Candidiasis: Difference between revisions

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{{Infobox_Disease |
  Name          = Candidiasis |
  Image          = Candida albicans .jpg |
  Caption        = [[Agar plate]] culture of ''Candida albicans'' |
}}
{{Candidiasis}}
{{Candidiasis}}
{{CMG}};{{AE}}{{AY}}
{{CMG}};{{AE}}{{AY}}  
 
{{SK}} Candida infection, Candida caused diseases


==Overview==
==Overview==
[[Candida]] is a normal [[commensal]] of the skin and mucous membranes. The balance between the [[virulence]] of the [[fungus]] and the [[Immune response|host immune defense]] is responsible avoiding [[opportunistic infection]] of candida.
Deficiency of [[cell-mediated immunity]] or poor general status are the main risk factors for having opportunistic candidiasis.
Candidiasis is usually localized to skin and mucous membranes. In rare cases, candidiasis can spread causing [[Candidiasis|candidaemia]] and distant infection. These cases are usually associated with [[Immunodeficiency|deficient immunity]]
[[C. albicans]] is the main species causing infection in humans more than any other candida species.


==Causes==  
==Causes==  
Candida Albicans is responsible for the majority of Candidal infections.  
[[Candida albicans|Candida Albicans]] is responsible for the majority of [[Candida]] infections.  
===Localized candidiasis===
===Localized candidiasis===
====Oral and esophageal candidasis:====  
====Oral and esophageal candidasis:====  
*Candida albicans accounts for majority of the cases followed by some non Albicans species as C. krusei and C. glabrata.<ref name="pmid21586373">{{cite journal |vauthors=Laurent M, Gogly B, Tahmasebi F, Paillaud E |title=[Oropharyngeal candidiasis in elderly patients] |language=French |journal=Geriatr Psychol Neuropsychiatr Vieil |volume=9 |issue=1 |pages=21–8 |year=2011 |pmid=21586373 |doi=10.1684/pnv.2011.0259 |url=}}</ref><ref name="urlCandidaesophagitis | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF01324956 |title=Candidaesophagitis &#124; SpringerLink |format= |work= |accessdate=}}</ref>
*[[Candida albicans]] accounts for majority of the cases followed by some non albicans species as [[Candida krusei|C. krusei]] and [[Candida glabrata|C. glabrata]].<ref name="pmid21586373">{{cite journal |vauthors=Laurent M, Gogly B, Tahmasebi F, Paillaud E |title=[Oropharyngeal candidiasis in elderly patients] |language=French |journal=Geriatr Psychol Neuropsychiatr Vieil |volume=9 |issue=1 |pages=21–8 |year=2011 |pmid=21586373 |doi=10.1684/pnv.2011.0259 |url=}}</ref><ref name="urlCandidaesophagitis | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF01324956 |title=Candidaesophagitis &#124; SpringerLink |format= |work= |accessdate=}}</ref>
   
   
====Candida vulvovaginitis:====  
====Candida vulvovaginitis:====  
Line 16: Line 27:
   
   
====Chronic mucocutaneous candidiasis:====  
====Chronic mucocutaneous candidiasis:====  
*C. albicans are the most isolated species.<ref name="urlChronic mucocutaneous candidiasis - Journal of the American Academy of Dermatology">{{cite web |url=http://www.eblue.org/article/S0190-9622(08)81260-1/fulltext |title=Chronic mucocutaneous candidiasis - Journal of the American Academy of Dermatology |format= |work= |accessdate=}}</ref>
*[[C. albicans]] are the most isolated species.<ref name="urlChronic mucocutaneous candidiasis - Journal of the American Academy of Dermatology">{{cite web |url=http://www.eblue.org/article/S0190-9622(08)81260-1/fulltext |title=Chronic mucocutaneous candidiasis - Journal of the American Academy of Dermatology |format= |work= |accessdate=}}</ref>


