Candida albicans

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Key Points

  • Candida albicans
    • Characteristics
      • Single-celled budding yeast with pseudohyphae
        • Pseudohyphae are not true hyphae but elongated yeast cells
      • Forms hyphal germ tubes  when food is readily available
      • Creamy white color of fungus and colonies
        • Candida is from Latin candidus (meaning white)
        • Albicans is from Latin albico (meaning becoming white)
    • Transmission
      • Opportunistic
        • Component of normal flora; rarely infects healthy people
        • Seen in immunocompromised patients
          • E.g. obesity, diabetes, steroids, chemo, HIV/AIDS, BMT, chemotherapy, neonates, elderly
          • Patients with impaired T-cells (or neutrophils) are particularly susceptible
            • Candida skin test
              • Small candida extract injected into skin
              • Used to test for Type 4 (delayed cellular) hypersensitivity
              • Reaction indicates normal functioning T-cells
        • Associated with antibiotic use
          • Kills other microorganisms (e.g. lactobacilli in vagina), opening niche for candida overgrowth
    • Presentation
      • Oral and esophageal thrush
        • Most common cause of HIV esophagitis
        • Presents with odynophagia
        • Endoscopy reveals white plaques on erythematous skin or mucosa
      • Vaginitis
        • Most common cause of fungal vaginitis
        • Presents with itchiness, redness, and white curd-like discharge
      • Candida intertrigo
        • Erythematous (red) plaques with satellite papules
        • Seen in skin folds with increased moisture and friction
          • E.g. axillae, groin, web spaces of fingers/toes, etc.
        • Responsible for diaper rash in neonates
      • Disseminated candidemia is rare
        • Usually seen in IV drug users
        • Endocarditis, renal or bladder abscesses, may be seen
    • Diagnosis
      • Diagnosis is primarily clinical
      • Yeasts and pseudohyphae seen on microscopy, with positive germ tube test
    • Treatment
      • Fluconazole for uncomplicated vaginitis or oral/esophageal infections
        • Boric acid, nystatin, amphotericin B, and flucytosine may be added for complicated vaginitis
        • Itraconazole, posaconazole, or voriconazole also used for oral/esophageal candidiasis
      • Nystatin also used for oropharyngeal infections
      • Echinocandins (caspofungin) used for severe disseminated infections
        • Fluconazole and amphotericin are second-line