Candida

Overview
  • Candida refers to a genus of opportunistic fungi which can produce cutaneous or mucosal disease in healthy individuals and life-threatening systemic disease in those with defective immunity.
Transmission
  • Candidal species are found ubiquitously in the environment and are a frequent part of the cutaneous and mucosal flora in healthy individuals.
Clinical Consequences
  • Mucocutaneous Disease
    • Cutaneous and mucosal disease can occur in healthy individuals although it is more prevalent in those with reduced immunity. The precise factors which lead to disease are unclear but ultimately pathology is due to localized overgrowth and cutaneous/mucosal invasion of organisms along with the corresponding inflammatory reaction.
    • Vaginitis: Is characterized by pruritis of the vagina along with a white, curd-like vaginal discharge and is commonly known as a "Yeast Infection"
    • Oral Candidiasis: Is commonly known as "Thrush" (see page)
    • Cutaneous Candidiasis: Candidal infections can occur anywhere on the skin but have a predilection for moist areas and usually manifest as an erythematous lesion
    • Diaper Rash: Refers to cutaneous candidasis of the infant perineum
    • Balanitis: Refers to cutaneous candidiasis of the penis
    • Onychomycosis: Refers to candidal infection of the nails.
  • Invasive Candidasis
    • Invasive candidiasis is almost exclusively seen in those with reduced immunity such as immunocompromised patients such as AIDS Patients and those with neutropenia. Dissemination usually occurs via a hematogenous route although contiguous spread to deeper mucosal surfaces may also be a mechanism. Nearly any organ can be seeded with infective foci and only a few or mentioned below.
    • Esophageal seeding results in esophagitis
    • Hepatic seeding can result in liver abscess
    • Retinal seeding can result in a characteristic white, fluffy endophthalmitic lesions visible on split lamp.
Diagnosis
  • Infected tissues or blood will reveal organisms with pseudohyphae.
Treatment
  • Mucocutaneous candidiasis can be treated with nystatin or azoles such as fluconazole. Invasive Candidiasis is usually treated with Amphotericin B.