b) Condidiasis:-
Is the mycosis caused by the dimorphic fungus candida. Candida albicans is a member of the normal microbiota within the gastrointestinal tract, respiratory tract, vaginal area and mouth. Most infections involve the skin or mucous membranes.
Oral candidiasis or " thrush" is a common disease in new borns. It is seen as many small white flecks that cover the tongue and mouth.
Vulvovaginal candidiasis can result from diabetes, antibiotic therapy, pregnancy. In this infection, Candida may proliferate, causing yellow- white discharge from the vaginal area.
Gastrointestinal candidiasis in which diarrhea occurs, it's watery diarrhea without blood or pus cell.
Cutaneous candidiasis occurs in the skin and nail in skin, especially warm and moist area: axillae, groin, skin folds. The infected area is inflammated and ulcerated with itching.
Systemic candidiasis Candida may gain access to the blood stream and in immunosuppressed patients may produce disseminated candidiasis with organisms in many oranges.

Treatment:-
Cutaneous candidiasis treated with nystatin, miconazole. While Ketoconazole , Amphotericin B can be used for systemic Candidiasis.

Pathogenesis:-
Relatively little is known about the pathogenesis of fungal infections, but it is clear that infection arises due to deficiencies in the host rather than becauses of any pathogenic properties of the fungus. Antigenic variation on the surface of candida cells may help the organism to avoid host defences.
Mannan, a cell wall polysaccharide of Candida spp and capsular mucopolysaccharide of Cryptococeus neoformans have been shown to suppress cellular immunity.

Clinical diagnosis:-
Superficial, cutaneous and subcutaneous mycoses often produce lesions which strongly suggest a fungul aetiology.
The first indication that a patient may have a systemic mycosis is often their failure to respond to antibacterial antibiotics.

Laboratory diagnosis:-
Laboratory diagnosis depends on recognition of the pathogen in tissue by microscopy, isolation of the caused fungus in culture, and the use of serological tests.

Types of specimen:-
Skin scales, nail clippings and scrapings of the scalp. Swabs should be taken from suspected candida infection of the mucous membranes.
For subcutaneous infections the specimens are scrapings, aspirated pus and biopsies.
In suspected systemic infection, specimens should be taken from as many sites as possible.

Direct microscopy:-
Most specimens can be examined in wet mounts after partial digestion of the tissue with (10 – 20)% potassium hydroxide.
Gram films may be used for the diagnosis of yeast infection of mucous membranes. Giemsa staining of smears is advised for detection of the yeast cells of H.capsulatum because of their small size.
Fluorescent antibody staining can be used to demonstrate fungi in tissues and smears, but this requires specific antisera which are not widely available.

Culture:-
Most pathogenic fungi are easy to grow in culture.
The agar media most commonly used are sabouraud's glucose agar and 4% malt extract agar. These may be supplemented with chloramphenicol (50µg /L) to minimize bacterial contamination and cycloheximide (500µm / L) to reduce contamination with saprophytic fungi. Many fungal pathogens have an optimum growth temp. below 37oc.
With some of the dimorphic pathogens, the mold form develops at (22–27)oc on sabouraud's agar and enriched media such as brain–heart infusion or blood agar are used, with incubation at 37oc to promote growth of the yeast phase.
Many fungi develop slowly, and cultures should be retained for at least 2–3 weeks and in some cases up 6 weeks before being discarded, yeasts usually grow within 1–5 days.
Moulds are identified by their macroscopic and microscopic morphology. Yeasts are identified by sugar fermentation and other biochanical tests, commercial kits are available for the identification of medically important yeasts.

Serology:-
Serological tests for fungal antigens or specific antibodies are used mainly in the diagnosis of systemic fungal infection. The most common tests for fungal antibodies are:- immunodiffusion (ID), whole cell agglutination (WCA), complement fixation (CF) and (ELISA). For antigen detection, Latex particle agglutination (LPA) , ELISA.

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