Candidiasis, Moniliasis, Oral thrush, Yeast infections


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Microbiology Fungal Infection particularly Candida albicans ie Candidiasis a.k.a Moniliasis.

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  • The clinical pathogen Candida albicans is a budding yeast that is capable of forming a range of polarized and expanded cell shapes from pseudohyphae to true nonconstrictedhyphae. Filamentous forms consist of contiguous uninucleated compartments that are partitioned by septa. It has long been held that the so-called "dimorphic transition" from a budding to a filamentous form may aid the fungus to penetrate epithelia and may therefore be a virulence factor. This review summarized new information regarding the physiology and ecology of hyphal growth in C. albicans. New evidence has demonstrated that hyphae of C. albicans have a sense of touch so that they grow along grooves and through pores (thigmotropism). 
  • Fungi occur in two basic growth forms or stages: (a) A unicellular or yeast form which is defined morphologically, as a single-celled fungus that reproduces by simple budding to form blastoconidia. Colonies are usually moist or mucoid. Yeast-like fungi may be basidiomycetes, such as Cryptococcus neoformans or ascomycetessuch as Candida albicans. (b) A filamentous or mould form which is a vegetative growth of filaments. Structures such as mushrooms consist simply of a number of filaments packed tightly together, and reproduction is by spores or conidia. Moulds produce a great variety of conidia which are borne on specialized hyphae or conidiophores. Many moulds can be identified by the morphology of these spores and by their arrangement on the hyphae. Fungal filaments are known as hyphae and a mass of hyphae collectively make up the mycelium. The terms "hyphae" and "mycelium" are used interchangeably. There are two kinds of hyphae; non-septate(coenocytic) and septate. The septa divide the hyphae into compartments but not into cells. In some groups nuclei and/or cytoplasm can flow through a hole or pore in the centre of these septa.
  • Candidaalbicans identified by production of germ tube or chlamydoconidiaGerm tube test is used for identification of yeast, aprox. 75% of clinical cases are due to Candida albicans and is confirmed by this testAnother Candida dubliniensis also produce germ tubes but infrequently encounteredCandida tropicalis produces pseudo germ tubesHow to distinguish?C.Tropicalis – constricted at the point of germ tube originC.Albicans – no constrictionAnother method is – chlamydoconidia in cornmeal agar containing 1% tween 80 and trypan blue incubated 24 to 48 hours.Another method – rapid enzymatic screening – candida albicans produce beta aminidase, L prolineaminopeptidase. Other species produce only ONE ENZYMES.Bacticard candidaMurex candida albicans-50Albicans sureAll are specific for candida albicans
  • Swabs were then streaked onto Sabouraud?s dextrose agar slopes to which chloramphenicol was added (40 gm dextrose, 10 gm peptone, 15 gm agar, and 1000 ml distilled water) and incubated at 37?C for 3 days. Macroscopic (creamy moist colonies) (Fig-1) and microscopic (yeast cells, pseudohyphae, and blastospores) examination of the growths verified the diagnosis of candidiasis.
  • Clinical specimens and identification of isolates. Specimens from oral lesions were collected by passing a sterile cotton swab several times across the affected surface. Candida infection was diagnosed by the presence of budding yeasts with hyphae and pseudohyphae on potassium hydroxide examination. Swabs were then streaked onto Sabouraud?s dextrose agar slopes to which chloramphenicol was added (40 gm dextrose, 10 gm peptone, 15 gm agar, and 1000 ml distilled water) and incubated at 37?C for 3 days. Macroscopic (creamy moist colonies) (Fig-1) and microscopic (yeast cells, pseudohyphae, and blastospores) examination of the growths verified the diagnosis of candidiasis.
  • Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin “swish and swallow”). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments.Candida esophagitis is typically treated with oral or intravenous fluconazole or oral itraconazole.  For severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.Amphotericin B is a polyene antifungal antibiotic which alters cell membrane permeability by binding to ergosterol, thus causing leakage of cell components and subsequent cell death. It is active against Absidiaspp, Aspergillusspp, Basidiobolusspp, B. dermatitidis, Candida spp, C. immitis, Conidobolusspp, C. neoformans, H. capsulatum, Mucorspp, P. brasiliensis, Rhizopusspp, Rodotorula spp. and S. schenckii.
