1. Current Developments
in Prevention
and
Treatment of
Candidiasis
P r o d i p t a c h a k r a b o r t y
D e p a r t m e n t o f p h a r m a c e u t i c s
H i m a l a y a n p h a r m a c y i n s t i t u t e

2.  Also known as Oral thrush
 Oral infection caused by fungi
(yeast) of the genus candida
 Multiple species of candida
(candida albican most common cause)
 Often an opportunistic infection
Can transmit via direct contact
Candida albican

3. • Candida albicans is an opportunistic fungal pathogen
that is responsible for candidiasis in human hosts.
• C. albicans grow in several different morphological
forms, ranging from unicellular budding yeast to true
hyphae with parallel-side wall .
• Candida albicans is a unicellular, oval-shaped diploid
fungus (a form of yeast ) Typically, C. albicans live as
harmless commensals in the gastrointestinal and
genitourinary tract and are found in over 70% of the
population. Overgrowth of these organisms, however,
will lead to disease

4. STRUCTURE OF CANDIDA

5. EPIDEMIOLOGY
Over 75% of women suffer from a C.albicans infection, usually vulvovaginal
candidiasis and 45-50% of them will have additional occurrences.
Interestingly, candida are the 4th leading cause for nosocomial infections in patients
Bloodstearms.
This could result in an extremely life-threatening. Systemic infection in hospital
patients with a mortality rate of 30% as per WHO
Several candida species are commensal and colonize the skin and mucosal surfaces
Of humans.

6. Symptoms of candida
overgrowth in the gut include:
Stomach pain
Diarrhea
Constipation
Bloating
Gas
Nausea
Abnormality of taste
Difficulty swallowing
Redness & white tongue
Bad breath & burning mouth
Pain in the vagina
Itching and rash at the affected site

7. Clinical Features
White, opaque, “patchy” plaque on tongue
or buccal membrane
Plaques are very adherent,
but it’s Painless
Other associated signs & symptoms:
Loss of sense of taste
Angular cheilitis

8. Risk factors
1) Immunosuppression
-local or systemic
2)Extremes of age
3)Comorbid conditions
-Diabetes, smoking
4)Malnutrition
-Vitamin deficiencies
5)Medications
-Recent use of antibiotics
6)Denture use

9. CANDIDIASIS IS A FUNGAL INFECTION THAT CAN AFFECT AREAS
SUCH AS THE:
Mouth
Throat
Gut
Lips
Vagina
BLOODSTREAM or INTERNAL ORGANS
Under the breasts and in the folds of the buttocks
Other parts of the body

11. Oral candidiasis was mostly frequent in HIV/AIDS patients
between 21-40 years.
A CD4 cell count less than 200 cells/μl was
a significant risk factor for acquiring
oral candidiasis in HIV/AIDS
Patients.

12. candidiasis
candida albican
Candida glabrata
Candida tropicalis
Candida
Parapsilosis
others candidiasis
46.3%
15.9%
14.6%
19.5%
3.7%

13. If it is in the mouth or throat, it is called oral candidiasis, oropharyngeal
candidiasis, or Thrush.
If it affects the genital area, it is called a yeast infection. In women, it may be called a
Vulvovaginal yeast infection.
If yeast infects the skin on a baby’s bottom area, it causes a diaper rash.
If the infection enters your bloodstream, it is called invasive candidiasis
or candidemia.
There are several types of candidiasis

14. • Candidiasis is caused by the abnormal growth in C. albicans, which
is usually due to an imbalance in the environment.
• Usually, this imbalance occurs in a woman’s vagina – this infection
less likely to occur for men.
• Several events can spark an imbalance. For example, antibiotic use
can decrease the amount of lactobacillus bacteria, which decreases
the amount of acidic products and the pH of the vagina. Other
events are pregnancy, uncontrolled diabetes, impaired immune
system, and irritation of the vagina.
• C. albicans are able to take advantage of the conditions and
outcompete the normal microflora, resulting in candidiasis or a
yeast infection

15. TRANSMITTED FROM MOTHER TO INFANT THROUGH CHILDBIRTH
BY KISSING
THE OVERGROWTH OF C.ALBICANS LEADS TO SYMPTOMS OF DISEASE,
AND IT OCCOURS WHEN THERE ARE IMBALANCES
RARELY SPREAD THROUGH SEXUAL INTERCOURCE
TRANSMITION

16. The diagnosis is most commonly made on the basis of the
skin's appearance and occasionally a skin scrape sample is
taken to confirm the clinical findings .
For oral thrush, a suspension of antifungal medication can be
swished in the mouth and swallowed.
vaginal mucosa are examined under the microscope; a
potassium hydroxide smear, Gram stain, or methylene blue is
useful for direct demonstration of fungal cells
Diagnosis:

17. Diagnosis of a yeast infection is done either via microscopic
examination or culturing. For identification by light microscopy, a
scraping or swab of the affected area is placed on a microscope
slide. A single drop of 10% potassium hydroxide (KOH) solution is
then added to the specimen. The KOH dissolves the skin cells, but
leaves the Candida cells intact, permitting visualization of
pseudohyphae and budding yeast cells typical of many Candida
species.
For the culturing method, a sterile swab is rubbed on the infected
skin surface. The swab is then streaked on a culture medium. The
culture is incubated at 37 °C for several days, to allow development
of yeast or bacterial colonies. The characteristics (such as
morphology and colour) of the colonies may allow initial diagnosis
of the organism causing disease symptoms.

18. P R E V E N T I O N
In general case:- In general, you can prevent most Candida infections
by keeping your skin clean and dry, by using antibiotics only as your
doctor directs, and by following a healthy lifestyle, including proper nutrition.
For Diabetes patients:- People with diabetes should try to keep their blood
sugar under tight control.
For HIV patients:- If you have HIV or another cause of recurrent episodes
of thrush, then antifungal drugs such as clotrimazole (Lotrimin, Mycelex)
can help to minimize flare-ups

19. Treatments for candidiasis for managing Candida infections are
usually based upon the anatomic location of the infection,
immune status of the patient, risk factors for patients with
infection, species responsible and lastly, upon the susceptibility
of the Candida species towards the anti-fungal drug.
T R E AT M E N T

20. Systemic Antifungal Agents:
A. Polyenes: Amphotericin B.
B. Pyrimidine analogue: Flucytosine.
C. Triazoles: Fluconazole, Itraconazole, Voriconazole,
Ravuconazole, Posaconazole, Ketoconazle.
D. Echinocandins: Caspofungin, Anidulafungin, Micafungin.
Topical Antifungal Agents:
A. Topical azoles: Terconazole, Butaconazole, Miconazole,
Clotrimazole, Tioconazole, Sulconazole, Oxiconazole
and Econazole.
B. Topical allylammines: Terbinafine and Naftifine

21. Nystatin
Fluconazole
Clotrimazole

22. Emerging Resistance
Antifungal resistance can develop either through the
selection of species with inherent resistance or through
the creation of resistance in isolates from ordinarily
susceptible species. The former is the most common, as
evidenced by the rise of C. glabrata following the
introduction of fluconazole and of C. parapsilosis in
environments where echinocandins were used more
frequently. Recent research reveals that the rate of
acquired echinocandin resistance in isolates from
sources other than blood may be underestimated,
implying that deep-seated candidiasis could serve as a
hidden reservoir of echinocandin resistance

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