Candida: Diagnosis and Treatment

Candida: Diagnosis and Treatment


Laboratory diagnosis: 

Specimen:

  • Specimen collection depends on the site of infection.

Specimens:

  • Mucosal scraping, skin & nail scraping, urine, blood, CSF, sputum etc.

Microscopy: 

  • Candida can be demonstrated as gram positive yeast like budding cells 
  • With or without pseudohyphae(Chains of elongated yeast cells that fail to detach after budding.) on Gram smear.
  • KOH mounts too can show yeast like cells.
  • Calcofluor white stain is also useful in demonstration of Candida in specimens.

Culture: 

  • It grows readily on bacteriological medium as well as SDA at 37oC after overnight incubation.
  • Colonies are white, creamy and bacteria-like.
  • A positive culture does not mean that the C. albicans is pathogenic, as it may be a commensal.

Identification: 

  • Different species of Candida can be identified by following tests:
  1. Chlamydospore formation on Cornmeal Agar (Dalmau plate)
  2. Germ tube test (Reynaud Braude)
  3. Carbohydrate assimilation
  4. Auxanography
  5.  Latex agglutination

Treatment:

Mucocutaneous

Cutaneous :

  • Topical azoles Topical nystatin

Vulvovaginal:

  •  Azole cream or oral fluconazole Nystatin suppository

Oropharyngeal: 

  • Clotrimazole or fluconazole Nystatin

Esophageal: 

  • Fluconazole or itraconazole

Deeply Invasive

Non-neutropenic: 

  • Fluconazole or amphotericin B

Neutropenic: 

  • Amphotericin B

Candida endophthalmitis

  • IV polyene + flucytosine
Exam Question
 
  • Pseudohyphae of candida with budding yeasts are present on this potassium hydroxide preparation
  • Ketoconazole would treat both dermatophysis and candidal infection
  • Drug of choice in systemic candidiasis is Amphotericin
  • Drugs used for candidiasis include Fluconazole, Nystatin, Clotrimazole, Itraconazole
  • Different species of Candida can be identified by following tests:
  1. Chlamydospore formation on Cornmeal Agar (Dalmau plate)
  2. Germ tube test (Reynaud Braude)
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