Pathobiologic Features of Human Candidiasis: A Common Deep Mycosis of the Brain, Heart and Kidney in the Altered Host

Abstract

In a review of 2,616 consecutive autopsies done at the University of Kentucky Medical Center over a 12-year period, 46 patients with complete postmortem examinations had tissue-verified candidiasis in two distinct patterns, with Candida albicans being most frequently cultured. Superficial candidiasis involving only lining surfaces was observed in 21 patients (46%). Usually, it complicated other lethal problems such as malignancy and bacterial sepsis. Nineteen of these patients (95%) had received antibiotics. No vessel invasion or deep organ involvement was evident in this group. The other pattern of candidiasis was a deep or systemic variety recognized in the remaining 25 patients (54%). It was characterized by deep parenchymal organ lesions usually involving the brain (52%), heart (48%), and kidney (80%), but any tissue seemed susceptible. Vessel invasion was seen in 8 patients (32%); intravenous lines were used in 13 (52%); and major operations were done in 16 (64%). All these patients were hospitalized for either benign or malignant conditions and were treated for bacterial sepsis with antibiotics for seven days or more. This investigation indicates that candidiasis occurs when the host's environment is altered primarily by antibiotic therapy. Candida then can colonize lining surfaces and from there could invade adjacent vessels and disseminate throughout the body.

Candida albicans Pathogenesis: Fitting within the Host-Microbe Damage Response Framework

“…Once in the bloodstream, C. albicans can infect a wide range of target organs, including the kidney, spleen, liver, heart, gastrointestinal (GI) tract, and lungs (58). Within target organs, invasive infections lead to significant tissue damage (59,60). One of the major problems in managing patients with HDC is the difficulty in establishing the diagnosis, because bloodstream Candida infections tend to present clinically with nonspecific symptoms similar to those seen with systemic bacterial infections (7).…”

Telomeric and dispersed repeat sequences in Candida yeasts and their use in strain identification

“…DNA fragments containing the telomeric repeats are highly variable among different C. albicans strains. We have shown that the Ca3 repeat is relatively more stable and is suitable for use as a species-specific and strain-specffic probe for C. albicans.Candida albicans and related species are responsible for the majority of oral and vaginal yeast infections (la, 26) and continue to increase in frequency as a major cause of systemic infections in immunocompromised hosts (1,4,5,25,30). Because C. albicans and related species lack sexual cycles (46), genetic studies have been difficult.…”

“…Candida albicans and related species are responsible for the majority of oral and vaginal yeast infections (la, 26) and continue to increase in frequency as a major cause of systemic infections in immunocompromised hosts (1,4,5,25,30). Because C. albicans and related species lack sexual cycles (46), genetic studies have been difficult.…”

Antigens and immune responses in Candida albicans infection

“…In mice, the organs most affected are the brain, heart and kidney; however, as the number of organisms used for challenge is reduced, the brain lesions remain almost constant in severity, whereas tissue damage in other organs becomes less obvious (66,67). A predominance of cerebral mycoses has also been reported to be a feature of the human disease as it occurs in endemic fungal areas in the United States (68), and in the immunocompromised host (69). The relevance of such models to mucocutaneous infections has been questioned, but such qualms may be groundless.…”