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Year 3 > Candidiasis (I) > Flashcards

Candidiasis (I) Flashcards

1
Q

What is candidiasis?

A

Infection by yeasts of the genus Candida, mostly C albicans

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2
Q

What pathogen is candidiasis most commonly caused by?

A

Candida albicans (type of dimorphic fungus):

  • opportunistic microbe, normally found throughout body (skin/mucous membranes)
  • penetrate epithelial tissue by secretion of protease enzymes (secretory aspartyl proteinases and phospholipase B)
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3
Q

Where does Candida albicans usually live?

A

Although Candida are considered normal flora in GI and GU tracts, healthy skin and oropharyngeal cavity, they are capable of:

  • local infection of mucous membranes - oropharyngeal candidiasis, oesophagitis, vulvovaginitis
  • focal invasion - endophthalmitis, meningitis, endocarditis
  • dissemination - candidaemia
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4
Q

Who does Candida albicans cause disease in?

A

High risk patients

Ability of Candida to colonise and infect tissues requires local and systemic defects in host immune responses e.g. immunocompromised

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5
Q

What is pseudomembranous candidiasis?

A
  • oral thrush - most common oral candidiasis
  • lesions on palate, buccal mucosa, and on lateral borders and dorsum of tongue
  • due to weakened immune system = destruction of stratified epithelium layer = white lesions (looks like cottage cheese that can be scraped away to leave behind a red mucosal base)
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6
Q

What is erythematous candidiasis?

A

Due to change in levels of microbial competition keeping Candida in check –> overgrowth of Candida –> increased blood flow to affected tissue with red painful lesions

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7
Q

What are the two ways candidiasis infection can occur?

A
  • local infection - imbalance in local flora leading to overgrowth of C. albicans
  • systemic infection - breach of skin barrier leading to direct invasion of bloodstream
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8
Q

What are the different types of disease Candida can cause? (4)

A
  • oral thrush (pseudomembranous candidiasis) - oropharyngeal lesion
    • erythematous candidiasis
  • oesophageal candidiasis - associated with AIDS
  • vulvovaginitis - vaginal yeast infection
  • systemic candidiasis
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9
Q

What are the clinical features of oral thrush (pseudomembranous candidiasis)? (3)

A
  • white plaque in oral cavity that can be scraped off leading to inflamed areas
  • feels cottony in mouth
  • fissuring at mouth corners (angular cheilitis)
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10
Q

What medication can cause oral thrush?

A

ICS (beclomethasone) in asthma

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11
Q

How does erythematous candidiasis (type of oral candidiasis) present? (4)

A
  • atrophic fiery red flat lesions
  • patchy areas of loss of filiform papillae on tongue dorsum
  • spotty red areas on buccal mucosa
  • burning oral pain
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12
Q

What symptom does oesophageal candidiasis lead to?

A

Odynophagia (retrosternal pain on swallowing)

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13
Q

How does vulvovaginitis (candidiasis) present? (4)

A
  • cottage cheese, non-offensive discharge
  • dysuria
  • dyspareunia
  • pruritic
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14
Q

What are some symptoms of systemic candidiasis? (4)

A
  • fever
  • fatigue
  • skin rash
  • neurological deficits e.g. altered mental state
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15
Q

How does candidaemia (disseminated candidiasis) present?

A

Persistent fever despite Abx therapy

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16
Q

What are some general risk factors for candidiasis? (3)

A
  • immunosuppression - HIV, diabetes, steroid use
  • imbalance in local flora - Abx, steroid use
  • compromised skin
17
Q

What are some specific risk factors for oral candidiasis? (11)

A
  • hyposalivation/xerostomia (reduced/absent saliva)
  • poor oral hygiene (e.g. denture wearers)
  • malabsorption and malnutrition
  • advanced malignancy
  • chemotherapy and radiotherapy
  • HIV
  • endocrine disturbance (DM, hypoparathyroidism, pregnancy, hypoadrenalism)
  • immunosuppressive agents (local/systemic corticosteroids)
  • current/recent use of broad-spectrum or multiple narrow-spectrum Abx
  • extremes of age
  • inhaled corticosteroids
18
Q

What is the first-line investigation for candidiasis?

A

Superficial smear of lesion for microscopy - positive for Candida hyphae

19
Q

What are some differential diagnoses for candidiasis? (8)

A
  • chemical burns
  • thermal burns
  • hairy leukoplakia
  • pre-malignant leukoplakia
  • plaque-type lichen planus
  • erosive lichen planus
  • reactive keratosis
  • migratory glossitis
20
Q

What topical antifungals are there for mild-moderate candidiasis? (3)

A
  • clotrimazole (main one)
  • miconazole
  • nystatin
21
Q

What do we give for severe candidiasis?

A

Systemic antifungal treatment - fluconazole

22
Q

What do we give for vaginal candidiasis?

A

Oral fluconazole

Local miconazole/clotrimazole creams

23
Q

What can we give to those severely immunocompromised as prophylactic therapy for candidiasis?

A

Suppressive therapy with fluconazole

24
Q

What are some complications of candidiasis? (5)

A
  • oral candidiasis –> oesophageal candidiasis
  • disseminated candidiasis (sepsis)
  • meningoencephalitis (obstructive hydrocephalus, calcifications, thrombosis)
  • pyelonephritis
  • abscess in multiple organs
25
Q

What is the prognosis like for oral candidiasis?

A

Patients tolerate repeated episodes of oropharyngeal candidiasis without difficulty, but aggressive treatment is effective in preventing recurrent infections

Year 3 (101 decks)

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