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Microbiology > Candidiasis > Flashcards

Candidiasis Flashcards

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Biology 101 flashcards
1
Q

What are fungi?

A

Eukaryotic organisms with cell wall containing chitin and/or cellulose

May be:
Sexual or asexual
Uni- or multi-cellular
Yeasts or moulds

Estimated to be at least 250,000 species

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2
Q

What are the clinically important fungi?

A 
Yeasts
Candida species
C. albicans
C. glabrata
C. tropicalis
C. krusei
C. parapsilosis
Others

Cryptococcus spp.
C. neoformans
C. gattii

Moulds
Dimorphic fungi
-Blastomyces dermatitidis
-Coccidioides immitis
-Histoplasma capsulatum
Aspergillus species
Zygomycetes
Dermatophytes
Pneumocystis carinii
Many others
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3
Q

What is the normal flora of the candida species? and what can altered host defense do? What type of immunity is important for containment?

A

Worldwide distribution

Normal flora
Mouth, lower GI in 10-50%

Altered host defense can result in infection and invasion

Cell mediated immunity important for containment

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4
Q

What is candidiasis?

A

Superficial infection

  • Mucosal
    • Oropharyngeal (thrush)
      - Esophageal
      • Vulvovaginal
  • Skin
    - Localized
    - Chronic Mucocutaneous candidiasis (where the immune system isn’t suppressing it at all)

Deep infection
- Localized:
- Intra-abdominal, urinary
Candidemia (blood stream infection) with dissemination
- Endocarditis, lung, CNS, renal, bone/joint, hepatosplenic, ocular, etc

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5
Q

What are the risk factors for oropharyngeal candidiasis?

A

Risk factors

Diabetes, corticosteroids, antibiotics, immunodeiciency (esp. HIV), dentures

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6
Q

What are the manifestation of oropharyngeal candidiasis?

A

Manifestations

Raised white patches or redness alone

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7
Q

What is the dianostic confirmations of oropharyngeal candidiasis?

A

Clinical: bleeding base after scraping

Yeast, pseudohyphae on microscopy

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8
Q

What is the management for oropharyngeal candidiasis?

A

Alter predisposing conditions

Topical or systemic antifungals

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9
Q

What are the risk factors for esophageal candidiasis?

A

Immunodeficiency

HIV, organ transplant, chemotherapy

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10
Q

What are the manifestations for esophageal candidiasis?

A

Retrosternal chest pain with swallowing

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11
Q

What is the diagnostic criteria for esophageal candidiasis?

A

Visualization +/- biopsy with endoscopy

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12
Q

What is the management for esophageal candidiasis?

A

Alter predisposing conditions

Systemic antifungals x 14-21 days

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13
Q

What are the manifestations for cutaneous candidiasis?

A

Immunocompetent:
- Infections in skin folds, nails & paronychium
Chronic Mucocutaneous Candidiasis (CMC)
- Skin, mucous membranes, hair, nails
Due to immune defect, usually diagnosed in infants or childhood

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14
Q

What is the diagnostic criteria for cutaneous candidiasis?

A

Skin scrapings for fungal stain and culture

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15
Q

What is the management for cutaneous candidiasis?

A

Topical or systemic (CMC) antifungal drugs

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16
Q

What are the risk factors for candidemia and disseminated candidiasis?

A 
Immunosuppression
     - Neutropenia, Corticosteroids
Broad-spectrum antibacterial antibiotics
Central IV catheters (risk increases with lumen #)
Abdominal surgery 
Total parenteral nutrition (TPN)
Severe burns 
Colonization (especially candiduria)
Acute renal failure
17
Q

What is one main risk factor to develop candidemia and disseminated candidiasis?

A

having a central line!!! you are more than 8 times more likely to develop this infection

18
Q

How is candidiasis diagnosed?

A

Microscopy = budding yeast
Gram +, calcofluor white fluorescence

Culture:
Regular solid media, blood culture bottles

Identification:
Germ tube + : presumptive C. albicans
Commercial strips (API): 48-72 h
MALDI-TOF / mass spectrometry: minutes!

19
Q

What is the germ tube test?

A

From pure culture:
Suspend in serum
Incubate 35-37oC
Examine after 2-3 h

Positive test = C. albicans
Early projection without constriction at junction with parent cell

20
Q

What are considerations to use when using antifungals for candidemia/

A

Expected infecting species
- Susceptibility can often be predicted

“Margin for error”
- Broader spectrum for unstable patients

Safety
- Potential for nephrotoxicity with AmB products

Cost

21
Q

Is it okay to wait a while before you get treatment?

A

no, the apache II scale showed that if a person doesn’t get good therapy early their chances for mortality ar e greatly increased.

22
Q

What does the role of non-albicans species show?

A

There’ve been more and more non-albicans coming up and less and less albicans.

23
Q

What are echinocandins and why are they good?

A

Echinocandins are newer drugs that are active against most fluconazole resistant strains but are more safe than those fluconazole ones.

Attractive features:
Activity -vs- potentially fluconazole resistant Candida strains
C. krusei, C. glabrata, C. lusitaniae

Tolerability
Not nephrotoxic
Comparable to FLU, superior to AMPHO

24
Q

What did they use to use to treat candida spp. usually?

A

fluconazole. when there was no previous treatment with fluconazole and they were hemodynamically stable.

25
Q

What used to be the other one other than fluconazole?

A

amphotericin B. For isolation of C. krusei and in some instances C. glabrata

26
Q

What is the new one to use?

A

echinocandins

caspofungin, micafungin, anidulafungin

27
Q

What are the guidelines fo candidemia infection medication?

A 
- Non-neutropenic adults
Fluconazole 800mg x1, then 400 mg/d
Echinocandin = caspo-, mica-, anidulafungin
Alternatives: 
AmB, Lipid AmB, voriconazole
- Neutropenic
Echinocandin
Lipid AmB formulation 3-5 mg/kg/d
Alternatives:
Fluconazole or Voriconazolele
28
Q

What are more guidelines for candidemia ?

A

Miscellaneous recommendations
Duration:
14d after last + blood culture and resolution of signs and symptoms
Remove all central catheters if feasible
Especially in non-neutropenic, C. parapsilosis
Fundoscopic exam within 1st week!

Specific organisms
C. krusei: Echinocandin, AmB or Vori
C. glabrata: Echinocandin; Flu or Vori if tested
C. lusitaniae: avoid AmB (may be resistant)

29
Q

What is the invasive candidiasis therapy?

A 
Hemodynamically stable, no prior azole
Preferred
FLU 800     400 mg/d IV/PO
IV Echinocandin (Caspofungin Anidulafungin, Micafungin)
Alternative
AmphoB deoxycholate 0.5-1 mg/kg/d
LF-AmB 3 mg/kg/d

Unstable and/or prior azole
Preferred: IV Echinocandin (FLU for C. parapsilosis)
Alternative: LFAmB or AmB deoxycholate

Toxicity
Alternatives to FLU that appear as safe
Echinocandins
Newer azoles (eg Voriconazole)

Efficacy
Alternatives to AmB that appear as effective
Echinocandins
(Newer azoles)

Microbiology (13 decks)

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