  • chlorhexidine is a very potent cationic chemoprophylactic agent that has a broad-spectrum of activity against gm+ve and gm-ve bacteria. It is both bacteriostatic and bactericidal depending on its concentration. The bactericidal effect, which is achieved at high concentrations, is due to the binding of the cationic to negatively charged bacterial cell walls and extramicrobial complexes. Bacteriostatic effect is achieved at low concentrations which causes an alteration of bacterial cell osmotic equilibrium and leakage of potassium and phosphorus.Absorption: Poorly absorbed from GI tract and skin.Excretion: Excreted mainly in the faeces (unchanged).
  • OverviewLactobacillusacidophilus (L. acidophilus) is the most commonly used probiotic, or "friendly" bacteria. Many healthy bacteria live in the intestines and vagina, where they protect against "bad" bacteria that can cause disease. They do this in a couple of ways: for example, when L. acidophilus breaks down food in the intestine, several substances are formed (such as lactic acid and hydrogen peroxide) that create an unfriendly environment for “bad” bacteria. Probiotics are often suggested as a supplement when you take antibiotics. Antibiotics kill bacteria, but don’t discriminate between “friendly” and “unfriendly” organisms, so the balance between good and bad bacteria in the intestines can be upset. It is thought that taking probiotics helps restore the healthy balance of bacteria.Other probiotics include several Lactobacillus species (spp.), such as L. bulgaricus, L. casei, and L. reuteri, Lactobacillus GG,Bifidobacteriumlongum, Bifidobacteriumbifidum, Streptococcus thermophilus, and Saccharaomycesboulardii (a kind of yeast).In addition to probiotics, some health care providers suggest taking “prebiotics.” These are the soluble fiber found in some foods or supplements that help prebiotics thrive in the intestine. Examples include fructooligosaccharides (FOS), a carbohydrate found in some fruits and vegetables.UsesProbiotics may be used for the following:Vaginal infectionsSeveral clinical studies suggest that using L. acidophilus vaginal suppositories can help treat bacterial vaginosis. A small number of clinical studies suggests that eating yogurt with L. acidophilus cultures may also help. Some people also use L. acidophilus to treat or prevent vaginal yeast infections, although the evidence about whether it is effective is mixed. Additional clinical research is needed.Diarrhea preventionThe evidence for using Lactobacillus to prevent diarrhea is mixed. Some clinical research suggests Lactobacillus acidophilus may be effective when used to prevent traveler’s diarrhea (caused by eating contaminated food). Other studies have found that Lactoabcillus GG was effective. A mix of probiotics (Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacteriumbifidum) helped treat traveler’s diarrhea in one study.Probiotics, especially Lactobacillus GG, may help prevent or treat infectious diarrhea in children and adults, although the evidence is mixed. Studies seem to show probiotics are most effective in treating rotavirus in children. Diarrhea in children can be serious, and you should call your doctor if it lasts more than a day or your child seems dehydrated.Other studies have found that probiotics, taken regularly, may help prevent gastrointestinal infections in adults.Several studies suggest that probiotics, especially Lactobacillus GG and S boulardi, may help prevent diarrhea associated with taking antibiotics. Antibiotic-related diarrhea can be serious, so you should tell your doctor about it.Other usesLactobacillus and other probiotics have been suggested for a number of conditions, although evidence in most cases is preliminary or mixed:Replacing the "friendly" intestinal bacteria destroyed by antibioticsHelping digestion and suppressing disease causing bacteriaTreating chronic constipationTreating symptoms of irritable bowel syndrome and inflammatory bowel disease (such as Crohn's disease and ulcerative colitis)Improving lactose tolerance in people who are lactose intolerantEnhancing the immune system. Studies have suggested that consuming yogurt or milk that contains specific strains of Lactobacillus or taking supplements with Lactobacillus or Bifidobacterium may improve the body’s natural