Microbiology
Pathogens
Which of the following is usually used first line for oral candidiasis:
Answer:
Oral candidiasis is treated with nystatin mouthwash or oral fluconazole in unresponsive cases.Candida
Microbiology / Pathogens / Yeasts and Fungi
Last Updated: 21st April 2019
Transmission
Candida spp. are normally widely distributed in the environment. They form part of the normal commensal flora of the skin, gastrointestinal tract and female genital tract and infection is usually endogenous. Infections can occur when normal bacterial flora is disrupted e.g. following treatment with broad-spectrum antibiotics, in pregnancy, in diabetes mellitus or when immunity is altered. Most infections are caused by Candida albicans.
Clinical Disease
- Skin
- Cutaneous candidiasis
- Candidal paronychia
- Nappy rash
- Oral
- Oral candidiasis (commonly associated with inhaled corticosteroids)
- Genitourinary tract
- Vulvovaginal candidiasis (thrush)
- UTI (colonises catheters)
- Gastrointestinal
- Candidal oesophagitis (can be severe in immunocompromised patients)
- Systemic infection
- Common in neutropenic patients, or patients in intensive care (e.g. line associated infection).
Diagnosis
Diagnosis is by microscopy (Gram-positive spores and pseudohyphae), culture or NAAT of specimens of skin, nails or oral or vaginal swabs. Given its widespread distribution in normal flora, the significance of each isolate is determined in relation to the overall clinical picture.
Treatment
- Vulvovaginal or cutaneous candidiasis - topical clotrimazole or oral fluconazole
- Oral candidiasis - nystatin mouthwash or oral fluconazole
- Invasive candidiasis - systemic fluconazole, echinocandin e.g. caspofungin or amphotericin
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
