Medical Mycology:
http://epubs.rcsi.ie/cgi/viewcontent.cgi?article=1036&context=medart
Patients with CF are at an increased risk of acquiring Candida due to use of inhaled steroids,
diabetes mellitus and lifelong antibiotic treatment however despite its frequent isolation from
sputum, oral and vaginal swabs, it remains unclear what such culture actually means in
practical terms for CF clinicians
Candida as the second most frequent fungal growth to Aspergillus in the CF airway and such
growth has been associated with more severe CF where patients receive prolonged treatment
with antibiotics, glucocorticoids and probiotics (9-12). I
whilst invasive airway infection is a rare event, extent
of airway damage from hypersensitivity phenomena remain unknown ............{{This airway sensitization is what I experience as I have never cultured it in my airways but, due to chronic colonization of the gut I believe it increased my overall inflammatory levels in my body and causes reactive airways as well as increased allergies and chemical sensitivities}}
((risk factors for orally recovery include))....
include poor dentition, older age, diabetes mellitus, use of inhaled or systemic steroids,
smoking, malignancy and frequent antibiotic use. Oral thrush usually presents as discomfort
associated with a dry mouth and associated dysphagia. In some cases, altered taste is
experienced. The diagnosis is usually straightforward and by direct observation of white
membraneous plaques on the buccal mucosa or soft palate.
. In our own institution’s experience, we encounter regular instances of oral
candidiasis annually following courses of antibiotics but which resolve after a short burst of
anti-fungal treatment (Fluconazole). We recommend microbiological confirmation by
scrapings in all cases unless white plaques are directly observed on oral examination. This is
because some of the symptoms described are not specific to oral thrush but can be found in
associated vitamin deficiencies (B6, B12) or by simple blistering. We recommend that CF
patients attending routine clinic be screened for risk factors and questioned at three-monthly
intervals with regard to the symptoms of oral thrush including frequency of sore or dry
mouth, crusting lips, dysphagia, dysphonia or hoarseness and difficulties with taste.
Despite this clear lack of available
literature, we strongly recommend screening questions for infection at all CF clinic visits anddepending on clinical findings, anti-fungal treatment prescribed either empirically or
following microbiological confirmation.
((HAVE YOU HAD TROUBLE WITH A PORT OR BLOOD INFECTION????))))
A more commonly encountered systemic infection associated with Candida involves the
presence of a “port”. Candida species in this setting are
recognized as the most common infecting organism associated with a port resullting in
septicaemia
CANDIDA....CHICKEN OR THE EGG
, a view of many clinicians and it may be
that the organism acts as nothing more than a microbiological marker of disease severity in
CF. To challenge this paradigm, we are currently prospectively evaluating whether airway
colonization by Candida albicans may act pathogenically by affecting clinical outcomes in
CF including FEV1, BMI, hospitalizations for infective exacerbations and sputum
colonization with Pseudomonas or Aspergillus species. Notably, a previous cross sectional
analysis of a European CF registry did show that Candida albicans colonization was
associated with 5-10% predicted decrease in pulmonary function
SO THE QUESTION IS DO WE GET SICKER BECAUSE OF CANDIDA OR DOES CANDIDA SIMPLY GET A FOOT HOLD ONCE WE ARE ALREADY SICKER? MY OPINION IS CANDIDA IS OVERLOOKED IN ITS ROLE IN OUR DETERIORATION!
Bacteria and fungi are found together in a variety of
environments but particularly in biofilms, where adherent species interact through diverse
signaling mechanisms. In the host C. albicans can often be found growing with bacteria in
polymicrobial biofilms and interspecies interactions occur that can impact on the transition of
C. albicans between virulent and nonvirulent states (27). Under conditions of immune
dysfunction, such as in the CF lung, colonising C. albicans can become an opportunistic
Bacteria and fungi are found together in a variety of
environments but particularly in biofilms, where adherent species interact through diverse
signaling mechanisms. In the host C. albicans can often be found growing with bacteria in
polymicrobial biofilms and interspecies interactions occur that can impact on the transition of
C. albicans between virulent and nonvirulent states (27). Under conditions of immune
dysfunction, such as in the CF lung, colonising C. albicans can become an opportunistic
...............BASICALLY THE PRESENCE OF YEAST/CANDIDA ALLOWS THE BACTERIA TO BE MORE RESISTANT AND CREATE MORE DESTRUCTIVE BIOFILMS IN OUR LUNGS....IE THEY TEAM UP
