Candidiasis

Question 1

Definition

Answer 1

Opportunistic infection caused by the yeast-like fungus = Candida Albicans.
- Candida is part of the normal flora of the GI tract.
However, colonisation with Candida can occur when host defences are lowered or mucosal barriers are disrupted, leading to Candida infection (candidiasis)

Question 2

Sites of infection

Answer 2

• Oral candidiasis
• Vulvovaginal candidiasis
• Oesophageal candidiasis
• Invasive disease affecting organs or the bloodstream = Invasive candidiasis

Question 3

Epidemiology and risk factors

Answer 3

Older adults
Younger children/infants (immature immunity)
Immunocompromised (HIV)
Smoking
Broad spec Abx
Pregnancy

Question 4

Signs and symptoms oral candidiasis

Answer 4

Curd-like, white or yellowish plaques can occur in the month, affecting the:
- cheeks
- gums
- palate
- tongue

Question 5

Signs and symptoms oesophageal candidasis

Answer 5

Impaired eating/chewing or dysphagia/odynophagia
May be have signs of associated conditions (e.g HIV)

Question 6

Signs and symptoms vaginal candidiasis

Answer 6

Vulva itching
Vulval soreness and irritation
Vaginal discharge (usually white and non-offensive)
Superficial dyspareunia
Dysuria

Question 7

Diagnosis

Answer 7

Clinical diagnosis
Consider:
- Vaginal pH testing : is recommended initially - a pH of <4.5 supports a diagnosis of candidiasis
- High-vaginal swab : can be performed to identify candida fungal infection

Question 8

Treatment Oral

Answer 8

FIRST LINE = Miconazole oral gel for 7 days: mild
Exclude risk factors: diabetes and nutritional deficiencies such as folic acid deficiency
Second line =
- Nystatin suspensions
- Oral fluconazole 50mg once for 7 days
- Biopsy: considered in people with chronic plaque-like oral candidiasis that is unresponsive.

Question 9

Treatment esophageal

Answer 9

In a HIV positive patient:
Oral fluconazole 100mg for 7 days
Consider admission: if widespread candida infection

Question 10

Vaginal Treatment

Answer 10

FIRST LINE = Anitfungal agent can be administered by local intravaginal cream or by oral agent
If pregnant: only local treatment
SECOND LINE = confirmation of diagnosis,
- Induction-maintenance
regime: oral fluconazole every 3 days for 3 doses (induction) followed by oral fluconazole weekly for 6 months (maintenance)

Question 11

Complications

Answer 11

Chronic pain and/or discomfort
Gastrointestinal effects:
Invasive candidiasis
Candidaemia