CANDIDIASIS

SOFYAN LUBIS
DEPARTEMEN MIKROBIOLOGI
FAK.KEDOKTERAN USU
MEDAN
2009

Opportunistic Mycoses
Opportunistic 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.

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

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

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

Candida albicans

In vitro (25o C): mostly yeast;

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

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).

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.

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 cellmediated immunity plays a major role.
Patients with defects in phagocytosis function and
myeloperoxidase deficiency are at risk for disseminated
(even fatal) Candidiasis.

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

Candidiasis of skin, mucous

membranes and nails
Oropharyngeal candidiasis, including:
THRUSH

GLOSSITIS,
STOMATITIS, AND
ANGULAR CHEILITIS ( PERLECHE )

Candidiasis of skin, mucous

membranes and nails

Candida albicans

Candidiasis
Thrush

Vaginal

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

Candidiasis of skin, mucous

membranes and nails

Tinea unguium
Tinea pedis

Candida albicans infection of the

nails

Source: Microbiology Perspectives, 1999.

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 of skin, mucous

membranes and nails

Vulvovaginal candidiasis and balanitis:

vaginal discharge,
dysuria,
erythematous
oral contraceptive,
pregnancy

Candidiasis

Thrush

Cutaneous

Risk factors for Candidiasis

Post-operative status
Cytotoxic cancer
chemotherapy
Antibiotic therapy
Burns
Drug abuse
Gastrointestinal damage.

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.

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

Lab diagnosis of C.albicans:

1. Germ tube test
2. Pembentukan khlamidospora di
3.
4.
5.

cornmeal agar
Di medium EMB Levine : membentuk
koloni seperti kaki laba-laba
Fermentasi sugars
Assimilasi sugars

Candidiasis

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.

Dont Litter
Keep our class
clean

Thank You