This document summarizes information about Candida and Cryptococcus infections. It discusses the common species that cause infection, pathogenesis factors like toxins and enzymes, and types of infections including mucocutaneous, disseminated, and organ-specific. Symptoms, diagnostic methods like microscopy, culture, and serology are described. Treatment approaches are mentioned. Cryptococcus is discussed as an opportunistic fungal infection spread by avian droppings, with pulmonary and CNS manifestations in immunocompromised individuals.

1. A.ANUSWEDHA
Associate Professor,
Department of Microbiology,
Justice Basheer Ahmed Sayeed College for
Women, Chennai

2.  Commonest infection – mucuous membrane, skin,
nail & internal organs
 In immunocompromised- disseminated- systemic
 C. AGENTS: C. albicans, C. krusei, C.guilliermondi,
C.parapsilosis, C. stellatoidea, C. tropicalis, C.
pseudotropicalis, C. lusitaniae, C. viswanthii
 Source: normal commensals –skin, GIT, Vagina
 PATHOGENESIS: entry- exogenous/ endogenous
 colonisation of local tissue
 invasion- facilitating by specific/non-specific
adherence factors

3. 1. TOXINS-glycoprotein extracts of
candida cell wall- pyrogenic similar to
bacterial endotoxins.
2. ENZYMES-
proteases,lipases,esterases,phospholipa
ses,phosphatases-invasion of hyphae in
tissues
3. ADHESIN-adhesins on the surface of
candida that have receptors for
attachment to epithelial cells
4. COMPLEMENT RECEPTORs-mediates
engulfment of microorganisms that
have complement
5. PHENOTYPING SWITCHING-
6. PROTEINASES-

4.  A) MUCOCUTANEOUS INVOLVEMENT:
 1. oral candidiasis- oral thrush- diffused or
confined to gums, palate, tongue or buccal
mucosa- congestive reddening-dry, shiny,
varnish-like appearance
 2. oropharygneal candidiasis-
 Angular cheilitis- sore, erythematous fissured
lesions at the corners of the mouth.
 3. Alimentary candidiasis- esophagitis,
gastritis, peritonitis
 4. Vulvovaginitis, balanitis, balanoposthitis
 5. CMCC-
 6. ocular candidiasis-keratoconjuctivitis,
corneal ulcerations, conjuctival edema

6. INFECTION MODE OF
INFECTION
SYMPTOMS
1. INTERTRIGINOUS SKIN Inflammation of skin folds;
lymphangitis, lymphadenitis
2. PARONYCHIA &
ONYCHOMYCOSIS
Nails Nail folds, hand and
feet,nails-white, opaque,
thickened, brittle
3. DIAPER
DISEASE(infants)
Skin Maculopapules & vesicles,
coalescing to patches with
satellite pustules- gluteal
folds, perineum & inguinal
folds
4. CANDIDAL
GRANULOMA(Children)
skin Papules on face, scalp,
trunk, legs & pharynx

8. 1. Urinary tract
candidiasis,
Candiduria
Vulva/vagina Infections of bladder
& kidneys
2. Pulmonary
candidiasis
Hematogenous spread Lung lesions
3. endocarditis “ Subacute endocarditis
in persons with
abnormal or prosthetic
valve
4. Meningitis Low birth wt infants,
neonates with
candidemia,
intracerebral
prosthetic devices,
neurosurgery
Hydrocephalus
5. Candidemia immunocompromised -
6. dissemination “ Systemic involvement

9. Arthritis Hematogenous spread/
joint surgery
Destruction of cartilage
osteomyelitis Hematogenous spread Osteolytic lesions with pus
endophthalmitis Disseminated candidiasis One or more focal, white
retinal lesions associated
with clouding vision
Candidemia, septicemia bloodstream
Nosocomial candidiasis invasive

10. 1. Candidids
REASON: allergic manifestation of
metabolites- resolves after
treatment of primary
infection/desensitation
Vesicular lesions on the interdigital
spaces of fingers, side of wrists or
throughout the body
2Eczema(allergic), asthma(colonisation
of candida), gastritis(overgrowth of
candida)
Erythema-vesicles-rupture-ooze pus-
heals with scar
Irritable bowl syndrome
1. Asymptomatic oral carriage IN HIV PATIENTS
2. Oropharyngeal thrush
3. laryngitis, oesophagitis
4. vulvovaginitis, balanitis
5. Hematogenous dissemination
6. leukoplakia- white thickened patch occuring on the mucuous membrane of lips,
mouth or genitalia
7. perleche-(angular cheilitis)- inflammation of lips at the angles of the mouth with
fissures & crust formation

