Fungal and Yeast Flashcards
Candida Species
Yeast-like fungi that can form true hyphae & pseudohyphae
Typically confined to human and animal reservoirs
Frequently recovered from the hospital environment (e.g. foods, countertops, air-conditioning vents, floors, respirators & medical personnel
Normal commensals of diseased skin and mucosal membranes of the gastrointestinal, genitourinary, and respiratory tracts
Candidiasis – Systemic Risk Factors
Hematologic malignancies Foley catheters Solid neoplasms Recent chemotherapy or radiation therapy Corticosteroids Broad-spectrum antibiotics Burns Recent surgery Gastrointestinal tract surgery Central intravascular access devices Premature birth Hemodialysis
Epidemiology of Candidiasis
Oropharyngeal colonization - 30-55% of healthy young adults
Candidaspecies detected in 40-65% of normal fecal florae
75% of women have at least one bout ofvulvovaginal candidiasis (VVC) during their lifetime
> 90% of persons infected with HIV (not receiving HAART develop oropharyngeal candidiasis (OPC)
10% develop at least one episode of esophageal candidiasis
Candidiasis - Etiology
C albicans,the most common species identified (50-60%)
Candida glabrata(previously known asTorulopsis glabrata) (15-20%) - 20% resistance to fluconazole
C parapsilosis(10-20%) - associated with vascular catheters prosthetic devices
Candida tropicalis(6-12%) - candidemia in patients with leukemia & bone marrow transplantation
Candida krusei(1-3%) - intrinsic resistance to ketoconazole and fluconazole, less susceptible to amphotericen B
Candida kefyr(< 5%)
Candida guilliermondi(< 5%)
Candida lusitaniae(< 5%) - intrinsically resistant to amphotericin B
Candida dubliniensis,primarily recovered from patients infected with HIV
Generalized cutaneous candidiasis
Unusual, diffuse eruption over the trunk, thorax, and extremities with generalized pruritus, increasing vesicles genitocrural folds, anal region, axillae, hands, and feet becoming confluent
Intertrigo
vesciculopustules that enlarge and rupture in intertriginous areas, causing maceration and fissuring, scalloped border with a white rim consisting of necrotic epidermis that surrounds the erythematous macerated base; satellite lesions common with coalescence
Paronychiaand onychomycosis
associated with immersion of the hands in water and with diabetes mellitus; inflammation that becomes warm, glistening, tense, and erythematous and may extend extensively under the nail; 2nd nail thickening, ridging, discoloration, and occasional nail loss
5 types of oropharyngeal candidiasis (OPC)
Membranous candidiasis Erythematous candidiasis Chronic atrophic candidiasis (denture stomatitis) Angular cheilitis Mixed
Oropharyngeal candidiasis and symptoms
usually history of HIV infection, wears dentures, has diabetes mellitus, or has been exposed to broad-spectrum antibiotics or inhaled steroids; usually asymptomatic. Sore and painful mouth Burning mouth or tongue Dysphagia Whitish thick patches on the oral mucosa
Membranous candidiasis
most common; creamy-white curdlike patches on the mucosal surfaces
Erythematous candidiasis
erythematous patch on the hard & soft palates
Chronic atrophic candidiasis
common; chronic erythema and edema of palate portion coming in contact with dentures
Angular cheilitis
soreness, erythema & fissuring at the corners of the mouth
Esophageal candidiasis
typically with chemotherapy, broad-spectrum antibiotics or inhaled steroids, increased with HIV infection or hematologic/solid-organ malignancy Normal oral mucosa (>50% of patients) Dysphagia Odynophagia Retrosternal pain Epigastric pain Nausea and vomiting
Non-esophageal gastrointestinal candidiasis and symptoms
Esophagus most common site
2nd - stomach (chronic gastric ulcerations, gastric perforations, or malignant gastric ulcers with concomitant candidal infection)
3rd - small bowel (20%)
4th – colon (20%)
symptoms Epigastric pain Nausea and vomiting Abdominal pain Fever and chills Abdominal mass (in some cases)
Laryngeal candidiasis
Uncommon form of invasive candidiasis may result in disseminated infection
Primarily patients with underlying hematologic or oncologic malignancies
Present with a sore throat and hoarseness; unremarkable exam; requires direct or indirect laryngoscopy
Candidatracheobronchitis
Uncommon form of invasive candidiasis
Most patients are HIV-positive or are severely immunocompromised
Presents usually with fever, productive cough, and shortness of breath; PE shows dyspnea and scattered rhonchi; diagnosed with bronchoscopy
Candidapneumonia
Rarely develops alone; may be associated with disseminated candidiasis
Most common form of infection is multiple lung abscesses due to the hematogenous dissemination
High degree ofCandidacolonization in the respiratory tract makes the diagnosis ofCandidapneumonia challenging
History shows risk factors similar to disseminated candidiasis: PE has shortness of breath, cough, respiratory distress, fever, dyspnea, and variable breath sounds, ranging from clear to rhonchi or scattered rales
Vulvovaginal candidiasis (VVC)
2nd most common cause of vaginitis
History of vulvar pruritus, vaginal discharge, dysuria, and dyspareunia; ~ 10% experience repeated attacks of VVC without precipitating risk factors
PE – erythema of vagina and labia, thick curdlike discharge; normal cervix
Candidabalanitis
Penile pruritus along with whitish patches on the penis
Acquired through direct sexual contact with a partner who has VVC
PE - vesicles on the penis that later develop into patches of whitish exudate; rash occasionally spreads to the thighs, gluteal folds, buttocks, and scrotum
Candidacystitis
Often asymptomatic; may have frequency, urgency, dysuria, hematuria, and suprapubic pain; increased risk with Foley catheter use
PE – may show suprapubic tenderness; limited findings otherwise
Asymptomatic candiduria
Catheterized patients with persistent candiduria usually asymptomatic, similar to noncatheterized patients
Invasive disease is difficult to differentiate from colonization based solely on culture; 5-10% of all urine cultures are positive for Candida
Ascending pyelonephritis
Stents and indwelling devices, along with the presence of diabetes, is the major predisposing risk factor in ascending infection
Most have flank pain, abdominal cramps, nausea, vomiting, fever, chills & hematuria
PE shows abdominal pain, CVAT & fever