Candida species, Antifungal Resistance & Treatment

• Candidiasis is a common opportunistic yeast infection involving Candida species, with Candida albicans being the most prevalent
• Overgrowth of Candida in the gastrointestinal, urinary, and respiratory tracts has increased in the past two decades, affecting immunocompromised patients, those with nosocomial infections, and even healthy individuals
• Candidiasis is a multifactorial syndrome because many causal factors contribute to yeast infections
• Research focuses on the treatment and prevention of candidiasis complications due to the rapid increase in incidence
• Prevention is more effective than eradicating yeast with antifungal agents, though diagnosis can be complicated
• Candida species is involved in opportunistic yeast infections worldwide
• Candida albicans accounts for 50–90% of human candidiasis and is part of the commensal flora in more than half of the healthy population
• Colonization can limit the growth of other opportunistic pathogenic fungi and promote the functioning of the immune system
• There is a considerable increase in deep fungal infections, including candidiasis, in immunocompromised patients
• The idea a restrict number of pathogenic fungi and specific geographical area were completely changed
• Candida species are involved in infections, which affects the virulence
• C. albicans, C. tropicalis, C. glabrata, C. dubliniensis, C. parapsilosis, C. orthopsilosis, C. metapsilosis, C. krusei, C. famata, C. guilliermondii and C. lusitaniae, etc
• Other factors affecting persistence and resistance to antifungals include adaptation to pH, yeast cell adherence, proteolytic enzymes, phenotypic switching, and morphological transition
• Significant increases in infections are caused by NCAC species, although Candida albicans is still a focus
• Hemolytic exoenzymes help yeasts acquire iron ions from hemoglobin, creating a positive correlation between the metal and infection
• Factors like metabolic activity and biofilm formation correlate with pathogenicity
• There is increasing frequency of fungal infections related to NCAC species, with a high metabolic activity, including possible systemic infections
• Colonization-infection processes, expression of virulence-associated factors, and strain dependency are complex
• Accurate identification of yeasts and their virulence-associated factors helps detect the emergence of yeasts and predict antifungal response
• Antimicrobial and antifungal resistance is increasing, research on alternative therapeutics is developing
• Natural products, particularly plants and phytochemicals, possess therapeutic potential and synergistic effects
• Many extracts and compounds from plants remain unknown, representing alternative treatments for candidiasis
• Candidiasis involves more than Candida albicans overgrowth

Candidiasis Topics

• Description of candidiasis and its classes
• Predisposing factors
• Diagnosis (signals, symptoms, and methods)
• Prevention
• Alternative treatments (diet, nutrition, immunity, detoxification, antiyeast agents, and therapeutics)

Candidiasis

• Candida albicans is a common species in genitourinary and gastrointestinal tracts, causing mouth and mucocutaneous infections
• Chronic forms can lead to septicemia, endocarditis, meningitis, and peritonitis, especially in the immunocompromised or those on antibiotics
• Oral candidiasis was described by Galen in the second century A.D. as aphthas albus
• Candida albicans has 166 synonyms worldwide
• Classified Candida species have major medical importance, with Candida albicans being the most important
• Other Candida species encountered include C. tropicalis, C. glabrata, C. parapsilosis, C. stellatoidea, C. krusei, and C. kyfer
• Organ transplant increase, immunocompromised people, and invasive devices contribute to nosocomial infections risk
• Candida species are also the fourth leading cause of hematogenous infections
• Classes of candidiasis are: genital, intrauterine, anal, nails, and oral

Genital Candidiasis

• Vulvovaginal candidiasis (VVC) is the most frequent type of genital yeast infection
• 75% of women experience ≥ 1 VVC episode in their life, 40–50% experience ≥ 1 additional episode
• The infection is common for pregnant women, especially in the last trimester of pregnancy
• Incidence of vaginal candidiasis is also higher in individuals with diabetes
• Balanitis in men after sexual contact has a rash, more or less prickly, followed by small pustules on rocking groove-preputial discharge, more or less abundant
• Factors associated with infections are: antibiotic therapies, diabetes and vaginal secretions of the sexual partner

Intrauterine Candidiasis

• This type of infection is frequent during pregnancy
• This type of intense vaginitis can complicate and extend to the uterus

Anal Candidiasis

• Has intense itching/pruritus, accompanied by burning sensation, and localized erythema around the anus
• More common in children

Nails Candidiasis

• Due to the nail disease can appear as paronychia characterized by an inflammation, more or less painful, in peripheral skin nail, which appears red and brilliant
• Predisposing factors are; sex, traumas, activity and hormonal variations

Oral Candidiasis

• Most common type of acute mucocutaneous candidiasis
• Usually found people w/ immune system disorders & those with dental prostheses
• Esophageal candidiasis can occur among HIV & cancer patients

Predisposing Factors

• In the past 2 decades, an abnormal overgrowth in the gastrointestinal (GI), urinary and respiratory tracts has been observed in healthy people
• Species colonize the mucosa of the GI tract (40-50%) after childbirth
• C. albicans increases 30-40% during pregnancy
• Overgrowth of C. albicans is an important cause of a wide variety of symptoms
• Main factors: decreased digestive secretions and dietary factors, impairment
• Diet affects the well-being & growing & colonization
• Important situation observed: food allergies, all known allergens should be eliminated
• Essetial nutrients usually in defecit on chronic candidiasis are: zinc, magnesium, selenium and vitamins

Immune System and Underlying Disease States

• A healthy immune system prevents overgrowth
• Frequent consumption of antibiotics, chemotherapy, steroids, radiation, stress, and environmental contaminants can increase the body's susceptibility, directly or indirectly

Impaired Liver Function

• Liver function is important for detoxification
• When not able to perform properly, toxins are absorbed by the intestine being accumulated,
• This affects more the liver and other organs function, and increases the body's sensitivity to chemicals

Altered Bowel Flora

• If the liver does not work properly, products and metabolites resulting from poor digestion are accumulated in the body causing toxicity and, favoring pathogenic strains, and also Candida albicans overgrowth
• Chronic stress and hormonal balance suppresses intestinal floral bacteria
• The oral contraceptive use is a risk factor

Diagnosis

• Diagnosis of candidiasis becomes complicated by the presence of fungi, but also other bacterias
• Some of the tools used in diagnosis include: questionnaire, stool analysis & lab techniques
• According to some authors, namely oral candidiasis is classified considering the following aspects: duration (acute or chronic) & location (median rhomboid glossitis, denture stomatitis

Prevention

• As prevention is the most effective treatment, much more than the eradication of the yeast with antifungal agents-synthetic or naturals, it is fundamental to address and amend the predisposing factors.
• Being women, a good vaginal helps
• Since increasing in hospitals, probes and catheters should be removed as soon as possible -Important factors such as diets rich in sugar should be avoided.

Alternative Treatment

• Candida albicans is an opportunistic yeast that cause infectious, lives and grows inside most human bodies
• Candida is not harmful because our bodies are able to keep it under control, mainly by antibodies and probiotic bacteria.
• Diet and exercise helps with over growth of C. albicans which need special attention

Dietary factors

• As previously discussed, some dietary factors affect and promote the overgrowth of C. albicans; there- fore, following a special diet for the treatment of candidiasis is crucial.
• Most important refinded sugar
• The best most cases in order to protect the organ