Clincal Mycology Lec 4.pdf

Lec (2) (1) LecLecture (5) Lec (3) (4) Lec Clinical Mycology Systemic Mycoses (2) ASPERGILLOSIS SUPERFICIAL MYCOSES Systemic Mycoses (1) Dermatophytosis Subcutaneous Mycoses Candidiasis Candidiasis ASPERGILLOSIS DR.WIFAG RABIH DR. WIFAG RABIH INTRODUCTION TO MYCOLOGY DR. WIFAG RABIH DR. DR.WIFAG WIF...

Lec (2) (1) LecLecture (5) Lec (3) (4) Lec Clinical Mycology Systemic Mycoses (2) ASPERGILLOSIS SUPERFICIAL MYCOSES Systemic Mycoses (1) Dermatophytosis Subcutaneous Mycoses Candidiasis Candidiasis ASPERGILLOSIS DR.WIFAG RABIH DR. WIFAG RABIH INTRODUCTION TO MYCOLOGY DR. WIFAG RABIH DR. DR.WIFAG WIFAGRABIH RABIH Dr. Wifag Rabih Dr. Wifag Rabih Candidiasis Dr.Wifag Rabih Dr. Wifag Rabih Dr.Wifag Rabih DR. WIFAG RABIH Objectives 1. Definition of candidiasis 2.Epidemiology 3. Types of candidiasis A. Oral candidiasis B. Vaginal candidiasis C. Invasive candidiasis Candidiasis Candida normally lives on the skin and inside the body, such as the mouth, throat, gut, and vagina, without causing problems. Candida can cause infections if it grows out of control or if it enters deep into the body. For example, it can cause infections in the bloodstream or internal organs like the kidney, heart, or brain. Candida albicans is an opportunistic fungal pathogen that is responsible for candidiasis in human hosts. C.albicans is a unicellular, oval-shaped diploid fungus(a form of yeast). Typically C.albicans live as harmless commensals in the gastrointestinal and genitourinary tract and are found in over 70% of the population. Overgrowth of this organism, however, will lead to disease. Candidiasis Candidiasis-Epidemiology Over 75% of women suffer from C.albicans infection, usually vulvovaginal candidiasis, in their lifetimes. Interestingly C.albican is the 4th leading cause of nosocomial infection in patients’ bloodstreams. This could result in an extremely life-threatening systemic infection in hospital patients with a mortality rate of 30% Several candida species are commensal and colonize the skin mucosal surfaces of humans. Candidiasis-Epidemiology Who is at increased risk? Babies with nappy rash. People with metabolic disorders, including diabetics. Overweight people. Pregnant women, and women who take high-dose contraceptive pills. People who work in wet conditions. People who are HIV positive or suffer from another type of immunodeficiency. Types of candidiasis 1- Candida infections of the mouth, throat, and esophagus Candidiasis in the mouth and throat is also called thrush or oropharyngeal candidiasis. Candidiasis in the esophagus is called esophageal candidiasis or Candida esophagitis. Esophageal candidiasis is one of the most common infections in people living with HIV/AIDS Symptoms Candidiasis in the mouth and throat can have many different symptoms, including: White patches on the inner cheeks, tongue, roof of the mouth, and throat Redness or soreness Cotton-like feeling in the mouth Loss of taste Pain while eating or swallowing Cracking and redness at the corners of the mouth Symptoms of candidiasis in the esophagus usually include pain when swallowing and difficulty swallowing. Figure 1. Angular chelitis (www.emed.com) Figure 2. Oral Thrush, atrophic (www.mycolog.com) Figure 3. Oral Thrush, pseudomembranous (www.emed.com) Candidiasis uncommon in healthy adults. People who are at higher risk for getting candidiasis in the mouth and throat include babies, especially those younger than 1 month of age, and people with at least one of these factors: Have diabetes, Have cancer, Have HIV/AIDS Take antibiotics or corticosteroids, including inhaled corticosteroids for conditions like asthma Take medications that cause dry mouth or have medical conditions that cause dry mouth and Smoke People who get candidiasis in the esophagus often also have candidiasis in the mouth and throat. Candidiasis Candida can multiply and cause an infection if the environment inside the mouth, throat, or esophagus changes in a way that encourages its growth. This can happen when: a person’s immune system becomes weakened, if antibiotics affect the natural balance of microbes in the body, The treatment for mild to moderate infections in the mouth or throat is usually an antifungal medicine applied to the inside of the mouth for 7 to 14 days. These medications include clotrimazole, miconazole, or nystatin. For severe infections, the most common treatment is fluconazole taken by mouth or through a vein. Candidiasis 2- Vaginal Candidiasis Affects the genital area, it is called a yeast infection. In women, it may be called a vulvovaginal yeast infection. If yeast infects the skin on a baby’s bottom area, it caused diaper rash Candida can cause an infection if conditions change