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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.

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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

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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

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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

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Candida albicans

In vitro (25o C): mostly yeast;

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

CandidiasisVaginal 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.

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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.

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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

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Candidiasis of skin, mucous

membranes and nails

Oropharyngeal candidiasis, including:

� THRUSH

� GLOSSITIS,

� STOMATITIS, AND

� ANGULAR CHEILITIS ( PERLECHE )

Candidiasis of skin, mucous

membranes and nails

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Candida albicans

Candidiasis

Thrush

Vaginal

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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

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Candidiasis of skin, mucous

membranes and nails

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Tinea unguium

Tinea pedis

Source: Microbiology Perspectives, 1999.

Candida albicans infection of the

nails

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CandidiasisVaginal 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

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Candidiasis

Cutaneous

Thrush

Risk factors for Candidiasis

Post-operative status

Cytotoxic cancer

chemotherapy

Antibiotic therapy

Burns

Drug abuse

Gastrointestinal damage.

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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.

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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

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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

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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.

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Don’t Litter

Keep our class

clean

Thank You…Thank You…