systemic caused by overabundance of natural yeast candidiasis
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7/19/09
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SystemicCandidiasis
SystemicCandidiasis
• Causedbyoverabundanceofnaturalyeast• Heldincheckby“good”bacteriainourbodies• Affectstheen=resystem
• An=bio=cs,loweredimmunesystems,recrea=onaldrugs,diabetes,hormonalcontracep=ves,stress,obesity,poorhygiene,poordiet,manyotherreasons.
• Species:CandidaAlbicans• Genus:Candida(80%)• Firstappearancein1923• Othergenusnames
– Mycotorula
– Torulopsis• Otherspeciesnames
– Moniliaalbicans
– Oidiumalbicans
Yeast
• TheCandidagenusismadeupofyeasts.• Reproduceviaasexualbuddingorsexualsporecrea=on.
• Themethodofreproduc=onisgreatlyinfluencedbytheenvironment.– Goodenvironment=budding
– Badenvironment=sexualspores
• Sporesaremoreresistanttohardercondi=ons.
E=ologicalAgents• AnyspeciesoftheCandidagenus
• 150differentspecies• Specifically,CandidaAlbicans(70‐80%)• ButincludesC.glabrata,C.parapsilosis,C.tropicalis,C.krusei,C.kefyr,C.guilliermondi,C.lusitaniae,andC.dubliniensis(whichaffectsalmostexclusivelyHIVpa=ents)
DifferencesbetweenSpecies• C.albicansisthemostcommonlyrecoveredfrompa=entswithcandidemia.
• C.glabratahasbecomemoreimportantrecentlyduetoitsresistancetoazolesandpolyenes.
• C.kruseiisresistanttoamphotericinBandazolesinmostcases.
• C.parapsilosisisthemostcommonlyassociatedwithcatheters.
• C.tropicalisisthemostcommonlyassociatedwithinfec=onsincancerpa=entsandbonemarrowtransplants.
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Epidemiology• Typicalinpa=entswhoarecri=callyill,inmedicalorsurgicalICUs,andimmunocompromisedindividuals,suchascancerpa=entsorHIVpa=ents.Neonatesarealsoverysuscep=ble.
• Insystemicinfec=ons,itisthe4thmostcommonlyisolatedpathogensfrombloodculturesandhasreplacedtheCryptococcusspeciesasthemostcommonfungalpathogenworldwide.
• Systemiccandidiasishascausedmoredeathsthananyothersystemicmycosis.
Symptoms• Redness• Itching• Papularrash• Muscletenderness
• Discomfort
• Burning• Soreness• Discharge• None
Diagnosis
• Feverandchills• An=bacterialtherapy• CTandMRI
• Difficult
• Bloodculture
Preven=on
• An=fungaltherapies• Garlic• Yogurt• Certainmilks
• Lowsugars• Reducedalcoholintake
CaseReport‐Pa=ent1
• 30yr.oldmanstartedonbroadspectruman=bio=csforpneumoniaduetoLegionellapneumophila.– Admifedtointensivecareafewdayslater.
• Confusionalsyndrome,feverandpurplishmaculesandpapulesinvolvingtheface,thorax,andlowerlimbs.
• Lesionsaffectedhairfolliclesmostly.
– Skinbiopsy• Perivascularandperiadnexialdermalandhypodermalinflammatoryinfiltratewithlobularnecrosisofthefat.
Pa=ent1
Figure 1 Patient 1. Erythematous ⁄ purplish papules and pustules disseminated on the face, neck and upper thorax. The lesions were well defined and slightly infiltrated on palpation.
Source: Clinical and Experimental Dermatology Journal
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Pa=ent1
Figure 2 Patient 1. Biopsy revealed necrosis of the epidermis and vascular thrombosis of small vessels in the underlying dermis. A sparse perivascular infiltrate was evident with variable degree of leucocytoclasia. Occasional small round fungal elements, predominantly spores, were seen between the inflammatory infiltrate (hematoxylin and eosin, original magnification ・ 200).
Source: Clinical and Experimental Dermatology Journal
Cont…– GramandPeriodic‐Acid‐SchiffStain
• Nobacteria,mycobacteria,orfungi.– Chestx‐ray:
• ShowedalveolarinfiltratesconsistentwithCandida.
– Ocularfundusexamina=onshowedre=nalinvolvement.
– AmphotericinBtreatmentadministered.• 1gramtotal.
• Cutaneouslesionsresolvedw/oresidualhyperpigmenta=onwithin4days.
Pa=ent2
• 31yr.oldmanwithchronicmyelocy=cleukemia.– Underwentbone‐marrowtransplanta=onfromhishumanleukocytean=gen‐compa=blebrother.
• 1yr.later,hehadablas=ccrisisandstartedoninduc=onchemotherapytreatment.
• Developederythematousnodulesonlowerlimbsandleiarm20dayslater.
– Approx.10nodules,5‐6mminsize– Well‐definedandslightlyinfiltrated
Pa=ent2
Erythematous ⁄ purplish papules and macules
Source: Clinical and Experimental Dermatology Journal
Pa=ent2
Source: Clinical and Experimental Dermatology Journal
Some of the plaques had a pustule in the centre.
Cont…
– Somelesionshadpustuleonsurface
– Histopathologicalexamina=onshowed• Yeastcellsindermoepidermaljunc=onwithminimalinflammatoryinfiltrate.