===Invasive candidasis===  
===Invasive candidasis===  
====Candidaemia:====  
====Candidaemia:====  
*C. albicans is the most common isolated organism. However, some non C. albicans species were isolated beside C. albicans.<ref name="pmid16505666">{{cite journal |vauthors=Ostrosky-Zeichner L, Pappas PG |title=Invasive candidiasis in the intensive care unit |journal=Crit. Care Med. |volume=34 |issue=3 |pages=857–63 |year=2006 |pmid=16505666 |doi=10.1097/01.CCM.0000201897.78123.44 |url=}}</ref>  
*[[C. albicans]] is the most common isolated organism. However, some non C. albicans species were isolated beside [[C. albicans]].<ref name="pmid16505666">{{cite journal |vauthors=Ostrosky-Zeichner L, Pappas PG |title=Invasive candidiasis in the intensive care unit |journal=Crit. Care Med. |volume=34 |issue=3 |pages=857–63 |year=2006 |pmid=16505666 |doi=10.1097/01.CCM.0000201897.78123.44 |url=}}</ref>  
*In severely immunocomoromised patients, non C. Albicans species were isolaetd alone.  
*In severely [[Immunodeficiency|immuno-copromised patients]], non C. albicans species were isolated alone.  
   
   
====Candida endocarditis:====
====Candida endocarditis:====
* Among causes of fungal endophthalmitis, Cadida and non candida species are the 2 most common causes. However, Non candida species are slightly more prevalent.<ref name="pmid11118386">{{cite journal |vauthors=Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W |title=Fungal endocarditis: evidence in the world literature, 1965-1995 |journal=Clin. Infect. Dis. |volume=32 |issue=1 |pages=50–62 |year=2001 |pmid=11118386 |doi=10.1086/317550 |url=}}</ref>
* Among causes of [[fungal endophthalmitis]], [[Candida albicans|Cadida albicans]] and non candida albicans species are the 2 most common causes. However, Non albicans species are slightly more prevalent.<ref name="pmid11118386">{{cite journal |vauthors=Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W |title=Fungal endocarditis: evidence in the world literature, 1965-1995 |journal=Clin. Infect. Dis. |volume=32 |issue=1 |pages=50–62 |year=2001 |pmid=11118386 |doi=10.1086/317550 |url=}}</ref>
   
   
====Candida osteoarticular disease:====
====Candida osteoarticular disease:====
* C. albicans is the most common cause. However, C. glabrata and C. tropicalis are also involved.<ref name="pmid3897399">{{cite journal |vauthors=Dupont B, Drouhet E |title=Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients |journal=J. Infect. Dis. |volume=152 |issue=3 |pages=577–91 |year=1985 |pmid=3897399 |doi= |url=}}</ref>
* [[C. albicans]] is the most common cause. However, [[Candida glabrata|C. glabrata]] and [[C. tropicalis]] are also involved.<ref name="pmid3897399">{{cite journal |vauthors=Dupont B, Drouhet E |title=Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients |journal=J. Infect. Dis. |volume=152 |issue=3 |pages=577–91 |year=1985 |pmid=3897399 |doi= |url=}}</ref>


==Classification:==
==Classification==
Candidiasis can be classified according to the site of infection into:<ref name="urlCandidiasis | Types of Diseses | Fungal Diseases | CDC">{{cite web |url=https://www.cdc.gov/fungal/diseases/candidiasis/ |title=Candidiasis &#124; Types of Diseses &#124; Fungal Diseases &#124; CDC |format= |work= |accessdate=}}</ref>
Candidiasis can be classified according to the site of infection into:<ref name="urlCandidiasis | Types of Diseses | Fungal Diseases | CDC">{{cite web |url=https://www.cdc.gov/fungal/diseases/candidiasis/ |title=Candidiasis &#124; Types of Diseses &#124; Fungal Diseases &#124; CDC |format= |work= |accessdate=}}</ref>
===Localoized mucocutaneous candidiasis:===
 
*Oropharyngeal candidiasis
 
*Esophageal candidiasis
{{Family tree/start}}
*Candida vulvovaginitis
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | |A01= '''Candidiasis'''}}
*Chronic mucocutaneous candidiasis.
{{Family tree | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | }}
====Invasive Candidiasis:====
{{Family tree | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | | | | | C02 |C01= Localoized mucocutaneous candidiasis| C02= Invasive Candidiasis}}
More serious and usually presenting in an immunocompromised host.
{{Family tree | | |,|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|.| | | | | | | | | | |,|-|-|-|v|-|-|-|^|-|-|-|v|-|-|-|.|}}
*Candidaemia
{{Family tree | | D01 | | D02 | | | | | | D03 | | D04 | | | | | | | | | D05 | | D06 | | | | | | D07 | | |D08 |D01=[[Oropharyngeal]] candidiasis |D02=[[Esophageal]] candidiasis|D03=[[Candida vulvovaginitis]] |D04=Chronic [[Mucocutaneous|mucocutaneous candidiasis]] |D05=Candidaemia|D06=[[Endophthalmitis|Candida endophthalmitis]] |D07=[[Endocarditis|Candida endocarditis]]|D08=[[Osteomyelitis|Candida osteoarticular disease]]}}
*Candida endophthalmitis
{{Family tree/end}}
*Candida endocarditis
*Candida osteoarticular disease


