Candidiasis

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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]

Overview

Causes

Classification:[1]

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

Localoized mucocutaneous candidiasis:

  • Oropharyngeal candidiasis
  • Esophageal candidiasis
  • Candida vulvovaginitis
  • Chronic mucocutaneous candidiasis.

Invasive Candidiasis:

More serious and usually presenting in an immunocompromised host.

  • 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:[2]

  1. Secreting molecules that mediate adherence into host cells
  2. Production of hydrolases which has a lytic effect on tissues and facilitate the invasion by the bacteria.
  3. 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.
  4. Biofilm production: which means the ability to form a thick layer of the organism on the 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.[3]

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.[4]

Conditions that compromises cell mediated immunity:

  • T cell deficiencies as in DiGeorge syndrome, Wiscot-Aldrich syndrome and ataxia-telengictasia.
  • Bone marrow transplant
  • Leukaemias
  • Corticosteroids use or immunosuppresive drugs.

Conditions that worsens the general condition:

  • Malignancies
  • Recent chemotherapy
  • Trauma
  • Recent surgery
  • Prolonged hospitalization
  • Broad spectrum antibiotics
  • Renal failure
  • Haemodialysis (especially if prolonged)

Dentures that provide a favorable media for forming biofilms:

  • Prolonged central venous catheters insertion
  • Prolonged foley’s catheter insertion
  • Prolonged mechanical ventilation

References

  1. "Candidiasis | Types of Diseses | Fungal Diseases | CDC".
  2. Mayer FL, Wilson D, Hube B (2013). "Candida albicans pathogenicity mechanisms". Virulence. 4 (2): 119–28. doi:10.4161/viru.22913. PMC 3654610. PMID 23302789.
  3. Donders GG, Babula O, Bellen G, Linhares IM, Witkin SS (2008). "Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis". BJOG. 115 (10): 1225–31. doi:10.1111/j.1471-0528.2008.01830.x. PMID 18715406.
  4. Pappas PG (2006). "Invasive candidiasis". Infect. Dis. Clin. North Am. 20 (3): 485–506. doi:10.1016/j.idc.2006.07.004. PMID 16984866.