immune response. One study found that supplementation for 6 months was a safe, effective way to reduce fever, cough, and duration of antibiotic treatment, as well as number of missed school days for children 3 - 5 years of ageLowering risk of pollen allergiesReducing the risk of childhood eczemaHelping to treat high cholesterolDietary SourcesThe primary dietary sources of L. acidophilus include milk enriched with acidophilus, yogurt containing live L. acidophilus cultures, miso, and tempeh.Prebiotics are found in breast milk, onions, tomatoes, bananas, honey, barley, garlic, and wheat.Available FormsL.acidophilus preparations consist of dried or liquid cultures of living bacteria. These cultures are usually grown in milk but can sometimes be grown in milk-free cultures. L. acidophilus is available in the following forms:Freeze dried granulesFreeze dried powdersFreeze dried capsulesLiquid L. acidophilus preparationsYogurt enhanced with probioticsVaginal suppositoriesTabletsRefrigerate L. acidophilus supplements for best quality. Some preparations are in a form that does not break down under normal temperatures and may be convenient for travelers who can’t refrigerate their supplements. Check the package label for storage instructions.Marketed probiotics are highly variable, with some products containing single microbes while others comprise multiple distinct microbes. Studies to verify the composition of probiotic formulations have found that discrepancies are common between the stated and actual number of viable organisms in any given product.Prebiotics occur naturally in foods, but supplements provide a more concentrated source. Prebiotics are oligosaccharides -- chains of sugar units linked together -- and include inulin and fructooligosaccharides (FOS). Fructoligosaccarhides (FOS) are the most commonly used.Source: Lactobacillus acidophilus | University of Maryland Medical Center University of Maryland Medical Center Follow us: @UMMC on Twitter | MedCenter on Facebook
  • Nearly 75% of all adult women have had at least one "yeast infection" in their lifetime. On rare occasions, men can also get genital candidiasis. VVC occurs more frequently and more severely in people with weakened immune systems. Other conditions that may put a woman at risk for genital candidiasis include:PregnancyDiabetesLong-term use of broad-spectrum antibioticsUse of corticosteroid medications
  • The symptoms of VVC are similar to those of many other genital infections, so it can be difficult to diagnose a yeast infection by physical examination only.  Usually the diagnosis is made by taking a sample of the vaginal secretions and looking at the sample under a microscope to see if an abnormal number of Candida organisms are present. A fungal culture may not always be useful because Candida species are normal inhabitants of the body.
  • Wearing cotton underwear may help to reduce the risk of developing a yeast infection. For women who experience recurrent yeast infections (more than three per year), some evidence suggests that oral or intravaginal probiotics may help to prevent frequent infections.
  • Restoration of lactobacillus flora after anti-infective or chemotherapeutic agents; atrophic vaginitis due to estrogen deficiency, as co-medication to hormone replacement therapy; vag discharge of unknown origin or mild to moderate cases of bacterial vaginosis & candidiasis.
  • Candidiasis, Moniliasis, Oral thrush, Yeast infections

    3. 3. TAXONOMY • KINGDOM : FUNGI • DIVISION : DEUTEROMYCOTA • SUBDIVISION : DEUTEROMYCOTINA • CLASS : BLASTOMYCETES • ORDER: CRYPTOCOCCALES • GENUS : CANDIDA SPECIES : 1. C.albicans 2. C.tropicalis 3. C.parapsilosis 4. C.krusei ( resistant to AZOLES ) 5. C.guilliermondii ( resistant to AZOLES ) 6. C.stellatoidea 7. C.glabrata 8. C.viswanathii 9. C.dubliniensis 10. C.lusitaniae 11. C.kefyr 4/17/2014 3
    4. 4. Candida albicans •UNIQUENESS : Ranges from BLASTOCONIDIA to PSEUDOHYPHAE(Dr Geetha: Pseudohyphae is NOT SEEN in C.albicans) to TRUE HYPHAE •HYPHAE are partitioned by SEPTA. •DIMORPHIC TRANSITION – Penetration of EPITHELIA – Virulence Factor •SPECIAL ABILITY : Hyphae of C.albicans have sense of TOUCH to grow along GROOVES and through PORES. (THIGMOTROPISM)4/17/2014 4
