candidiasis

Introduction 

Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida

-the most common species is Candida albicans

-Candida albicans can exist in both hyphal and yeast forms (dimorphism)

-It can form hyphae and pseudohyphae 

-Risk factors: use of oral antibiotics, use of steroids, immunodeficiency, diabetes, pregnancy, birth control pills, obesity and trauma 

Symptoms & Signs 

-It can appear in different manifestations: Cutaneous candidiasis, oral candidiasis, paronychia, onychomycosis, vulvovaginitis, balanitis, chronic mucocutaneous candidiasis, and disseminated candidiasis 

Morphology: Macules, beefy-red patches, plaques with satellite papules and pustules at the periphery 

Oral thrush: Whitish-curd-like pseudomembranous lesions over an erythematous base; it “wipes off” with the application of gauze 

Onychomycosis: Erythematous swelling of the nail folds 

Diagnosis 

Clinical features: Whitish, curd-like pseudomembranes

Potassium hydroxide (KOH) preparation: pseudohyphae and budding yeasts

-Candida albicans also shows true hyphae as germ tubes or chlamydospores

Other tests: Blood cultures, antigen and antibody testing, β-D-glucan tests 

Treatment 

Therapy for candidiasis includes three classes of medications:

1.Azoles: Ketoconazole, Fluconazole,miconazole, clotrimazole, itraconazole, posaconazole, isavuconazole, voriconazole

2.Echinocandins: Caspofungin, Anidulafungin, Micafungin 

3.Polyenes: Amphotericin B 

Mild disease: Nystatin or azoles 

Severe disease: Azoles or echinocandins or amphotericin B

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