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Candidiasis
Candidiasis: The most common opportunistic mycosis.
Caused by species of Candida, especially Candida albicans*
– Other important species include C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei.
Candida are thermally dimorphic:*
– They exist as budding yeast and pseudohyphae at 20 degrees Celsius, and form germ tubes at 37 degrees Celsius.
– In the third image in the diagram, we can see a Candida albicans colony that comprises yeast-like cells with filamentous cells on top.
Candida are commonly found in our gastrointestinal and urogenital tracts, and on the skin*.
– Thus, most infections are endogenous.
– Exogenous infections are less common, but are more likely in health care settings.
Candidiasis can manifest in several forms throughout the body; we'll organize in terms of superficial and invasive infections.
Superficial candidiasis is the result of localized overgrowth.
- On mucosal surfaces, overgrowth is visible as whitish plaques and pseudomembranous exudate;
- On the skin, overgrowth produces erythematous and/or vesiculopustular lesions.
- Mucosal and cutaneous forms are typically easy to treat.
- Chronic muco-cutaneous candidiasis is rare, but difficult to treat.
- Esophageal candidiasis produces plaques or pseudomembranes in the esophagus, and produces pain upon swallowing (odynophagia); this is most common in HIV patients with low CD4+ T-cell counts (thus, it is an AIDS-defining illness).
- Intra-abdominal overgrowth is associated with hospitalized patients, especially those who have had abdominal surgery.
- Cutaneous candidiasis tends to occur in the body folds, where conditions are warm and moist, such as the armpits, under the breasts, and groin area.
- Vulvovaginal candidiasis (aka, vaginal yeast infections) is characterized by whitish plaques, itching, and a foul-smelling discharge.
- Invasive candidiasis
- Infection can be focal, for example, localized within the heart, lungs, brain, bones, or other organ system, or, can be systemic.
- Candidemia and dissemination to the viscera is more likely in neutropenic and hospitalized patients.