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Candida albicans

C. albicans

Morphology: Yeast with pseudohyphae and true hyphae; germ tube positive (specific for albicans). Forms white pseudomembranes on mucosa.

Yeast

Typical drugs

  1. #1Fluconazole— Drug of choice for susceptible C. albicans (mucosal, UTI, mild candidemia in stable host).
  2. #2Micafungin— First-line for invasive candidiasis / candidemia in unstable patients.
  3. #3Caspofungin— Alternative echinocandin.
  4. #4Amphotericin B (liposomal)— Reserved for refractory or CNS disease.

Empiric therapy when resistant

If echinocandin or azole resistance suspected, switch to amphotericin B and call ID. Most C. albicans remain fluconazole-susceptible (>95% in US).

Resistance mechanisms

  • Target alteration

    Erg11 (CYP51) point mutations reduce azole binding

    Example: Acquired fluconazole resistance, uncommon in albicans.

  • Efflux pump

    Cdr1/Cdr2 and Mdr1 efflux pump upregulation

    Example: Multi-azole resistance.

Resistance notes

Resistance uncommon in albicans relative to non-albicans species. Always confirm species ID — empirics differ.

Pearls

Most common Candida species worldwide. Mucosal disease (thrush, esophagitis, vaginitis) responds to fluconazole. Candidemia mandates ophtho exam (endophthalmitis), echo if persistent (endocarditis), and remove central lines. Treat 14 d from first negative blood culture.

References