Candida

Question 1

Overview

Answer 1

Oropharyngeal candidiasis (thrush) and esophageal candidiasis

Most commonly caused by candida albicans (susceptible to fluconazole)

Infections due to non-albicans or fluconazole-resistant may be due to long-term exposure to fluconazole

Question 2

CD4 count

Answer 2

< 200

Esophageal candidiasis occurs at even lower levels

Question 3

Oropharyngeal candidiasis (thrush)

Answer 3

Diagnosis: clinical exam

Painless, creamy white, plaque-like lesions

Dry mouth and taste altercations

Question 4

Oropharyngeal candidiasis (thrush) treatment

Answer 4

1st line: Fluconazole 200 mg loading, followed by 100-200 mg PO QD x 7-14 days

Alternative: topical agents for initial, mild-moderate episodes:
- Nystatin 5 mL swish and swallow QID x 7-14 days
- Clotrimazole Troches 10 mg lozenges 5 times daily x 7-14 days: dissolve slowing in mouth for 15-30 minutes

Question 5

Esophageal Candidiasis

Answer 5

Diagnosis: Fever, RETROSTERNAL BURNING OR DISCOMFORT WHEN SWALLOWING, dysphagia, odynophagia

Whitish plaques with superficial ulceration of esophageal mucosa

Question 6

Esophageal Candidiasis treatment

Answer 6

1st line: Fluconazole 200 mg IV/PO QD x 14-21 days

DO NOT USE TOPICAL THERAPY

Question 7

Vulvovaginal Candidiasis

Answer 7

Diagnosis: white, thick vaginal discharge, vaginal itching, burning, redness

Question 8

Vulvovaginal Candidiasis treatment

Answer 8

Uncomplicated: Fluconazole 150 mg PO x 1, Topical Azole x 3-7 days, Ibrexfungerp 300 mg PO BID x 1

Severe: Fluconazole 100-200 mg PO QD x ≥ 7 days, Topical Azole x ≥ 7 days

Azole refractory C. glabrata: Boric acid 600 mg vaginal suppository QD x 14 days

Question 9

Prophylaxis

Answer 9

NOT RECOMMENDED