• Candidatropicaliswasisolatedfromblood.
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Cont…
– Computedtomographyscanshowed:• Hepa=c,splenicandrenalfocallesions,consistentwithandinfec=ousorigin.
– Pa=entstartedonCaspofunginandVoriconazoletreatment• Mostlesionsresolvedinafewdays,withresidualhyperpigmenta=on.
Pa=ent3• Mathaietal.,JournalofForensicandLegalMedicine.(2009)16:31‐34.
• A63year‐oldmalewasadmifedtohospitalaieratrafficaccident
• Receivedtreatmentforaheadinjuryandmul=plefractures
Pa=ent3
• Pa=entwasunconsciousuponadmissionthenlaterplacedonaven=lator
• Correc=vesurgerieswereperformedformul=plefractures
Pa=ent3
• Laboratoryinves=ga=onsyieldednormalresults
• Washospitalizedforfourmonthsbeforedying
Pa=ent3
• AutopsyFindings– Kidneyswereenlargedaswellashavingirregulargrayishwhite“patchyareas”
– Necrosiswasfoundthroughoutthemedullaandcortex
– MicrocoloniesofCandidaspecieswerefoundininters==umandtubules
Pa=ent3
Fig. 1. Cut surface of the kidney showing grayish white irregular areas involving the entire renal cortex and medulla.
Source: Journal of Forensic and Legal Medicine
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Pa=ent3
• Autopsy(cont.)– Nootherobserva=onspertainingtoCandidaspecieswerefoundinothermajororgans
– Diagnosedwithrenalcandidiasis• Whilenotcauseofdeath,wasconsideredacontributorycauseofdeath
Pa=ent3
Fig. 4. Periodic acid-Schiff stain and Gram’s stain highlighting the yeast like budding cells with pseudohyphae in (a) and (b), respectively, (original magnification 1000).
Source: Journal of Forensic and Legal Medicine
Treatment• Thedrugofchoiceisfluconazoleduetoitseaseofuseandlowertoxicitytothenephronsofthekidneys.
• Animportantcomponentistheremovalofthefocusoftheinfec=on,suchasthecatheters.
• Some=mes,surgicalremovalofthecandidalabscessesisrequired,whichcanleadtoreplacementsurgeriesinsomeorgans,suchasvalvereplacementforendocardi=s.
• AmbisomeandAbelcet
WorksCited• BilgenH,OzekE,KortenV,EnerBandMolbayD.(1995).Treatmentof
SystemicNeonatalCandidiasiswithFluconazole.Correspondence,58(6),394.
• Candidiasis:[Print]‐eMedicineInfec=ousDiseases.eMedicine‐MedicalReference.RetrievedJuly15,2009,from:hfp://emedicine.medscape.com/ar=cle/213853‐print
• Candidiasis.(2008,March27).DepartmentofHealthandHumanServices:CentersforDiseaseControlandPrevenBon.RetrievedJuly10,2009,from:hfp://www.cdc.gov/nczved/dsmd/disease_lis=ng/candidiasis_=.html
• DiggsC,EskenasyG,SutherlandJandWiernikP.(1976).FungalInfec=onofMuscleinAcuteLeukemia.Cancer,38,1771‐1772.
• EladS,WexlerA,GarfunkelAA,ShapiraMY,BitanMandOrR.(2006).Oralcandidiasispreven=onintransplanta=onpa=ents:acompara=vestudy.ClinicalTransplantaBon,20,318‐324.
• Fisher,M.D.andZaou=s,M.D.(2008).TreatmentofCandidiasisinImmunocompromisedPediatricPa=ents.PediatricDrugs,10(5),282‐298.
• MathaiAM,MenezesRG,NaikR,KanchanT,KumarS,BhatG,ChauhanAandRaiM.(2008).Anautopsycaseofrenalcandidiasis.ForensicandLegalMedicine,16,31‐34.
• MooreN,LeefJandPangY.(2003).SystemicCandidiasis.RadioGraphics,23(5),1287‐1290.
• PedrazJ,Delgado‐JimenezY,Perez‐GalaS,Nam‐ChaS,Fernandez‐HerreraJandGarcia‐DiezA.(2008)BlackwellPublishingLtd.ClinicalandExperimentalDermatology,34,106‐110.
• SvobodaPandKantorovaI.(2006).SystemicCandidaInfec=onintheICU.YearbookofIntensiveCareandEmergencyMedicine,2006(15),595‐603.
• SystemicCandidiasis.(2005,January).TheBody:TheCompleteHIV/AIDSResource.RetrievedJuly10,2009,from:hfp://www.thebody.com/content/art4977.html
• SystemicCandidiasis.CandidiasisCure:Whatisitandwhatcanyoudoaboutit.RetrievedJuly13,2009,from:hfp://www.candidiasiscure.com/systemic‐candidiasis.html
• SystemicCandidiasis‐Causes,SymptomsandCurefor‘Candida’.(2009,April25).ArBclesbase.RetrievedJuly17,2009,from:hfp://www.ar=clesbase.com/women's‐health‐ar=cles/systemic‐candidiasis‐causes‐symptoms‐and‐cure‐for‐candida‐885999.html
• Yeast‐LifeCycle.ScienceEncyclopedia.RetrievedJuly15,2009,from:hfp://science.jrank.org/pages/7438/Yeast‐Life‐cycle.html
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