Candidiasis

Question 1

What comborbidities increase risk of candidal infections?

Answer 1

Diabetes
Severe anaemia
Immunocompromised (radiotherapy, chemo, HIV)
Poor dental hygeiene
Smoking
Use of broad spec abx
Oral steroids

Question 2

Clinical presentation of oral candidiasis? Who does it most commonly affect?

Answer 2

White/yellowish plaques.

Commonly affects neonates, elderly, diabetics, cancer pts.

Question 3

Management for oral candidiasis in children?

Answer 3

Swabs are not indicated because candidal organisms are commonly found in healthy people

Topical antifungal (miconazole gel) for 7 days

ALTERNATIVE: oral nystatin suspension

Repeat tx for extra 7 days if some response then seek specialistic advice if recurrent episodes or not responding to 2 weeks of tx

Advise:
Good inhaler technique, use a spacer device, good oral hygeine

Question 4

Management of oral candidiasis in adults?

Answer 4

Mild/localised: po miconazole gel 7/7

Severe: po fluconazole 50mg 7/7 then follow up

Consider specialist advice if recurrent episodes/not adaquately responding to multiple courses of tx

Question 5

Management of oral candidiasis in immunosupressed patients?

Answer 5

If taking steroids or DMARDS:
po miconazole gel 7/7 or nystatin if mild infection
If severe: po fluconazole 50-100mg 7/7

Question 6

Risk factors for vulvovaginal candidiasis?

Answer 6

Recent abx use
Local irritants like shampoos/douching
Diabetes/immunosuppresion
Endogenous and exogenous oestrogen

Question 7

Clinical presentation of vulvovaginal candidiasis?

Answer 7

Vulval/vaginal itching, soreness
White, cheese like discharge
Superficial dyspareunia
Dysuria

Examination may be normal, but may see:
Erythema, oedema

Question 8

Investigations of vulvovaginal candidiasis?

Answer 8

Investigations not needed if clinical features suggest candidiasis

Consider:
High vaginal swab for microscopy for acute vulvovaginal candidiasis
HVS for reccurent infections
HbA1c

Question 9

Management of acute vulvovaginal candidiasis?

Answer 9

Self management:
Avoid contact with irritant products, avoid douching and tight clothing

Optimise management of underlying conditions like diabetes

1) Fluconazole 150mg po single dose
OR
Clotrimzaole 500mg intravaginal pessary
OR intravaginal clotrimazole creams

Vulval sx: clotrimazole cream

Question 10

Management of recurrent vulcovaginal candidiasis?

Answer 10

Induction regime:
3 doses of 150mg po fluconazole to take every 3 days

Then maintenance:
po fluconazole 150mg once week for 6 months

If still recurrent:
Check high vaginal swab and request culture

Question 11

How to manage vulvovaginal candidiasis in pregnancy?

Answer 11

Acute: Clotrimazole 500mg intravaginally 7/7

Reccurent:
Induction with clotrimazole 500mg pessary up to 14 days then…
Maintenance- continue once a week for 6 months

Consider topical imidazole creams for vulval sx