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Questions Answered: 215

Final Score 69%

148
67

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Microbiology

Pathogens

Question 120 of 215

Regarding Candida species, which of the following statements is INCORRECT:

Answer:

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 candidal infections are sensitive to fluconazole. Vulvovaginal or cutaneous candidiasis may be treated with topical clotrimazole and/or oral fluconazole. Oral candidiasis is treated with nystatin mouthwash or oral fluconazole in unresponsive cases. Invasive candidiasis may be treated with systemic fluconazole, echinocandin e.g. caspofungin or amphotericin.

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
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