YEASTS

Introduction

 Unicellular fungi – spherical, oval, elongated

 Reproduce by asexually by budding (blastoconidia) and
sexually by production of ascospores/basidiospores
 Gram positive
 Important properties useful in differentiating yeasts
 Size of yeast
 +/- capsule
 Broad based/narrow necked budding
 Cause infections in
 immunocompromised host
 Postsurgical patients
 trauma patients
 long-term indwelling catheters
 Some are resistant to commonly used antifungal agents
 Yeasts of medical
importance

 Candida
 Cryptococcus
 Trichosporon
 Saccharomyces
 Candida

Round or oval budding yeast cells

Thin walled dimorphic fungus
Candida have both true hyphae and
pseudohyphae
Grows most often as a yeast
Hyphae formation triggered by changes
in pH, temperature, available nutrients
 Candida

≈200 species
 Epidemiology

Commensal: oral cavity, female genital

tract and GIT
Opportunistic pathogen
Endogenous infections (superficial and
systemic) in immunocompromised
patients.
Nosocomial infections
 Virulence factors

 Adhesins: colonisation
 Secrete enzymes e.g. hydrolases: Nutrient acquisition
and degradation of host tissue
 Yeast-to-hyphal transition: Δtemp, nutritional starvation,
alkaline PH
 Biofilm formation- resistant to antifungals and host
immune defenses
 Candidalysin- peptide toxin that promotes epithelial
damage, stimulates immune activation, and phagocyte
function Source: Alessandrada 2016 “Cell biology of Candida albicans–host interactions”
 Clinical manifestations

Mucocutaneous
Cutaneous
Systemic
 Mucocutaneous
infections

Oral thrush/oropharyngeal candidiasis

Vaginal candidiasis
Esophageal candidiasis
Chronic mucocutaneous candidiasis
(CMC) in pts with T-lymphocyte
immunodeficiencies
 Chronic mucocutaneous
candidiasis

Note: thickened, fragmented, and discolored

hyperkeratotic nails
Source:Walter Reed Army Medical Center
 Cutaneous infections

* Develops on skin folds, under the breasts,

interdigits and the groin
* Starts with papules that enlarge and become
confluent.
* Larger lesions are erythematous with an irregular
margin.
* The differential diagnosis: Onychomycosis, diaper
dermatitis, intertrigo and Candidial granuloma
 Systemic infections

Candidemia, urinary tract candidiasis,

gastrointestinal, pulmonary candidiasis,
endocarditis, meningitis, arthritis, and
osteomyelitis
NAC

Source: https://www.semanticscholar.org/
 Lab diagnosis

 Specimen: Exudates or epithelial

scrapping, aspirates, biopsy, blood, etc
 Direct microscopy: KOH &/or Gram stain:
budding yeasts & pseudohyphae
 Culture: BA or SDA, in air, 37°C, 12-24hrs:
cream smooth colonies
Gram stain Colonial morphology
 Presumptive diagnosis

 Germ tube test: Positive for C.albicans

Source: https://microbiologyinfo.com/
 Species identification

* Morphological characteristics on
ChromAgar
* Carbohydrate assimilation &
fermentation
* Chlamydospore production
 Treatment

* Superficial; nystatin or azole preparations.

* disseminated or relapsing infections;
amphotericin B and fluconazole +/-
flucytosine
 Cryptococcus

Basidiomycete that normally grows as a

haploid-budding yeast
Possess a capsule rich in mucin
In culture, Cryptococcus species produce
whitish mucoid colonies
Hydrolyzes urea
 Cryptococcus

 Four serotypes A,B,C and D:

 Serotypes A and D are classified as C.
neoformans var. neoformans,
 serotypes B and C are classified as C.
neoformans var. gatii
  Cryptococcus neoformans var. neoformans major
cause of cryptococcal disease worldwide.
Epidemiology/infection

Source: Environmental Niches for Cryptococcus neoformans and Cryptococcus

gattii, ASM
 Virulence factors
 Inhaled and reach alveoli
 Melanin: antioxidant polysaccharide
interferes with oxidative killing and aids
intracellular survival in phagocytes
 Polysaccharide capsule: resists killing by
neutrophils, monocytes, or macrophages 
 Proteases and phospholipases- invasins
 Clinical manifestations

Pulmonary cryptococcosis :asymptomatic

 CNS disease – Meningitis,
meningoencephalitis, cryptococcoma
Rarely: Cutaneous, Bone and joint, Ocular
cryptococcosis
 Lab diagnosis

Specimens - CSF, blood, sputum,

biopsy
CSF:
India ink or nigrosin staining of CSF
deposit
India ink preparation

Source: https://www.keydiagnostics.com.au/
 Lab diagnosis

Latex agglutination tests (Cryptococcal

Antigen – CRAG test):
On CSF or serum
Detects polysaccharide capsular antigen
Rapid test
Culture :SDA, 37°C, in air, may
require >48hrs – creamy, mucoid
colonies
Selective media – Birdseed agar –
melanin production (brown
colonies)
Birdseed agar
Biochemical tests:
 Urease test- positive
Carbohydrate assimilation &
fermentation tests
 Treatment

Amphotericin B
Flucytosine – combined with
amphotericin B
Fluconazole