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Dr. Usman Ali,
Ph.D. Pharmacology
Candidiasis
Introduction
• 200 species  20 A/W human or animal diseases
• Major pathogen – Candida albicans
• Others: C. dubliniensis, C. glabrata, C. guilliermondii,
C.kefyr, C.kruesi, C. lusitaniae, C. parapsilosis,
C.tropicalis etc.
• Budding cells, psudohyphae and true hyphae – all
simultaneously possible
• Candida albicans transforms frequently between 3 phenotypic forms in
tissues  Phenotypic switching (evasion of host defence)
Ending Host Defense system (Phenotype Switching)
• Endogenous source:
• GI,
• Vagina,
• Urethra,
• Skin,
• subungual
• Exogenous source: Catheters and lines, indwelling device
 usually deep seated systemic infection.
• Person to person transmission: Rare
• oral thrush in new-borns
• Sexual transmission
Pathogenesis
•Predisposing Factor–
• Extremes of age,
• Pregnancy,
• HIV infected,
• Steroid, cytotoxic drug (or similar)
therapy,
• Malignancy,
• post transplantation,
• Broad spectrum antibiotics,
• Diabetes,
• neutropenia etc.
•Virulence factors
• Adhesins
• Enzymes: proteinases, phospholipase
• Toxins: GP extracts pyrogenic
properties
• Pseudohyphae : Active infection
marker
Mucosal candidiasis
Oral thrush Chronic mucocutaneous candidiasis
Cutaneous candidiasis
Onychomycosis and paronychia Intertrigo
Lab diagnosis
• Specimen: Depending on site – swabs (mucosal patches, skin lesion),
nail scrapings, sputum, blood, urine
• Direct Microscopy:
• Gram positive, oval budding yeast (4-6um) or KOH mount
• Pseudohyphae
• Pseudohyphae V/S true hyphae
Feature Pseudohyphae True Hyphae
Septa Constricted No Constriction
Origin of branches Constricted and septate No Constriction & No
septum present
Grows by Budding Apical elongation
• Culture: SDA with antibiotic, Blood agar, Blood culture bottle,
CHROM agaretc (@ 370C)
• Creamy white colony with yeasty odour after 24-48 hrs (SDA)
• Gram + budding yeast with pseudo-hyphae
Species identification
• Germ tube test: Reynold Braude phenomenon
• Colonies mixed with serum & incubated for 2 hours
• Wet mount under microscope
• Long tube like projections extending from yeast cells no constriction at
origin
• Specific for C. albicans (C. dubliniensis)
• Cornmeal agar:
• Chlamydiospore is specific for Candida albicans
• CHROME Agar
• Growth at 450C : C. albicans & C. dublinensis
• Sugar assimilation tests
• PCR
• Serology
• Antibody : ELISA, Latex agglutination
• ANTIGEN DETECTION: Cell wall mannan & Cytoplasmic antigen by
ELISA
• Enzyme assay : Enolase, Proteinase
• Metabolites – alpha1-3 glucan (G test)
Treatment
• Depending on type of candidiasis
Polyene
-Amphotericin B
Antifungal azoles
-Ketoconazole
-Fluconazole
-Itraconazole
Summary
• Candidiasis (Candida albicans)
• Phenotypes
• Predisposing Factors
• Clinical manifestation
• Lab diagnosis
• Treatment

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Candida oral pathology. .pptx

  • 1. Dr. Usman Ali, Ph.D. Pharmacology Candidiasis
  • 2. Introduction • 200 species  20 A/W human or animal diseases • Major pathogen – Candida albicans • Others: C. dubliniensis, C. glabrata, C. guilliermondii, C.kefyr, C.kruesi, C. lusitaniae, C. parapsilosis, C.tropicalis etc. • Budding cells, psudohyphae and true hyphae – all simultaneously possible
  • 3. • Candida albicans transforms frequently between 3 phenotypic forms in tissues  Phenotypic switching (evasion of host defence)
  • 4. Ending Host Defense system (Phenotype Switching)
  • 5. • Endogenous source: • GI, • Vagina, • Urethra, • Skin, • subungual • Exogenous source: Catheters and lines, indwelling device  usually deep seated systemic infection. • Person to person transmission: Rare • oral thrush in new-borns • Sexual transmission
  • 6. Pathogenesis •Predisposing Factor– • Extremes of age, • Pregnancy, • HIV infected, • Steroid, cytotoxic drug (or similar) therapy, • Malignancy, • post transplantation, • Broad spectrum antibiotics, • Diabetes, • neutropenia etc. •Virulence factors • Adhesins • Enzymes: proteinases, phospholipase • Toxins: GP extracts pyrogenic properties • Pseudohyphae : Active infection marker
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  • 9. Mucosal candidiasis Oral thrush Chronic mucocutaneous candidiasis
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  • 18. Lab diagnosis • Specimen: Depending on site – swabs (mucosal patches, skin lesion), nail scrapings, sputum, blood, urine
  • 19. • Direct Microscopy: • Gram positive, oval budding yeast (4-6um) or KOH mount • Pseudohyphae
  • 20. • Pseudohyphae V/S true hyphae Feature Pseudohyphae True Hyphae Septa Constricted No Constriction Origin of branches Constricted and septate No Constriction & No septum present Grows by Budding Apical elongation
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  • 22. • Culture: SDA with antibiotic, Blood agar, Blood culture bottle, CHROM agaretc (@ 370C) • Creamy white colony with yeasty odour after 24-48 hrs (SDA) • Gram + budding yeast with pseudo-hyphae
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  • 24. Species identification • Germ tube test: Reynold Braude phenomenon • Colonies mixed with serum & incubated for 2 hours • Wet mount under microscope • Long tube like projections extending from yeast cells no constriction at origin • Specific for C. albicans (C. dubliniensis)
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  • 26. • Cornmeal agar: • Chlamydiospore is specific for Candida albicans
  • 27. • CHROME Agar • Growth at 450C : C. albicans & C. dublinensis • Sugar assimilation tests • PCR
  • 28. • Serology • Antibody : ELISA, Latex agglutination • ANTIGEN DETECTION: Cell wall mannan & Cytoplasmic antigen by ELISA • Enzyme assay : Enolase, Proteinase • Metabolites – alpha1-3 glucan (G test)
  • 29. Treatment • Depending on type of candidiasis Polyene -Amphotericin B Antifungal azoles -Ketoconazole -Fluconazole -Itraconazole
  • 30. Summary • Candidiasis (Candida albicans) • Phenotypes • Predisposing Factors • Clinical manifestation • Lab diagnosis • Treatment