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Candida
Pathology
Introduction
• 4th Century BC – ‘Epidemics’ (by Hippocrates) mentioned oral aphtha
(Thrush)
• 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
Pathogenesis
• Most common fungal infection in human
• Increased risk of infection –
• 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
• Candida albicans transforms frequently between 3 phenotypic forms
in tissues  Phenotypic switching (evasion of host defence)
Candida pathogen.pptx
• Mostly 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
Candida pathogen.pptx
Candida pathogen.pptx
Mucosal candidiasis
Oral thrush Chronic mucocutaneous candidiasis
Candida pathogen.pptx
Candida pathogen.pptx
Candida pathogen.pptx
Cutaneous candidiasis
Onychomycosis and paronychia Intertrigo
Candida pathogen.pptx
Candida pathogen.pptx
Candida pathogen.pptx
Candida pathogen.pptx
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
Candida pathogen.pptx
• 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
Candida pathogen.pptx
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)
Candida pathogen.pptx
• 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
• Azoles
• Amphotericin B

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Candida pathogen.pptx

  • 2. Introduction • 4th Century BC – ‘Epidemics’ (by Hippocrates) mentioned oral aphtha (Thrush) • 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. Pathogenesis • Most common fungal infection in human • Increased risk of infection – • Extremes of age, • Pregnancy, • HIV infected, • Steroid, cytotoxic drug (or similar) therapy, • Malignancy, • post transplantation, • Broad spectrum antibiotics, • Diabetes, • neutropenia etc.
  • 4. • Virulence factors • Adhesins • Enzymes: proteinases, phospholipase • Toxins: GP extracts pyrogenic properties • Pseudohyphae : Active infection marker
  • 5. • Candida albicans transforms frequently between 3 phenotypic forms in tissues  Phenotypic switching (evasion of host defence)
  • 7. • Mostly 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
  • 10. Mucosal candidiasis Oral thrush Chronic mucocutaneous candidiasis
  • 19. Lab diagnosis • Specimen: Depending on site – swabs (mucosal patches, skin lesion), nail scrapings, sputum, blood, urine
  • 20. • Direct Microscopy: • Gram positive, oval budding yeast (4-6um) or KOH mount • Pseudohyphae
  • 21. • 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
  • 23. • 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
  • 25. 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)
  • 27. • Cornmeal agar: • Chlamydiospore is specific for Candida albicans
  • 28. • CHROME Agar • Growth at 450C : C. albicans & C. dublinensis • Sugar assimilation tests • PCR
  • 29. • Serology • Antibody : ELISA, Latex agglutination • ANTIGEN DETECTION: Cell wall mannan & Cytoplasmic antigen by ELISA • Enzyme assay : Enolase, Proteinase • Metabolites – alpha1-3 glucan (G test)
  • 30. Treatment • Depending on type of candidiasis • Azoles • Amphotericin B