Skin System: Lec.4 - Candida

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Skin System: Lecture 4- Candida

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Skin System: Lecture 4- Candida

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4Q: The most common Candida spp. responsible for opportunistic infections.

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4A: Candida Albicans- part of normal flora, low levels in skin and mucus membranes. At least in GI tract.
- ass’d with 50% of all candida diseases

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4Q: The Candida spp. most commonly resistant to antifungals.

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4A: Candida Glabrata and Candida Krusei

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4Q: Candida Dubliniensis

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4A: found in Africa, a true pathogen . causing disease in healthy hosts.

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4Q: Name various cutaneous opportunistic diseases with candida infections

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4A:generalized cutaneous candidiasis (in skin folds where the moisture is) , folliculitis (hair), balanitis (penile), intertrigo (skin fold appearance of infection),
paronychia/onychomycosis (nail, nailbed), diaper rash (normal flora found in feces)

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4Q: Name various systemic opportunistic diseases with candida infections

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4A: CNS, Resp., CV, Hepatic, Ocular, Neonatal, Disseminated (to multiple organs)
* systemic is where the causes of deaths are

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4Q: Name various mucus membrane opportunistic diseases with candida infections

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4A:
➡acute pseudomembranous candidosis (oral thrush)- test for HIV
➡vulvovaginal candidiasis (yeast vaginitis)- common
➡esophagitis
➡gastrointestinal candidiasis, UTI- candida can spread if you’re wiping out normal flora with antibiotics

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4Q: 3 most common manifestations of candida

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4A: oral, penile, vaginal- most common manifestations of candida diseases, but they are mild. They are easily treatable and quickly overcome.

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4Q: What can cause candida overgrowth?

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4A: Neutropenia (neutrophil deficiency which are the prime defense against fungi), immunodeficiency, diabetes, cancer, broad spectrum low level antibiotics, prolonged hospital stay, GI mucosa alterations

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4Q: Name a couple diagnostic procedures in confirming candida infection.

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4A:
1)Direct microscopy (Gram stain, KOH); to see yeast and pseudohyphae (can easily see the huge yeast cells); KOH gets rid of the tissue. Mostly see yeast, but can see pseudohyphae
2) Agar culture (differential media available – colony color) blue-tropicalis, white- paraosilosis, green- albicans

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4Q: Why is pseudohyphae dangerous?

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4A: From gene switching depending on the environment, it will go into the pseudohyphae form when there is a lack of nutrients so it will penetrate through tissues looking for food.

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4Q:The pathogenic factors associated with Candida organisms.

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4A:
1) Adherence (fungal adhesins)- once out of the GI tract, they adhere to various tissue sites
2) Colonization
3) Dimorphism (pseudohyphae more dangerous)
4) Enzymes to break down proteins and lipids
5) Phenotype switching- candida has 3x as many genes as it needs

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4Q: Why do infants get oral thrush?

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4A: underdeveloped immune system and don't have candida in their GI tract when they're born
-often acquired from breast feeding (infected nipple) because of the moisture. The candida can be passed back and forth between the baby and mother
-or first exposure in birth canal

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4Q: Adolescents/Adults and oral thrush

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4A: only when predisposed.
➡ “cottage cheese” patches
➡ pseudomembranous; leukoplakia – first sign in an HIV patient

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4Q: How do geriatrics get oral thrush?

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4A:➡ denture stomatitis (gums, palate); most common from wearing dentures and a lack of hygiene. Candida can grow on gums and palate. Need to keep the dentures clean

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4Q: If a woman has 25% vaginal candida, is that diagnostic?

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4A: No, since candida is normal flora. It has to be the predominant flora.

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4Q: What do the pH changes mean for the vaginal bacterial flora?

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4A: pH is the key to vaginitis. Usually the vaginal pH is about 4.5. Bacteria is higher than 7. Candida/fungal/yeast is 4.0 or lower.

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4Q: How does cutaneous candidiasis occur?

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4A: candida is unable to penetrate intact skin. But disease occurs in moist areas like skin folds, webbings of toes and fingers, groin, nail/nail beds, diaper rashes (since candida is in feces)

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4Q:
What is onychomycosis? and what is paronychia?

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4A:
onychomycosis- fungal infection of the nail
paronychia- fungal infection of the nail bed

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4Q: Why do you get systemic candidiasis?

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4A:associated esp. w/ neutropenia and/or immunodeficiency

➡ Almost always originates from GI Candida
➡ hematogenous spread to any organ (candidemia)
➡ Candida 4th most common organism isolated from blood cultures
➡ Cardiovascular: endocarditis, pericarditis, myocarditis
➡ CNS: meningitis, brain abscesses
➡ Respiratory: pneumonia
➡ Abdominal abscesses, peritonitis (liver, spleen, gallbladder, pancreas)
➡ UTI almost always associated with urinary catheterization

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4Q:Candida parapsilosis

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4A: 20% of hospital workers found this on their hands

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4Q: the most common disease associated with candida

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4A: Diaper rash

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4Q: Second most common disease associated with candida

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4A: Thrush; seen in infants and geriatrics. Adolescents and adults get it only if they are predisposed (since they have fully functioning immune systems)