CANDIDIASISCANDIDIASIS

SOFYAN LUBISDEPARTEMEN MIKROBIOLOGI

FAK.KEDOKTERAN USUMEDAN

2009

Opportunistic MycosesOpportunistic mycoses are fungal infections that do not normally cause disease in healthy people, but do cause disease in people with weakened immune defenses (immunocompromised people).

Weakened immune function may occur due to

inherited immunodeficiency diseases, drugs that suppress the immune system (cancer chemotherapy,

corticosteroids, drugs to prevent organ transplant rejection), radiation therapy, infections (e.g., HIV), cancer, diabetes mellitus advanced age ,and malnutrition.

Opportunistic Mycoses

The most common infections are:

CANDIDIASIS

ASPERGILLOSIS

CRYPTOCOCCOSIS

ZYGOMYCOSIS

PNEUMOCYSTIS JIROVECI ( P.carinii)

Candida albicans• widespread yeast

• infections can be short-lived, superficial skin irritations overwhelming, fatal systemic diseases

• budding cells of varying size that my form both elongate pseudohyphae & true hyphae

• forms off-white, pasty colony with a yeasty odor

Candida albicans

• Normal flora of oral cavity, genitalia, large intestine or skin of 20% of humans

• Account for 80% of nosocomial fungal infections• Account for 30% of deaths from nosocomial

infections• Thrush – occurs as a thick, white, adherent growth

on the mucous membranes of mouth & throat• Vulvovaginal yeast infection – painful

inflammatory condition of the female genital region that causes ulceration & whitish discharge

• Cutaneous candidiasis – occurs in chronically moist areas of skin and burn patients

Candida albicans

• Normal flora of oral cavity, genitalia, large intestine or skin of 20% of humans

• Account for 80% of nosocomial fungal infections

• Account for 30% of deaths from nosocomial infections

Candida albicans

• Thrush – occurs as a thick, white, adherent growth on the mucous membranes of mouth & throat

• Vulvovaginal yeast infection – painful inflammatory condition of the female genital region that causes ulceration & whitish discharge

• Cutaneous candidiasis – occurs in chronically moist areas of skin and burn patients

Candida albicans

C. albicans is a member of the indigenous microbial flora of humans. 1. Found in the gastrointestinal tract, upper respiratory tract, buccal

cavity, and vaginal tract.2. Growth is normally suppressed by other microorganisms found in

these areas.3. Alterations of gastrointestinal flora by broad spectrum antibiotics

or mucosal injury can lead to gastrointestinal tract invasion.4. Skin and mucus membranes are normally an effective barrier but

damage by introduction of catheters or intravascular devices can permit Candida to enter the bloodstream.

In vitro (25o C): mostly yeast;

In vivo (37o C): Yeast, hyphae and pseudohyphae

Candida albicans

In vitro (25o C): mostly yeast;

In vivo (37o C): Yeast, hyphae and pseudohyphae

Candidiasis Vaginal candidiasis is the most common

clinical infection. Local factors such as pH and glucose concentration (under hormonal control) are of prime importance in the occurrence of vaginal candidiasis.

In mouth, normal saliva reduces adhesion (lactoferrin is also protective).

Immune ResponseHyphae are too big for phagocytosis but are damaged by PMNs and by extracellular mechanisms (myeloperoxidase and b- glucuronidase). Cytokine activated lymphocytes can inhibit growth of C. albicans.  Resistance to invasive infection by Candida is mediated by phagocytes, complement and antibody, though cell-mediated immunity plays a major role. Patients with defects in phagocytosis function and myeloperoxidase deficiency are at risk for disseminated (even fatal) Candidiasis.

Candidiasis• Vaginal candidiasis is the most common clinical infection. Local factors such as pH and glucose concentration (under hormonal control) are of prime importance in the occurrence of vaginal candidiasis.

• In mouth, normal saliva reduces adhesion (lactoferrin is also protective).