    5. 5. • Candidiasis(Moniliasis) is a FUNGAL INFECTION caused by YEASTS which belong to genus Candida. • There are over 20 species of Candida yeasts that can cause infection in humans. • The most common one is Candida albicans. • Candida yeasts are normal fungal flora of skin, female genital tract, git (mouth & oropharnyx). • Overgrowth of these can cause infections. 4/17/2014 5
    6. 6. CANDIDIASIS OROPHARYNGEAL CANDIDIASIS VULVO-VAGINAL CANDIDIASIS SYSTEMIC CANDIDIASIS • Candidiasis in mouth or throat is called ORAL THRUSH • Candidiasis in the vagina • Commonly referred to as YEAST INFECTION • This occurs when Candida yeasts invades BLOODSTREAM 4/17/2014 6
    7. 7. OROPHARYNGEAL / ESOPHAGEAL CANDIDIASIS MOST COMMON symptom : White patches or plaques on the tongue and oral mucous membranes. 4/17/2014 7
    8. 8. OROPHARYNGEAL / ESOPHAGEAL CANDIDIASIS • Candida yeasts : Normal FUNGAL FLORA of SKIN, FEMALE GENITAL TRACT, GIT(mouth & oropharnyx)in small amounts. • Candida overgrowth occurs when environment in mouth or throat becomes IMBALANCED. • Candida overgrowth in oropharynx : Oropharyngeal candidiasis • Candida overgrowth in esophagus : Candida esophagitis, or Esophageal candidiasis. 4/17/2014 8
    9. 9. OROPHARYNGEAL / ESOPHAGEAL CANDIDIASIS • OTHER SYMPTOMS : • Redness or soreness in the affected areas • Difficulty swallowing • Cracking at the corners of the mouth (angular cheilitis) 4/17/2014 9
    10. 10. Oral herpes vs Oral thrush 4/17/2014 10
    11. 11. RISK FACTORS WEAKENED IMUMUNE SYSTEM ASSOCIATING FACTORS • BABIES less than ONE MONTH old. • ELDERLY • HIV/AIDS • Cancer Treatments • Organ Transplantation • Diabetes • Corticosteroid use • Broad Spectrum Antibiotic use 4/17/2014 11 Type 2 Diabetes – Glucose in vaginal secretions promote Yeast growth. (overgrowth) Lactobacillus acidophilus given(probiotic) It utilizes glucose to produce LACTIC ACID and H2O2. Restoration of altered normal flora.
    12. 12. DIAGNOSIS 1. Based on the symptoms 2. Scrap the affected areas to examine under a microscope. 3. A culture may also be performed. however, because Candida organisms are normal inhabitants. Positive culture does not make the diagnosis. 4/17/2014 12
    13. 13. • Simple budding • Forms Blastoconidia • Colonies are moist CLASSIFICATION OF FUNGI YEAST MOULDS • Vegetative growth of filaments • Reproduction by spores or conidia. • Spores are arranged on Hyphae. • Hyphae are fungal filaments • Mass of Hyphae make up the Mycelium. 4/17/2014 13
    14. 14. LABORATORY DIAGNOSIS BLASTOCONIDIA •Large, spherical conidia at TERMINAL HYPHAE •Chains of ELONGATED BLASTOCONIDIA is PSEUDOHYPHAE •Grown in CORNMEAL AGAR – 1% Tween 80 •Trypan Blue incubated 24 to 48 hours at 25 degree Celcius •RAPID ENZYMATIC SCREENING – •beta aminidase • L proline aminopeptidase Specific for Candida albicans 4/17/2014 14
    15. 15. 4/17/2014 15 Candidal colonies on Cornmeal Agar plate
    16. 16. BLASTOCONIDIA BLASTOCONIDIA 4/17/2014 16
    17. 17. Specimens • Swabs • Scrapings • Blood • Spinal fluid • Tissue biopsies • Urine • Removed IV catheters 4/17/2014 17
    18. 18. Microscopic examination • Tissue biopsies • Centrifuged spinal fluid • Scrapings placed in drop of 10% KOH and Calcofluor white. • Candida is diagnosed by presence of budding yeasts with hyphae and pseudohyphae and germ tube 4/17/2014 18
    19. 19. 4/17/2014 19 Gram-stain of vaginal smear showing Candida albicans hyphae and many gram-negative rods(not important)
    20. 20. 4/17/2014 20 germ tube Gram stained Germ tube ( Candida albicans )
    21. 21. Candida dubliniensis • C.albicans and C.dubliniensis have GERM TUBES in common. • C.dubliniensis is seen commonly in HIV positive patients. • C.dubliniensis is rarely seen in HIV negative patients. • Culture on CHROM agar Candida • Dark green colonies C. dubliniensis • Light green colonies C. albicans 4/17/2014 21
    22. 22. Candida dubliniensis – Biofilm in Immunocompromised patient (HIV) 4/17/2014 22
    23. 23. 4/17/2014 23 Hyphae Blastoconidia
    24. 24. Culture • Swabs streaked onto Sabourauds dextrose agar. • Incubated at 37 degree Celcius for 3 days. • Creamy moist colonies • Microscopically : Yeast cells, Pseudohyphae and Blastoconidia • Sputum cultures have NO VALUE. • ALL depends on the OVERGROWTH OF Candida yeast. 4/17/2014 24
    25. 25. 4/17/2014 25 Candidal colonies on Sabourauds dextrose agar slope.
