Candida Albicans

is an opportunistic dimorphic fungus that grows as budding yeast cells, pseudohyphae, true hyphae, or spores. Pseudohyphae are distinguished from true hyphae by the lack of cytoplasmic connection between cells and relative frailty.

For most dimorphic fungi, the mnemonic "mold = cold, yeast = heat" applies. C. albicans is unusual because the mold form grows at 37°C while the yeast form (pseudohyphae and budding yeasts) predominates at 20°C.

Butterfly morphs

Germ tube test

A diagnostic test where a sample of fungal spores are suspended in serum and examined by microscopy for germ tubes, which is an outgrowth produced by spores from fungi during germination. A positive germ tube test is strongly indicative of C. albicans.

Germ tube= true hyphae

Snow cones at 37, ice balls at 20

Normal

mold = hyphae = cold

yeast = budding = hot

Candida

mold = hyphae = hot

yeast = budding = cold

Normal habitat

Found in the mucous membranes of respiratory, GI, and female genital tracts, with tendencies to overgrow in warm, moist areas.

Part of the normal flora

may contaminate sputum cultures

Overgrowth

Can lead to:

  • Oral thrush of the mouth that appears as a white exudate on mucous membranes. mmunocompromised or steroid usage KOH: used for scraping prep Adult scraping the snow
  • Vaginitis that presents with itching, copious secretion, and “cottage cheese” appearing clumps.
  • Cutaneous candidiasis can present as a beefy red rash with satellite pustular lesions in moist intertriginous areas (where two skin areas touch) such as under the breasts, axilla of the arm, or anogenital region. This can also manifest as a diaper rash in infants. Red diper. Heat and humidity.

Oral candidiasis risk

Use steroids: Little boy with blue steroid inhaler

Use steroids without rinsing the equipment

Vaginitis risks

  • Candies: diabetes
  • Drugs: Antibiotics
  • Birth control pills all risks for candida Teacher getting hit:

Vaginitis typically presents with a normal vaginal pH less than 4.5 versus bacterial vaginosis or trichomonal vaginitis, where vaginal pH may be higher than 4.5.

Open until 4pH

Oral thrush presents as white plaques that can be removed or scraped away. Contrast this with hairy leukoplakia, a manifestation of EBV also present in AIDS patients, which presents as white plaques on the side of the tongue that cannot be scraped off.

In immunocompromised individuals, persistent infection can spread and lead to esophagitis and disseminated candidiasis, which may lead to infective endocarditis.

Pink slides with white snow. Pseudomembrane formation

Endocarditis

3 mountains with hearts: tricuspid valve

Commonly seen in IV drug users (in heroine)

First valve drug goes to

Candida esophagitis presents as retrosternal pain upon swallowing is considered an AIDS-defining illness. Oral thrush is not considered AIDS-defining.

Starts seeing at CD4<100

Max 100 lbs

T-cell deficient patients are more likely to get superficial Candida infections, whereas neutropenic patients are more likely to have disseminated candidiasis (hematogenous).

Catalase positive cat. CGD: disseminated

Treatment

Treatment include:

  • Nystatin mouthwash and oral fluconazole for thrush and esophagitis
  • Topical azoles or oral fluconazole for vaginitis
  • Oral fluconazole or any IV echinocandins for disseminated candidiasis. Pinecones for conazoles Play Nyce for oral Frogs, amphibians for immunocompromised Cap on elderly: capsofungin for immunocompromised