==Pathophysiology==
==Pathophysiology==
Candida is a normal commensal of skin and mucous membranes. A competent immune system and an intact regenerating healthy skin prevent the virulence of Candida.
Candida is a [[Commensal|normal commensal]] of skin and mucous membranes. A [[Immune system|competent immune system]] and an intact regenerating healthy skin prevent the [[virulence]] of [[Candida]].


===Candida Virulence factors===
===Candida Virulence factors===
The main virulence factors that mediate the infection:<ref name="pmid23302789">{{cite journal |vauthors=Mayer FL, Wilson D, Hube B |title=Candida albicans pathogenicity mechanisms |journal=Virulence |volume=4 |issue=2 |pages=119–28 |year=2013 |pmid=23302789 |pmc=3654610 |doi=10.4161/viru.22913 |url=}}</ref>
The main virulence factors that mediate the infection:<ref name="pmid23302789">{{cite journal |vauthors=Mayer FL, Wilson D, Hube B |title=Candida albicans pathogenicity mechanisms |journal=Virulence |volume=4 |issue=2 |pages=119–28 |year=2013 |pmid=23302789 |pmc=3654610 |doi=10.4161/viru.22913 |url=}}</ref>
#Secreting '''molecules that mediate adherence''' into host cells
*Secreting '''molecules that mediate adherence''' into host cells
#Production of '''hydrolases''' which has a lytic effect on tissues and facilitate the invasion by the bacteria.
*Production of '''[[hydrolases]]''' which has a [[Lytic|lytic effect]] on tissues and facilitate the invasion by the fungus.
#'''Polymorphism:''' Candida has the ability to grow either as pseudohyphae (elongated elipsoid form) or in a yeast form (rounded to oval budding form. While the role of #polymorphism is not clearly understood in the virulence of Candida, it’s noted that species capable of producing the most severe form of the disease has this ability.
*'''[[Polymorphism]]:''' [[Candida]] has the ability to grow either as [[Hyphae|pseudohyphae]] (elongated ellipsoid form) or in a [[Yeast|yeast form]] (rounded to oval budding form. While the role of polymorphism is not clearly understood in the [[virulence]] of [[Candida]], it’s noted that the species that are capable of producing the most severe form of the disease has this ability.
#'''Biofilm production:''' which means the ability to form a thick layer of the organism on the mucosal surfaces or even on catheters and dentures.
*'''[[Biofilm|Biofilm production]]:''' which means the ability to form a thick layer of the [[organism]] on the [[Mucosal|mucosal surfaces]] or even on [[catheters]] and [[dentures]].


Patients was candida vulvovaginitis were found to have decreased levels of mannose binding lectins (MBL) . Further investigations revealed that 2 genetic mutations in genes responsible for MBL and IL4 production increase the host susceotibility of getting recurrent candidal vulvovaginitis.<ref name="pmid18715406">{{cite journal |vauthors=Donders GG, Babula O, Bellen G, Linhares IM, Witkin SS |title=Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis |journal=BJOG |volume=115 |issue=10 |pages=1225–31 |year=2008 |pmid=18715406 |doi=10.1111/j.1471-0528.2008.01830.x |url=}}</ref>
Patients with [[candida vulvovaginitis]] were found to have decreased levels of [[Lectins|mannose binding lectins (MBL)]] . Further investigations revealed that 2 [[genetic mutations]] in [[genes]] responsible for [[Lectins|MBL]] and [[Interleukin 4|IL4]] production increase the host susceptibility of getting recurrent [[candida vulvovaginitis]].<ref name="pmid18715406">{{cite journal |vauthors=Donders GG, Babula O, Bellen G, Linhares IM, Witkin SS |title=Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis |journal=BJOG |volume=115 |issue=10 |pages=1225–31 |year=2008 |pmid=18715406 |doi=10.1111/j.1471-0528.2008.01830.x |url=}}</ref>


