Candida Albicans (Yeast Infection) in Hospital Settings

The sixth most common cause of nosocomial (hospital acquired) infections, Candida Albicans is an exceptionally widespread fungus - on a global scale. Candida is responsible for commonplace yeast infections, as well as a number of other more serious infections of various organs. As a dimorphic fungus, it can grow in two forms: round yeast cells, and web-like filamentous cells. Common in human gut flora, its growth is usually limited by the immune system. Its relationship with the human host is not symbiotic (in which there is a mutual benefit between organism and host).

Rather, it has a commensal relationship with humans, meaning it benefits from the human host while the human is unaffected. However, the fungus can advance from commensal to pathogenic (in which the organism causes illness in the host), if and when the immune system is impaired or competing microbial flora are destroyed. "Good" intestinal flora can be wiped or severely reduced through long-term antimicrobial treatment, for example. This allows Candida to flourish, with a newfound lack of microbial competition. Like most opportunistic pathogens that take hold when immunity is reduced, Candida can potentially infect of a number of different organs. Candidiasis of the skin and nails is exceptionally common (known as thrush), with more than 3 million cases annually in the US. Vaginal yeast infections are also rather commonplace, with some 200,000 cases per year and a 75% likelihood that any given woman will get one in her lifetime.

Candida is among a group of pathogens which commonly cause hospital acquired infections. It is the chief source of fungal infections in the immunocompromised. The albicans species is responsible for the majority of human Candida infections, as much as 90%. In nosocomial cases, a handful of other species have been identified in infections, including C. tropicalis, C. glabrata, C. parapsilosis, C. krusei, and C. lusitaniae. It appears that other species of candida have become more common due the species-specific anti-fungals that attack the albicans species, allowing others to arise and thrive. It is the most frequent cause of fungemia (fungal infections of the blood) and hematogenously disseminated candidiasis

Despite its massive prevalence and reputation as a community-acquired infection, nosocomial (hospital acquired) candida is very possible. Because the bacteria can ably infect healthy hosts, it becomes an even graver threat for immune impaired individuals during hospital stays. Even though an otherwise healthy individual with a Candida overgrowth cannot transmit the infection to another healthy individual because the parasite is not contagious, there is a slim possibility that a healthy individual with Candida could transmit it to a patient whose immune system is compromised. The incidence of nosocomial candida infections has increased dramatically since the 1980's. Growing antifungal resistance represents a significant challenge to public health.

Causes of Candida Albicans

The fungus exists naturally in the gut, but certain circumstance and stressors can cause the commensal organism to become an agent of infection.

These include:

  • many invasive procedures
  • natural protection barriers are broken
  • use of broad-spectrum antibiotics

The wide variety of organs candida can infect bespeak its wide commensal presence throughout the human body. In a community acquired infections, a high sugar diet is a leading culprit of candida infections, as the yeast feeds off sugar and proliferates when it is in abundance for a long period of time. In nosocomial infections, sugar consumption is not so much a factor as treatments, procedures or conditions that impair the immune system. Antimicrobial treatment especially can almost be characterized as a proximate cause of nosocomial candida infections.

Symptoms of Candida Albicans

Different conditions can be caused by the organism and symptoms vary based on the site and type of infection but can include:

  • bloodstream infections (fungemia)
  • septic shock
  • Urinary Tract Infection (UTI)
  • surgical wound infections
  • skin abscesses related to catheter insertion
  • infection of the heart muscle
  • persistent yeast infection
  • oral thrush
  • digestive problems
  • joint pain
  • abnormal stool (for intestinal infections)
  • chronic fatigue
  • nail infections
  • irritability
  • mood swings
  • depression

Risk Factors of Candida Albicans

There is something of an overlap between risk factors and causes in candida infections because the organism is endogenous (already present) in most human bodies. Therefore, risk factors become proximate causes, although there are plenty of candida risk factors that do not lead to candida infection. An individual cannot contract candida from those around them, making it difficult to pin down causes that are themselves not simple risk factors, such as antimicrobial therapy. In addition, benign colonization with the fungus frequently precedes infection. Conditions that raise the risk of contracting candida in its many forms include:

  • HIV/AIDS
  • mononucleosis
  • cancer treatments
  • steroids
  • stress
  • antibiotic usage
  • diabetes
  • severe burns
  • nutrient deficiency
  • time spent in ICUs
  • neutropenia related to cancer
  • major surgery
  • preterm infancy
  • administering a catheter with unclean hands
  • benign mucosal candida colonization

Treatment of Candida Albicans

Successful management of candida has been and remains a challenge. Antifungal drugs are usually a first course of action in moderately to severely ill patients, while diet changes will usually suffice in the case of endogenous infection or overgrowth in healthy individuals.

In nosocomial Candida infections, the timing of treatment is critical. When cultures reveal the presence of candida in the blood, for example, mortality sits at 15% if treatment with fluconazole begins on the same as the culture, but jumps to 24, 36 and 41% when started on days 1, 2 and 3, respectively. Fluconazole is usually the chief anti fungal with which candida is treated. Although dietary adjustments may be of some aid, antifungals are considered a mainstay of treatment.

Prevention of Candida Albicans in Hospitals

A preventative strategy for candida fungal infections is empirical treatment/preemptive therapy of the condition in high-risk groups. Antifungals can be prescribed prior to the patient ever developing symptoms, especially because the poor sensitivity of microbiological and clinical findings has led to delayed diagnosis and increased mortality in the past. Prophylaxis may be suitable for specific high-risk groups. The only risk of preemptive treatment is that it increases the risk of azole-resistant fungal species isolates.

Research has indicated that candida can survive on surfaces for a period of time, meaning nosocomial transmission by contact with contaminated surfaces is possible, therefore surface sanitization is another means of prevention. Health care workers, as in all situations, should practice meticulous hand hygiene, especially when administering catheters, which is a known reservoir of candida infection.

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