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

This quiz explores factors contributing to the persistence and antifungal resistance in Candida species. It addresses the challenges posed by teleomorph forms and biofilms, as well as the impact of non-Candida albicans species and antibiotic use on candidiasis treatment.