Summary about Disease
Non-Candida Albicans (NCA) infections are fungal infections caused by Candida species other than Candida albicans. While Candida albicans is the most common cause of candidiasis (yeast infections), other species like Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida auris are increasingly responsible for infections, particularly in healthcare settings. These NCA species can exhibit different drug resistance patterns compared to Candida albicans, making treatment more challenging. Infections can range from superficial mucosal infections (like oral thrush or vaginal yeast infections) to invasive bloodstream infections (candidemia).
Symptoms
Symptoms vary depending on the location and severity of the infection.
Oral Thrush: White patches on the tongue, inner cheeks, gums, and palate; redness or soreness; difficulty swallowing.
Esophagitis: Painful swallowing, chest pain, feeling like food is stuck in the throat.
Vaginal Yeast Infection: Itching, burning, soreness, redness, and swelling of the vagina and vulva; thick, white, cottage cheese-like discharge.
Invasive Candidiasis (Candidemia): Fever, chills, fatigue, and other symptoms that can mimic bacterial infections. This can affect organs like the heart, brain, eyes, bones, and other parts of the body.
Skin Infections: Red, itchy rash, often in skin folds (e.g., under the breasts, in the groin).
Causes
NCA infections are caused by various Candida species other than Candida albicans. Common species include:
Candida glabrata
Candida parapsilosis
Candida tropicalis
Candida krusei
Candida auris Risk factors include:
Weakened immune system (e.g., HIV/AIDS, chemotherapy, organ transplant)
Diabetes
Antibiotic use (disrupts normal flora, allowing Candida to overgrow)
Central venous catheters or other invasive medical devices
Surgery
Hospitalization, especially in intensive care units
Medicine Used
Treatment depends on the species of Candida involved, the location of the infection, and its severity. Due to the potential for drug resistance in NCA species, antifungal susceptibility testing is often performed to guide treatment. Medications include:
Azoles: Fluconazole, voriconazole, itraconazole, posaconazole (Fluconazole resistance is common in some NCA species)
Echinocandins: Caspofungin, micafungin, anidulafungin (Often the first-line treatment for invasive infections, especially if azole resistance is suspected)
Amphotericin B: (Used for severe or resistant infections)
Topical antifungals: Nystatin, clotrimazole (for oral or vaginal infections)
Is Communicable
Most NCA infections are not readily communicable from person to person in everyday settings. However, some species, like Candida auris, can spread in healthcare settings through contaminated surfaces or equipment, and potentially through direct contact. Transmission is more likely in immunocompromised individuals. Vaginal yeast infections are generally not considered sexually transmitted, but sexual activity can sometimes trigger symptoms.
Precautions
Good Hygiene: Frequent handwashing, especially in healthcare settings.
Avoid Unnecessary Antibiotics: Antibiotics can disrupt the normal balance of microorganisms and increase the risk of Candida overgrowth.
Control Underlying Conditions: Managing diabetes and other medical conditions that weaken the immune system.
Healthcare Settings: Strict adherence to infection control protocols, including appropriate cleaning and disinfection of surfaces and equipment, and isolation of patients with Candida auris.
Vaginal Health: Avoid douching, which can disrupt the natural flora of the vagina. Wear breathable cotton underwear.
How long does an outbreak last?
The duration varies.
Oral/Vaginal Thrush: Can clear within a few days to 2 weeks with appropriate antifungal treatment.
Invasive Candidiasis: Can take weeks or even months of antifungal therapy to resolve, and mortality rates can be high.
Chronic Mucocutaneous Candidiasis: Can persist for years, with intermittent flare-ups.
How is it diagnosed?
Diagnosis depends on the location and type of infection:
Microscopic Examination: Scrapings or swabs from the affected area (e.g., mouth, vagina) can be examined under a microscope to identify Candida.
Culture: Samples are cultured to identify the specific Candida species and determine antifungal susceptibility.
Blood Cultures: Used to diagnose candidemia (bloodstream infection).
Imaging Studies: X-rays, CT scans, or MRIs may be used to assess organ involvement in invasive infections.
Beta-D-Glucan Assay: A blood test that can help detect fungal infections, including candidemia.
T2Candida Panel: A blood test that can rapidly identify Candida species directly from a blood sample.
Timeline of Symptoms
Mucosal Infections (Oral, Vaginal): Symptoms typically develop gradually over a few days to a week.
Invasive Candidiasis: Symptoms can develop rapidly, especially in immunocompromised individuals. Fever and chills are often early signs. The timeline will vary greatly on the organ system involved, the health of the patient and the specific species.
Important Considerations
Drug Resistance: NCA species are often more resistant to certain antifungal medications (e.g., fluconazole) than Candida albicans. Susceptibility testing is crucial for guiding treatment.
Invasive Infections: Invasive candidiasis can be life-threatening, especially in immunocompromised individuals. Early diagnosis and appropriate treatment are critical.
Candida auris: This species is of particular concern due to its multidrug resistance, ability to spread in healthcare settings, and association with outbreaks.
Underlying Conditions: Identifying and addressing underlying risk factors, such as weakened immune systems or uncontrolled diabetes, is important for preventing recurrent infections.