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Candida parapsilosis is part of the Candida genus. It is the second most common infection, the first being Candida albicans. It is part of the normal flora in humans, but under the right conditions, it can cause mild infections of the eye, mouth, or vagina or something as severe as systemic shock and possible death. Symptoms vary depending on the location and progression of the disease. Most of the time fluconazole is prescribed. This antifungal medication slowly stops the fungi from growing. If this isn't effective, or if the infection is spread throughout the body, Amphotericin B is injected intravenously. Caspofungin is another alternative that is also intravenous. The problem with C. parapsilosis is that it adheres to a surface, but then forms a biofilm. This biofilm is resistant to most medications and protects the cells of the bacteria from the body's immune system, making the disease much harder to treat once the biofilm has been formed.
Candida parapsilosis is a fungus that comes from the yeast genus Candida. It is part of the normal flora in humans and has been found in nonhuman sources, but Candida infections are the fourth common cause of nosocomial infections in the United States. Candida parapsilosis accounts for about 15% of all Candida infections and has become the second most common Candida infection. There have been three strains of Candida parapsilosis identified. They are classified as Group I (C. parapsilosis), Group II (C. orthopsilosis), and Group III (C. metapsilosis) with Group I being the most common in clinical environments. (Stanfield, 2009)
Records of pathogenicity show that outbreaks started around 2000. One of the first cases concerned a drug addict who used intravenously. It was ruled as endocarditis until other cases arose and it was discovered to be C. parapsilosis. When these other cases arose in hospitals, it was soon discovered to be a spreading pathogenic causing nosocomial infection. Symptoms vary depending on where the infection is and how far it has progressed. It can be something as mild as an infection of the eye, mouth, or vagina or something as severe as systemic shock with the possibility of death. It can also cause septic arthritis or pneumonia.
The people at the most risk for acquiring C. parapsilosis are neonates, patients that have undergone surgery, people with immunodepression (such as patients with cancer, HIV/AIDS, etc.), and elderly people. Those who take steroids, have eating disorders, diabetes, obesity, cancer, or hyperhidrosis are more at-risk for this disease. People who have recently taken antibiotics are also more likely to encounter this disease because the antibiotics kill the bacteria that normally compete with Candida, allowing it to grow unsupervised. (Porter et.al, 2009)
Considering that C. parapsilosis is naturally present, it is thought that lack of both a strong immune system and healthy bacteria cause this disease. Another important factor is the accidental contamination of a wound, surgical device, or medical equipment either by the patients themselves, or more likely, by a healthcare provider. Catheters, heart valves, and prosthetics are common examples of equipment that may become contaminated and the hands of health care workers are the most common source for transmission of the disease.
C. parapsilosis is unique in that it has the ability to attach and form a biofilm. It can adhere to a feeding tube, ventilator, or some other type of plastic equipment and colonize a shiny, slick biofilm. This biofilm makes treatment more difficult because it resists penetration of antifungal medicine and protects the cells from the body's immune response. This can be hazardous to the patient if it manages to enter the bloodstream through the device. It can also infect the gastrointestinal tract, genitourinary tract, or the skin. It is the same process in that C. parapsilosis adheres and colonizes, forming a dangerous biofilm.
Treating C. parapsilosis may be a challenge. The article, Candida Parapsilosis: Characterization in an Outbreak Setting, provides some insight into this disease. Multiple virulence factors have not been correlated to outbreaks of this disease, making it harder to understand treatment. DNA fingerprinting is used to determine genetic variability and markers such as adhesion, biofilm formation, and protein secretion are compared. Results from the DNA fingerprinting show that outbreaks of C. parapsilosis are genetically distinct from clinical databases of C. parapsilosis. The biofilm of the outbreak was greater than that of the sporadic isolates, which suggests that the biofilm plays a role in the production of C. parapsilosis outbreaks. (Kuhn et. al, 2004)
C.parapsilosis is antibiotic resistant, so the first step should be to remove anything that may be contaminated by it (such as any medical equipment). The next step includes experimenting with a variety of antifungal medications, some which may work and some that may not. The most common fungal medication is fluconazole, which slows the growth of the fungi. It is taken as a tablet and a liquid, with the duration varying depending on how the well the person responds. However, some people are resistant to the effects of fluconazole. In this case, Amphotericin B is used, especially if the infection has spread throughout the body. This can be taken orally or given intravenously. Caspofungin is another alternative that attacks the cell walls of the fungi, causing the contents to leak out, and destroying the fungus. It is administered intravenously and the average duration of treatment is a little over a month. The patient's response to the antifungal therapy that is used and the progression of the disease determines what type of medicine should be used and the duration.
Candida parapsilosis isolated culture. C. parapsilosis has been isolated from humans, as well as nonhuman sources. It is most commonly isolated from patients with bloodstream infections.
Candida parapsilosis infection in a patient that received a bone marrow transplant. This infection has likely come from health care providers who did not use gloves or did not wash their hands prior to the transplant.
Candida albicans is the most common of the Candida infections, but Candida parapsilosis has been found to be the second most common and still increasing.
Thrush is probably the most common infection caused by the Candida genus. Candida albicans is usually faulted for it, but Candida parapsilosis may also be the causative agent.
Stanfield, M., (2009). What is Candida Parapsilosis? Retrieved from: http://www.ehow.com/about_5150848_candida-parapsilosis.html
Porter, R., Kaplan, J., Homeier, B. (2009). The Merck Manual: Home Health Handbook. West Point, PA: Merck & Co., Inc.
Kuhn, D., Mukherjee, P., Chandra, J., Ghannoum, M., Clark, T., Hajjeh, R., Warnock, D., Pujol, C., Soll, D. (2004, June). Emerging Infectious Diseases. Retrieved from: http://web.ebscohost.com/ehost.