===Host immune defects===
===Host immune defects===
Any condition that compromises cell mediated immunity, worsens the general status of the patient or provide a favorable medium for candida to form biofilms  put the patient at increased risk for having candidiasis.<ref name="pmid16984866">{{cite journal |vauthors=Pappas PG |title=Invasive candidiasis |journal=Infect. Dis. Clin. North Am. |volume=20 |issue=3 |pages=485–506 |year=2006 |pmid=16984866 |doi=10.1016/j.idc.2006.07.004 |url=}}</ref>
Any condition that compromises [[Cell-mediated immunity|cell mediated immunity]], worsens the general status of the patient or provide a favorable medium for [[Candida]] to form [[biofilms]] put the patient at increased risk for having candidiasis.<ref name="pmid16984866">{{cite journal |vauthors=Pappas PG |title=Invasive candidiasis |journal=Infect. Dis. Clin. North Am. |volume=20 |issue=3 |pages=485–506 |year=2006 |pmid=16984866 |doi=10.1016/j.idc.2006.07.004 |url=}}</ref>
====Conditions that compromises cell mediated immunity:====
====Conditions that compromises cell mediated immunity:====
*T cell deficiencies as in DiGeorge syndrome, Wiscot-Aldrich syndrome and ataxia-telengictasia.
*[[T lymphocyte|T cell deficiencies]] as in [[DiGeorge syndrome]], Wiscott-Aldrich syndrome and [[Ataxia-telangiectasia]].
*Bone marrow transplant  
*[[Bone marrow transplant]]
*Leukaemias
*[[Leukaemias]]
*Corticosteroids use or immunosuppresive drugs.
*[[Corticosteroids]] use or [[Immunosuppresive drug|immunosuppresive drugs]].


====Conditions that worsens the general condition:====
====Conditions that worsens the general condition:====
*Malignancies
*[[Malignancies]]
*Recent chemotherapy
*[[Chemotherapy|Recent chemotherapy]]
*Trauma
*[[Trauma]]
*Recent surgery
*Recent surgery
*Prolonged hospitalization
*Prolonged hospitalization
*Broad spectrum antibiotics
*[[Broad-spectrum antibiotic|Broad-spectrum antibiotics]]
*Renal failure
*[[Renal failure]]
*Haemodialysis (especially if prolonged)
*[[Haemodialysis]] (especially if prolonged)


====Dentures that provide a favorable media for forming biofilms:====
====Dentures that provide a favorable media for forming biofilms:====
*Prolonged central venous catheters insertion
*Prolonged [[central venous catheters]] insertion
*Prolonged foley’s catheter insertion
*Prolonged [[Foley catheter|foley’s catheter]] insertion
*Prolonged mechanical ventilation
*Prolonged [[mechanical ventilation]]
 