Candidiasis, immune response

Hyphae are too big for phagocytosis but are damaged by PMNs and by extracellular mechanisms (myeloperoxidase and b- glucuronidase). Cytokine activated lymphocytes can inhibit growth of C. albicans.  Resistance to invasive infection by Candida is mediated by phagocytes, complement and antibody, though cell-mediated immunity plays a major role. Patients with defects in phagocytosis function and myeloperoxidase deficiency are at risk for disseminated (even fatal) Candidiasis.

Candidiasis of skin, mucous membranes and nails

• Predisposing factors

• Infancy, pregnancy, old age

• Disorders of immune function, e.g., leukemia, corticosteroid therapy

• Chemotherapy, e.g., immunosuppressive, antibiotic

• Endocrine disease, e.g., diabetes mellitus

• Carcinoma

Candidiasis of skin, mucous membranes and nails

Oropharyngeal candidiasis, including:

THRUSH

GLOSSITIS,

STOMATITIS, AND

ANGULAR CHEILITIS ( PERLECHE )

Candidiasis of skin, mucous membranes and nails

Candida albicans

Candidiasis

Thrush

Vaginal

Opportunistic Infection by Candida albicans in an AIDS Patient

Source: Atlas of Clinical Oral Pathology, 1999

Candidiasis of skin, mucous membranes and nails

Cutaneous candidiasis , including :

• intertrigo,

• diaper candidiasis,

• paronychia ,and

• onychomycosis

Candidiasis of skin, mucous membranes and nails

Tinea unguium

Tinea pedis

Source: Microbiology Perspectives, 1999.

Candida albicans infection of the nails

Candidiasis Vaginal candidiasis is the most common

clinical infection. Local factors such as pH and glucose concentration (under hormonal control) are of prime importance in the occurrence of vaginal candidiasis.

In mouth: normal saliva reduces adhesion (lactoferrin is also protective).

Candidiasis of skin, mucous membranes and nails

• Vulvovaginal candidiasis and balanitis:

• vaginal discharge,

• dysuria,

• erythematous

• oral contraceptive,

• pregnancy

Candidiasis

Cutaneous

Thrush

Risk factors for Candidiasis

Post-operative statusCytotoxic cancer

chemotherapyAntibiotic therapyBurnsDrug abuseGastrointestinal damage.

Chronic mucocutaneous candidiasis

Chronic mucocutaneous candidiasis (CMC) is the label given to a group of overlapping syndromes that have in common a clinical pattern of persistent, severe, and diffuse cutaneous candidal infections. These infections affect the skin, nails and mucous membranes.

Immunologic studies of patients with CMC often reveal defects related to cell-mediated immunity, but the defects themselves vary widely.

Chronic mucocutaneous candidiasis

Chronic mucocutaneous candidiasis (CMC) is the label given to a group of overlapping syndromes that have in common a clinical pattern of persistent, severe, and diffuse cutaneous candidal infections. These infections affect the skin, nails and mucous membranes.

Immunologic studies of patients with CMC often reveal defects related to cell-mediated immunity, but the defects themselves vary widely.

Mucutaneous candidiasis: response to fluconazole

Transfusion of a Candida-specific transfer factor has been reported to be very successful (remission for > 10 years) when combined with antifungal therapy. The availability of effective oral agents, especially the azole antimicotics, has dramatically changed the life of patients living with CMC.

Candida albicans

Lab diagnosis of C.albicans:1. Germ tube test

2. Pembentukan khlamidospora di cornmeal agar

3. Di medium EMB Levine : membentuk koloni seperti kaki laba-laba

4. Fermentasi sugars

5. Assimilasi sugars

Candidiasis

Chlamydospores of C.albicans

Vulvovaginitis of children• The vagina is close to the anus and the vulva

lacks the protective labial fat and pubic hair of

an adult.

• Also, children often have poor personal hygiene.

• Children with vulvovaginitis may complain of pain, itching, and burning around the vagina; a vaginal discharge; and pain when urinating.

• Causes of vulvovaginitis in children include:

bacteria or fungus,

pinworm, contact irritants, skin diseases, and

and foreign body.

Don’t Litter

Keep our class clean

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