Candidiasis

Question 1

Define:

Answer 1

• Infection caused by Candida.

Question 2

Aetiology:

Answer 2

• Caused by 15 different Candida species
• Candida albicans is the MOST COMMON cause of candidiasis in humans

Main types of candidiasis:
o	Oral candidiasis – common in children, elderly and immunocompromised 
o	Oesophageal candidiasis
o	Candidal vulvovaginitis 
o	Candidal skin infections 
o	Invasive candidal infections

Question 3

Risk factors:

Answer 3

o	Broad-spectrum antibiotics 
o	Immunocompromise (e.g. HIV, corticosteroids) 
o	Central venous lines 
o	Cushing's disease 
o	Diabetes mellitus 
o	GI tract surgery 
o	Poor oral hygiene – oral candidiasis 
o	Pregnancy and Pill – specific for vaginal thrush

Question 4

Epidemiology:

Answer 4

• 60% of the healthy adult population are carriers
• Candidiasis occurs in over 80% of people with HIV
• One of the most common causes of invasive fungal infections in the Western world

Question 5

Symptoms of oral candidasis:

Answer 5

o Oral Thrush (pseudomembranous oral candidiasis) - curd-like white patches in the mouth, which can be removed easily revealing an underlying red base. Most common in neonates

o May get cracks, ulcers or crusted fissures around month

Question 6

Symptoms of oesophageal candidasis:

Answer 6

o Dysphagia
o Pain on swallowing food or fluids
o It is an AIDS-defining illness

Question 7

Symptoms of candidal skin infections:

Answer 7

o Soreness and itching
o Skin appearance can be variable
o Red, moist skin area with ragged, peeling edge and possibly papules and pustules

Question 8

Symptoms of vaginal thrush:

Answer 8

o White curd discharge

o Vulva and vagina may be red, fissured and sore

Question 9

Symptoms of invasive candidasis:

Answer 9

o Fever and chills

o Can spread to cause fungemia, endocarditis, endophthalmitis, osteomyelitis and CNS infections

Question 10

Investigations:

Answer 10

• Oral Candidiasis - swabs and cultures are not particularly useful because a lot of normal people have candida in their mouth
Swabs may be relevant to check for drug-resistance
• Therapeutic trials of antifungal (e.g. fluconazole) can help with diagnosis
• Candidal skin infections: skin scraping microscopy
• Oesophageal Candidiasis: definitive diagnosis is by endoscopy with/without biopsy of lesions
• Vaginal thrush: mostly can do just clinical examination, or microscopy – strings of myecelium or oval spores. Culture on Sabouraud’s medium.
• Invasive Candidiasis: blood cultures required if candidaemia is possible