inside the vagina to encourage its growth. Things like hormones, medicines, or changes in the immune system can make infection more likely. The common term for candidiasis in the vagina is a vaginal yeast infection. Other names for this infection are vaginal candidiasis, vulvovaginal candidiasis, or candidal vaginitis. Symptoms The symptoms of vaginal candidiasis include: Vaginal itching or soreness Pain during sexual intercourse Pain or discomfort when urinating Abnormal vaginal discharge Vaginal candidiasis is often mild. However, some women can develop severe infections involving redness, swelling, and cracks in the wall of the vagina. Candidiasis Vaginal candidiasis is common. Women who are more likely to get vaginal candidiasis include those who: Are pregnant Use hormonal contraceptives (for example, birth control pills) Have diabetes Have a weakened immune system (for example, due to HIV infection or medicines such as steroids and chemotherapy) Are taking or have recently taken antibiotics vulvovaginal candidiasis Diagnosis & Testing Sample: vaginal discharge. They examine the sample under a or send it to a laboratory for a fungal culture. However, a positive fungal culture does not always mean that Candida is causing symptoms. Some women can have Candida in the vagina without having any symptoms. Treatment Often, the treatment is an antifungal medicine applied inside the vagina or a single dose of fluconazole taken by mouth. You may need other treatments if your infection is: Is more severe Doesn’t get better Keeps coming back after getting better These treatments include: More doses of fluconazole taken by mouth Other medicines applied inside the vagina, such as boric acid, nystatin, or flucytosine Candidiasis 3- Invasive candidiasis Invasive candidiasis is a serious infection that can affect the blood, heart, brain, eyes, bones, and other parts of the body. Candidemia, a bloodstream infection with Candida, is a common infection in hospitalized patients. In the United States, candidemia is one of the most common causes of bloodstream infections in hospitalized patients, and it often results in long hospital stays and death Symptoms People who develop invasive candidiasis are often already sick from other medical conditions, so it can be difficult to know which symptoms are related to a Candida infection. However, the most common symptoms of invasive candidiasis are fever and chills that don’t improve after antibiotic treatment for suspected bacterial infections. Other symptoms can develop if the infection spreads to other parts of the body, such as the heart, brain, eyes, bones, or joints. Invasive candidiasis doesn’t spread directly from person to person. However, some species of the fungus that causes invasive candidiasis normally live on skin, so it’s possible that Candida can be passed from one person to another and possibly cause an infection in someone who is at high risk Candidiasis People who are at high risk for developing invasive candidiasis include those who: of time in the intensive care unit (ICU) Have spent a lot Have a central venous catheter Have a weakened immune system Have recently had surgery, especially multiple abdominal surgeries Have recently received lots of antibiotics in the hospital Receive total parenteral nutrition (food through a vein) Have kidney failure or are on hemodialysis Have diabetes People who inject drugs are also at risk for invasive candidiasis, especially for bloodstream infections, heart valve infections, and bone and joint infections. Invasive candidiasis Diagnosis and testing for Invasive Candidiasis Medical history, symptoms, physical examinations, and laboratory tests to diagnose invasive candidiasis. The most common way that healthcare providers test for invasive candidiasis is by taking a blood sample or sample from the infected body site and sending it to a laboratory to see if it will grow Candida in a culture. Treatment for Invasive Candidiasis The specific type and dose of antifungal medication used to treat invasive candidiasis usually depends on the patient’s age, immune status, and location and severity of the infection. For most adults, the initial recommended antifungal treatment is an echinocandin given through the vein (intravenous or IV). Fluconazole, amphotericin B, and other antifungal medications may also be appropriate in certain situations. How long does the treatment last? For candidemia, treatment should continue for 2 weeks after signs and symptoms have resolved and Candida yeasts are no longer in the bloodstream. Other forms of invasive candidiasis, such as infections in the bones, joints, heart, or central nervous system, usually need to be treated for a longer period of time.