The Big Five

Fluconazole resistance in Candida spp.

1. Clinicians were using suboptimal dosing = inducible resistance (Especially glabrata)

The big five (5)

1. Candida krusei

2. Candida tropicalis

3. Candida parapsilosis

4. Candida glabrata

5. Candida albicans

Candida krusei commonality

Least common

Candida krusei CHROM agar

Rough pink with white boarder

Candida krusei suseptability testing

Constitutive/ natural fluconazol R

Candida krusei morphology

• “Tree like” Ballistoconidia

Candida tropicalis CHROM agar

Deep blue pigment

Candida tropicalis commonality

Most virulent

Candida tropicalis susceptible

Leukemia is predisposing factor

Candida parapsilosis CHROM agar

can’t call :(

Candida parapsilosis disease

1. Endocarditis

2. Blood stream infection

Candida parapsilosis morphology (2)

1. Single blastoconidia out of junction

2. Macaroni-shaped pseudohyphae

Candida glabrata disease

UTI

Candida glabrata susceptibility

Inducible fluconazole R

Candida glabrata morphology

1. Do not form psudohyphe

2. Tiney cells

3. Micky mouse ears when bud

Candida glabrata CHROM agar

Mauve, waxy

Candida glabrata Colonies

Smaller on BA than on EMB!

Candida glabrata biochemical reactions

Metabolize trehalose

Candida albicans commonality

Most common

Candida albicans reservoir (1)(4)

1. Normal flora

   1. GI tract

   2. Skin

   3. Oral cavity

   4. Vaginal tract (Small #)

Candida albicans at risk (3)

1. Immunocompromised

2. Indwelling catheter

3. Broad spectrum antibiotics

4. AIDS

Candida albicans disease

1. Thrush

2. Vaginitis (Yeast infection)

3. Candidemia (Bloodstream)

4. Esophagitis (Common in AIDS)

Candida albicans identification

1. Grow on BA star like projections

2. Germ tube test +

Candida albicans CHROM agar

Teal

Candida albicans morphology

• Terminal chlamydoconidia

Antifungal susceptibility testing (3)

1. Broth and disk

2. Variable incubation time

3. Can’t test all yeast, only subset