Candida albicans 

is an endogenous organism, found in 40 to 80% of normal human beings as

commensal in gastrointestinal tract, oropharynx . It is a commonest cause of candidiasis
(moniliasis).  Candida albicans is a gram positive yeast with a single bud. Other most common
isolate of Candida species are Candida tropicalis, Candida parapsilosis, and Candida glabrata.

Some of the multiple choice questions test your knowledge regarding this fact; e.g., MCQs
like, ‘all of the following organisms are dimorphic fungi except’; or ‘which of the following
fungal pathogen is Gram positive in nature’

In direct stained smear (of the pathogenic sample), the yeasts can often be seen attached to
pseudohyphae. Both the yeasts and pseudohyphae are Gram positive.

Candida albicans in Gram Staining

Most Candida infections are opportunistic, occurring when a patient has some alteration in

cellular immunity, normal flora or normal physiology. Infection may be caused by endogenous
yeasts or may be nosocomial. Candidiasis is the most common fungal infection in HIV infected
individuals.

 The more debilitated the host, the more invasive the disease.
 Associated with prolonged broad-specturm antibiotic or steroid therapy
 Invasive procedures e.g. surgery / indwelling catheters predispose to Candida

PATHOGENESIS:
Fibronectin receptor on Candida albicans facilitates its adherence to the (fibronectin, a component
of the host extracellular matrix) epithelium of the gastrointestinal or urinary tract. Hydrophobic
molecules on the surface of Candida also helps in adhesion. Aspartyl proteases found in C.
albicans has shown increased ability to cause disease in animal models. Phenotypic
switching and presence of phospholipase also play a role in pathogenesis.

DISEASES:
C.albicans is responsible for several different types of infections in healthy and
immunocompromised patients.  Main diseases includes;
Oral thrush caused by Candida albicans
 Oropharyngeal candidiasis (oral thrush): Common in those with HIV/AIDS.
 Vulvovaginal candidiasis (vaginal thrush): Common infection during pregnancy
 Candidemia/disseminated infections
 Pneumonia
 Meningitis.

Other diseases caused by Candida are paronychia, onychomycosis, endocarditis, eye infection,

intertriginous candidiasis etc.  Disseminated infection of Candida and meningitis is seen mostly in
immunocompromised and/or seriously ill patients.

LABORATORY DIAGNOSIS
Specimen depends on disease presentation. Common submitted sample includes; urine (in case
of UTI), vaginal discharge (suspected cases of vaginal thrush) or CSF (when meningitis is
suspected), sputum (when pneumonia is suspected) or other exudates from mucosal surface.

Pseudohyphae of Candida albicans

Microscopy and Staining

Candida yeast cells can be detected in unstained wet preparations or Gram stained preparations
of sample. In Gram stained smears, Candida appears as gram positive budding yeast cells
(blastoconidia) and/or pseudohyphae showing regular points of constriction.

Culture:
Candida albicans grows well on Sabouraud dextrose agar and most routinely used bacteriological
media. Cream colored pasty colonies usually appear after 24-48 hours incubation at 25-37°C.
The colonies have a distinctive yeast smell and the budding cells can be easily seen by direct
microscopy in stained or unstained preparations.

In Blood Agar, Candida albicans gives white, creamy colored colonies which can be mistaken
for Staphylococcus spp.  Whenever you are analyzing the culture report of ‘high vaginal swab’,
take extra care as the colony you are observing can be of Candida albicans instead
of Staphylococcus aureus or vice versa (quick solution for this is to perform wet mount or gram
staining and observing under microscope).

Germ tube of Candida alibacns

Further tests from culture isolate:

Candida albicans can be identified presumptively by a simple germ tube test.