==Differential diagnosis==
Candidiasis should be differentiated from other diseases presenting with an erythmatous, scaly, annular and pruritic rash. The differentials include the following:
{| class="wikitable"
! align="center" style="background: #4479BA; color: #FFFFFF; " |Name of superficial infection
! align="center" style="background: #4479BA; color: #FFFFFF; " |Clinical presentation
! align="center" style="background: #4479BA; color: #FFFFFF; " |Extension to hair follicle
! align="center" style="background: #4479BA; color: #FFFFFF; " |Fungus(i)
! align="center" style="background: #4479BA; color: #FFFFFF; " |Systemic disease
! align="center" style="background: #4479BA; color: #FFFFFF; " |KOH preparations
! align="center" style="background: #4479BA; color: #FFFFFF; " |Morphology in tissue sections
|-
| colspan="1" rowspan="1" |Tinea or [[Ringworm Infection|ringworm]]
| colspan="1" rowspan="1" |Round lesions with [[Scaling skin|scaly]] border, accompanied by [[pruritis]] and burning
| colspan="1" rowspan="1" |Yes; when [[suppurative]] known as [[kerion]], when chronic known as [[Majocchi's granuloma]]
| colspan="1" rowspan="1" |Dermatophytes (''[[Epidermophyton]]'' spp., ''[[Trichophyton]]'' spp., ''[[Microsporum]]'' spp.)
| colspan="1" rowspan="1" |Very rare but can invade the [[dermis]] and [[Soft tissue|soft tissues]], causing [[Mycetoma|mycetomas]]
| colspan="1" rowspan="1" |[[Hyphae]] with or without septations
| colspan="1" rowspan="1" |[[Hyphae]] cannot be visualized in the [[keratin]] with [[H&E stain|H&E]], special stains are needed
|-
| colspan="1" rowspan="1" |[[Tinea versicolor]]
| colspan="1" rowspan="1" |Hypo and [[hyperpigmentation]] in patients with oily and sweaty skin, fine [[Scaling skin|scales]] when scratching
| colspan="1" rowspan="1" |Yes, known as ''Pityrosporum'' folliculits
| colspan="1" rowspan="1" |''[[Malassezia]]'' spp.
| colspan="1" rowspan="1" |Systemic infections may occur in [[Premature birth|premature]] [[neonates]] receiving [[parenteral]] nutrition and in other [[Immunosuppression|immunosuppressed]] [[Host (biology)|hosts]]
| colspan="1" rowspan="1" |[[Yeast|Yeasts]] and [[hyphae]] (“spaghetti and meat balls”)
| colspan="1" rowspan="1" |Faintly [[basophilic]] hyphae in the [[stratum corneum]]
|-
| colspan="1" rowspan="1" |[[Tinea nigra]]
| colspan="1" rowspan="1" |Brown to black [[macule]], usually on palms, with some scaling
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |''Phaeoannellomyces werneckii''
| colspan="1" rowspan="1" |Not described
| colspan="1" rowspan="1" |Darkly pigmented, septated, and branching [[hyphae]]
| colspan="1" rowspan="1" |Pigmented [[hyphae]] in the [[stratum corneum]]
|-
| colspan="1" rowspan="1" |[[White piedra]]
| colspan="1" rowspan="1" |Creamy-white, small, soft nodules in hair shafts
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |''[[Trichosporon]]'' spp.
| colspan="1" rowspan="1" |[[Immunosuppressed]] patients may have [[lung]] infiltrates, [[renal]] involvement, and [[fungemia]]
| colspan="1" rowspan="1" |Septate [[hyphae]] perpendicular to hair shaft
| colspan="1" rowspan="1" |Not used for diagnosis
|-
| colspan="1" rowspan="1" |[[Black piedra]]
| colspan="1" rowspan="1" |Hard dark nodules in hair shafts
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |''Piedraia hortae''
| colspan="1" rowspan="1" |Not described
| colspan="1" rowspan="1" |Collections of crescent ascospores surrounded by [[Pigmented lesions|pigmented]] [[hyphae]]
| colspan="1" rowspan="1" |Not used for diagnosis
|-
| colspan="1" rowspan="1" |[[Candidiasis|Superficial candidiasis]]
| colspan="1" rowspan="1" |[[Intertrigo]], chronic [[paronychia]], [[onychodystrophy]], [[cheilitis]]
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |''[[Candida]]'' spp.
| colspan="1" rowspan="1" |Yes, particularly in patients with [[AIDS]] and depending on the level of [[immunosuppression]]
| colspan="1" rowspan="1" |[[Yeast|Yeasts]], pseudohyphae may be observed
| colspan="1" rowspan="1" |[[Fungal]] elements may be seen through the biopsy, vascular invasion must be determined
|}


==References==
==References==
{{reflist|2}}
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Hematology]]
[[Category:Otolaryngology]]
[[Category:Neurology]]
[[Category:Gynecology]]
[[Category:Dermatology]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Infectious disease]]

Latest revision as of 20:47, 29 July 2020

Candidiasis
Agar plate culture of Candida albicans

Candidiasis Main page

Patient Information

Overview

Causes

Classification

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Synonyms and keywords: Candida infection, Candida caused diseases

Overview

Candida is a normal commensal of the skin and mucous membranes. The balance between the virulence of the fungus and the host immune defense is responsible avoiding opportunistic infection of candida. Deficiency of cell-mediated immunity or poor general status are the main risk factors for having opportunistic candidiasis. Candidiasis is usually localized to skin and mucous membranes. In rare cases, candidiasis can spread causing candidaemia and distant infection. These cases are usually associated with deficient immunity C. albicans is the main species causing infection in humans more than any other candida species.

Causes

Candida Albicans is responsible for the majority of Candida infections.

Localized candidiasis

Oral and esophageal candidasis:

Candida vulvovaginitis:

Chronic mucocutaneous candidiasis:

Invasive candidasis

Candidaemia:

Candida endocarditis:

Candida osteoarticular disease:

Classification

Candidiasis can be classified according to the site of infection into:[9]


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Candidiasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Localoized mucocutaneous candidiasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Invasive Candidiasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oropharyngeal candidiasis
 
Esophageal candidiasis
 
 
 
 
 
Candida vulvovaginitis
 
Chronic mucocutaneous candidiasis
 
 
 
 
 
 
 
 
Candidaemia
 
Candida endophthalmitis
 
 
 
 
 
Candida endocarditis
 
 
Candida osteoarticular disease

Pathophysiology

Candida is a normal commensal of skin and mucous membranes. A competent immune system and an intact regenerating healthy skin prevent the virulence of Candida.