11. DIFFERENTIAL DIAGNOSIS – 1. leucoplakia 2. trichomonas
vaginitis 3. TB, 4. chronic bacterial infection
DIRECT MICROSCOPY-KOH , gram’s staining- budding yeast cells
with pseudohyphae
CULTURE- SDA, BA- colony morph- LPCB mount, CHROMagar
Candida-light green to bluish green
GERM TUBE TEST:Incubate 37C for 2-4 hrs in serum, wet
mount- germ tubes
CHLAMYDOSPORE FORMATION: CMA/rice starch agar- highly
refractile thick walled terminal chlamydospores
BIOCHEMICAL TEST: CHO assimilation/ fermentation
DECTECTION OF METABOLITES: 1. D.mannose 2. D-
arabinitol- GLC
ANIMAL PATHOGENICITY: rabbit/mice

13. SEROLOGY
A) DECTECTION OF ANTIBODIES-slide
agglutination, ID, immunoprecipitation,
phytohaemagglutination, ELISA, RIA,
CIE
B) NON SPECIFIC CANDIDA AG- latex
agglutination, immunoblotting
C) CELL WALL COMPONENTS- cellwall
mannoprotein, beta(1,3 D glucan)
E) CANDIDA ENOLASE AG testing
SEROTYPING FOR EPIDEMIOLOGICAL
STUDIES- MR (morpho & resistotyping), PMS,
RFLP,Southern blotting
TREATMENT:
1.oral/ mucocutaneous- oral nystatin
2.Azole creams- clotrimazole
3.Systemic candidiasis- AmpB+ flucytosine

14.  Opportunistic systemic fungal infection
 SOURCE: excreta of pigeons; avian sps
 CLASSIFICATION: 5 serotypes based on the capsular
ag- A, B, C, D & AD
 3 varities based on ecological & epidemiological
differences
 1. Cr. neoformans var neoformans(world-wide)-
serotype D
 2. Cr. neoformans var gattii(tropical & subtropical)-
serotypes B & C
 3. Cr. neoformans var grubii( serotype A)
 4. Non-neoformans cryptococcus sp- non-
pathogenic/rarely pathogenic- Crypt.albidus,

15.  CLINICAL FEATURES: common in males than
females; gets disseminated in
immunocompromised.
 Incubation period: 2-4 weeks
!. PULMONARY CRYPTOCOCCOSIS Resp route: asymptomatic colonisation;
self-limited pneumonitis with dry cough,
dull chest pain, little or no fever
2. CNS CRYPTOCOCCOSIS A diffuse meningoencephalitis,
intracranial space occupying
lesions(ICSOL), well circumsribed
granuloma of brain or spinal
cord(cryptococcoma)-
Nausea, dizziness, irritability, vomiting,
impaired memory, fits, blurred vision,
nuchal rigidity- onset of coma- resp
arrest- death

16. 3.CUTANEOUS CRYPTOCOCCOSIS-
hematogenous spread to skin
Painless papule, enlarges; centre
becomes shiny & flat, centre
depressed and ulcerates, draining a
thin fluid that contains cryptococci
4. OSSEOUS CRYPTOCOCCOSIS
Hematogenous spread-
Osteolytic lesions; no periosteal
proliferation, pain & swelling of the
local area for a long time
5. VISCERAL CRYPTOCOCCOSIS Lungs, meninges & any organ-
granulomatous lesion
6. CRYPTOCOCCAEMIA Disseminated in immunocompromised

17. PATHOGENESIS
Only capsulated yeast
infects man
Inhalation of spores or
dessicated yeast
Inflammatory resp to
inhaled yeast produces
lung lymph node complex
that restrains spread of
yeast
In lungs, cryptococcis
proliferated in the alveolar
space
In immunocompetent- gets
localised to lungs
In immunocompromised-
gets disseminated-CNS
VIRULENCE FACTORS
Capsule, melanin, high temp
growth,urease prod. of
extracellular phospholipase

19. DIFFERENTIA
L DIAGNOSIS
1. Malignant
neoplasia
2. TB
3. Bacterial
4. Fungal
Suspected
immunoco
mpromised
state of
patient
RADIOLOGY
1. CT
2. MRI
DIRECT MICROSCOPY
1. CSF- negative staining
2. Histopathogy- H & E, PAS,
GMS, Mayer’s mucicarmine
staining
Budding yeast cells in tissue
sections

21. CULTURE
1. SDA
mucoid,
buff-
coloured
colonies
2. Capsule
prod is
enhanced
–growth
on CA in
CO2
3. BSA/NSA-
brown
coloured
colonies
4. BA,
CHHA
BIOCHEMICAL
TEST
1. phenol-oxidase
2. Growth at 37C
3. Urease
4. Inositol& nitrate
assimilation
5. Morp of
blastospores
MICE
PATHOGENICITY
Infected material
Inoculated into
swiss albino mice-
IC, IV,IP
10-14 days
Autopsy exam of
body sites &
visceral organs for
cyptococci
SEROLOGY
1. Demo of
capsular ag in
serum/CSF-
Crypto LA test
Eiken LA test
2. Demo of AB
1. Agglutination
2. IFAbT
3. CFT
TYPING: serotyping,
RFLP, PMS