimen with hematogenous spread of the yeast to ≥1 organs
- 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
- Renal failure
- 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
- 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
- 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
- Infections within the eye can be:
- Exogenous affecting the anterior chamber of the eye that occur following trauma or surgical procedure
- Endogenous is when Candida infection reaches the posterior chamber of he eye via hematogenous spread; it can be manifested as chorioretinitis with or without extension into the vitreous leading to vitritis
- Signs and symptoms: Retina has visible white lesions that may progress to vitritis with high risk of vision loss
- 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
- 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
- Signs and symptoms: Fever and cough
- Often a complication of peritoneal dialysis, gastrointestinal tract surgery and perforation of an abdominal viscus
- Prior antibiotic administration is a predisposing factor
- Signs and symptoms: Arthritis and osteomyelitis (eg similar to disease of bacterial etiology, includes suppurative synovitis)
- 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