Candida Virulence factors

The main virulence factors that mediate the infection:[10]

Patients with candida vulvovaginitis were found to have decreased levels of mannose binding lectins (MBL) . Further investigations revealed that 2 genetic mutations in genes responsible for MBL and IL4 production increase the host susceptibility of getting recurrent candida vulvovaginitis.[11]

Host immune defects

Any condition that compromises cell mediated immunity, worsens the general status of the patient or provide a favorable medium for Candida to form biofilms put the patient at increased risk for having candidiasis.[12]

Conditions that compromises cell mediated immunity:

Conditions that worsens the general condition:

Dentures that provide a favorable media for forming biofilms:

Differential diagnosis

Candidiasis should be differentiated from other diseases presenting with an erythmatous, scaly, annular and pruritic rash. The differentials include the following:

Name of superficial infection Clinical presentation Extension to hair follicle Fungus(i) Systemic disease KOH preparations Morphology in tissue sections
Tinea or ringworm Round lesions with scaly border, accompanied by pruritis and burning Yes; when suppurative known as kerion, when chronic known as Majocchi's granuloma Dermatophytes (Epidermophyton spp., Trichophyton spp., Microsporum spp.) Very rare but can invade the dermis and soft tissues, causing mycetomas Hyphae with or without septations Hyphae cannot be visualized in the keratin with H&E, special stains are needed
Tinea versicolor Hypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratching Yes, known as Pityrosporum folliculits Malassezia spp. Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hosts Yeasts and hyphae (“spaghetti and meat balls”) Faintly basophilic hyphae in the stratum corneum
Tinea nigra Brown to black macule, usually on palms, with some scaling No Phaeoannellomyces werneckii Not described Darkly pigmented, septated, and branching hyphae Pigmented hyphae in the stratum corneum
White piedra Creamy-white, small, soft nodules in hair shafts No Trichosporon spp. Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemia Septate hyphae perpendicular to hair shaft Not used for diagnosis
Black piedra Hard dark nodules in hair shafts No Piedraia hortae Not described Collections of crescent ascospores surrounded by pigmented hyphae Not used for diagnosis
Superficial candidiasis Intertrigo, chronic paronychia, onychodystrophy, cheilitis Yes Candida spp. Yes, particularly in patients with AIDS and depending on the level of immunosuppression Yeasts, pseudohyphae may be observed Fungal elements may be seen through the biopsy, vascular invasion must be determined

References

  1. Laurent M, Gogly B, Tahmasebi F, Paillaud E (2011). "[Oropharyngeal candidiasis in elderly patients]". Geriatr Psychol Neuropsychiatr Vieil (in French). 9 (1): 21–8. doi:10.1684/pnv.2011.0259. PMID 21586373.
  2. Corsello S, Spinillo A, Osnengo G, Penna C, Guaschino S, Beltrame A; et al. (2003). "An epidemiological survey of vulvovaginal candidiasis in Italy". Eur J Obstet Gynecol Reprod Biol. 110 (1): 66–72. PMID 12932875.
  3. Okungbowa FI, Isikhuemhen OS, Dede AP (2003). "The distribution frequency of Candida species in the genitourinary tract among symptomatic individuals in Nigerian cities". Rev Iberoam Micol. 20 (2): 60–3. PMID 15456373.
  4. "Chronic mucocutaneous candidiasis - Journal of the American Academy of Dermatology".
  5. Ostrosky-Zeichner L, Pappas PG (2006). "Invasive candidiasis in the intensive care unit". Crit. Care Med. 34 (3): 857–63. doi:10.1097/01.CCM.0000201897.78123.44. PMID 16505666.
  6. Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W (2001). "Fungal endocarditis: evidence in the world literature, 1965-1995". Clin. Infect. Dis. 32 (1): 50–62. doi:10.1086/317550. PMID 11118386.
  7. Dupont B, Drouhet E (1985). "Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients". J. Infect. Dis. 152 (3): 577–91. PMID 3897399.
  8. "Candidiasis | Types of Diseses | Fungal Diseases | CDC".
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