    26. 26. SEROLOGY • No CLEAR CRITERIA to establish diagnosis. • Latex Agglutination Test and Enzyme Immunoassay lacks sensitivity. • Many cases are TRANSIENTLY POSITIVE because DETECTABLE ANTIGEN titers produced LATE in disease. • Serum antibodies and Cell mediated immunity. • CD4 cells control Candidiasis • NEUTROPHILS for Candidemia. • Antibody titers ELEVATED in Candidemia. 4/17/2014 26
    29. 29. PREVENTION • Good oral hygiene practices • Chlorhexidine (CHX) mouthwash can help to prevent oral candidiasis in people undergoing CANCER TREATMENT. • ASTHMATIC patients could REDUCE the risk of oral thrush by washing mouth with WATER after using INHALER. 4/17/2014 29
    30. 30. CHLORHEXIDINE MOUTHWASH 4/17/2014 30
    31. 31. VULVO-VAGINAL CANDIDIASIS / YEAST INFECTIONS • Relatively COMMON : • ALMOST 75% of all adult women suffer at least one Yeast Infection in their lifetime. • Overgrowth of Candida yeast due to: • Acidity of the vagina changes • Hormonal balance changes 4/17/2014 31
    32. 32. SYMPTOMS • Genital Itching • Burning • sometimes a cottage cheese-like vaginal discharge • Men may experience itchy rash on penis 4/17/2014 32
    33. 33. RISK FACTORS • Frequently in people with WEAKENED IMMUNE SYSTEM • Other conditions are : 1. Pregnancy 2. Diabetes 3. Broad spectrum antibiotics 4. Corticosteroid use 4/17/2014 33
    34. 34. DIAGNOSIS • DIFFFICULT because symptoms are similar to other GENITAL INFECTIONS. • ABNORMAL no. of Candida yeasts in vaginal secretion sample under microscope. • Fungal culture is NOT ALWAYS USEFUL. 4/17/2014 34
    36. 36. PREVENTION • WEARING COTTON UNDERWEAR Reduces the risk of developing Yeast Infection • Avoid tight fitting clothes 4/17/2014 36
    37. 37. SYSTEMIC CANDIDIASIS • Candida yeasts enter the bloodstream • Candidemia (a bloodstream infection with Candida) • Fourth most common bloodstream infection among hospitalized patients in the United States. 4/17/2014 37
    38. 38. SYMPTOMS • NOT SPECIFIC • MOST COMMON : • Fever and chills do not improve after antibiotic therapy. • Infection spreads to Kidneys, Liver, Bones, Muscles, Joints, Spleen, or Eyes. • Untreated – ORGAN FAILURE 4/17/2014 38
    39. 39. RISK FACTORS • Intensive care unit (ICU) patients • Surgical patients • Patients with a CENTRAL VENOUS CATHETER • People whose immune systems are weakened (HIV/AIDS) • Very low-birth-weight infants 4/17/2014 39
    41. 41. 4/17/2014 41
    42. 42. REFERENCES • Candidiasis | Fungal Diseases | CDC • • • • • candida-focus-on-candida-species-22.html#.U06rmlUbV-p • Biofilm Formation by Candida dubliniensis • • • • Medical Microbiology by Jawetz • Textbook of Microbiology by Surinder Kumar 4/17/2014 42
    43. 43. THANK YOU 4/17/2014 43